Obamacare Co-op fails: This is what you could do with the money lost!

Today there is more fallout from the collapse of a New York state insurance Co-op set up to offer health insurance as part of the Affordable Care Act.  Health Republic Insurance ceased to exist today and has left a whole bunch of people (okay, a few more than a bunch - 200,000 patients!) without insurance.  

If you have been following my posts on the ACA and music therapy (just type in Obamacare into the search box for a list of articles), you may remember that the insurance co-ops are joint ventures with a given state and the federal government that acts like an insurance company to offer insurance plans on the state exchanges.  

Of the 23 co-ops set up around the country, 12 of them have gone bankrupt this year.  Part of the problem is that these co-ops set artificially low prices for monthly premiums on their insurance plans.  There was a fund set up by the federal government to reimburse these co-ops for the first few years until their subscriber pool became stabilized with the right mix of young and old, and sick and healthy customers.  Unfortunately for the co-ops, this pool of money has been cut back and it will not be able to bail out the co-ops as originally intended.

So this brings us back to the most recent failure: Health Republic Insurance.  The news reports that $265 million dollars in federal loans has virtually disappeared through this company!  Hospitals and doctors that offered services to patients on this health insurance do not expect to get reimbursed for any of the services they have rendered.

So I did some quick calculations based on the 2014 workforce analysis by the American Music Therapy Association and came up with the following as a better use for the wasted $265 million dollars:

• $265 million would have paid for 4,152,954 hours (yes, that is over 4 million hours!) of direct music therapy services at the average hourly rate of $63.81/hour for 2014!
• $265 million also would have paid the average yearly salary of $50,808 for 5,215 music therapists! 

 I don't know about you, but I think the money would have been much better spent on music therapy!  And that is only one of the 12 failed co-ops this year.  Only one co-op out of 24 did not lose money in 2015.  I guess I should keep my calculator handy for next November!           

The ACA and Music Therapy: Revisited!

 

Prezi presentation at the 2015 National Conference of the American Music Therapy Association in Kansas City. 

Handout-ACA an Update

Hey Justice Roberts! Can We Get Some Music Therapy With That??

Obamacare = SCOTUScare

If you are a regular reader, you know that I have been following the Affordable Care Act for the last several years.  My goal has always been to try to help music therapists and other related professionals figure out what the law actually might mean for access to music therapy and whether or not it will help or hurt our profession on the whole.  

This is obviously a huge task!  And not without peril!  Over the last few years I have found that many people are reluctant to engage in the conversation simply because there are so many strong opinions on both sides of the issue.  I have tried to to be very even-handed in my treatment of the topics discussed here on Music Makes Sense, and generally have kept things focused on the impacts the law may have for music therapy.  I believe I have been pretty successful so far and I appreciate the dialogues that have been opened up about the topic within my professional field.  

So let me break down the latest ruling for you:

Many people have been waiting on the Supreme Court decision King vs. Burwell that was handed down this morning.  This case basically asked the question, "Do words matter?"  

... and the justices have answered the question, "No!"  The Affordable Care Act specifically stated that federal subsidies for low income participants to help them pay for premiums purchased through the Health Care Exchanges could only be provided through exchanges "established by the States."  This was intentionally written into the original law as a way to encourage individual states to set up their own marketplace exchanges.  As it turned out, 27 states decided not to develop their own exchanges.  The federal government decided to step in and created Healthcare.gov for participants in those states to use.  In King vs. Burwell, states sued the federal government because the law did not say that people in these states should be able to receive subsidies.  

Now, whether you oppose or support the law, you can see the conundrum here.  If the Court ruled that the law meant what it said (and what Congress had intended), there would be a lot of people who have been receiving subsidies for almost two years, who would lose their subsidies and be unable to pay for their premiums.  These same people would then suffer a tax penalty for not having insurance.  What a mess!

(...I could digress here and point out that perhaps it is a good idea to write laws clearly, in a bi-partisan manner, and allow public review before voting on it...but, we'll leave that for a different blogger!)

But alas, we have been "saved" by SCOTUS!  The 6-3 ruling today explained that although the law was badly written, it was meant to help people.  Therefore, the court ruled that it will be okay for subsidies to extend to people signed up under the federal exchanges.  Basically, six unelected and unaccountable (except maybe to history) individuals have written a new law that applies to every citizen. 

Deciphering the Affordable Healthcare Act One Year Later: Implications for Music Therapy

This Prezi was presented as part of a concurrent session at the 2014 National Conference of the American Music Therapy Association in Louisville, KY.  I invite you to ask questions and make comments regarding the presentation or the effect of Obamacare on music therapy services.

Deciphering the Affordable Care Act One Year Later (1)

I Told You So!

The New York Times Explains the Problems with High Deductible Insurance Plans

I really hate to say it, but if you go back a few months and read my post about High Deductible insurance plans you shouldn't be surprised.  You can read my original post here. 

You really need to read this article from the New York Times!  High deductible insurance plans are the newest fad and are increasingly becoming the norm.  The latest news from the New York Times explains exactly what I had been talking about.  Many people have been choosing high deductible plans on the Bronze and Silver levels from the new Obamacare health exchanges in order to keep their monthly premiums low.  As they are discovering, the premiums may be lower than a traditional plan, but they are not saving enough money to make up the difference in order to pay for services until they meet the large out of pocket deductibles.

This is problematic in several ways:

1. Some people are choosing not to seek medical care because they don't feel like they can afford it, and they likely will not end up paying out $6000 over the year, or whatever very high amount  is in their plan before some insurance kicks in.  And remember -- once you meet your deductible it is not just a free ride after that!  Usually there is still a 10-20% co-insurance that you have to pay.

2. I thought that one of the main purposes behind the Affordable Care Act (AKA: Obamacare) was to get everyone on insurance so as to increase the insurance pool and provide people with medical care outside of the emergency room and promote preventive care??  It sure sounds like this is failing.  Although some people are getting preventive care, they are not following up on problems because they simply do not have the out of pocket money to pay for treatment.  

Adding my Voice to the Voices of the Sea

American Music Therapy Association National Conference

Jacksonville, FL

November 20-24, 2014

I will have the opportunity to speak three times at this year's national conference for music therapy. 

Here is a sneak preview:

November 20, 2013 

12:30 pm - 6:30 pm

Institute: Medical Music Therapy for Infants & Children

*Chair: Jayne M. Standley, PhD, MT-BC

This session will feature prominent clinicians and researchers who specialize in medical music therapy for infants and children. It will include presentations on NICU MT research and innovations, music therapy for soothing infants with Neonatal Abstinence Syndrome, music therapy for burn treatment and other serious illnesses, pediatric and pediatric intensive care music therapy, use of music therapy in the Emergency Room with children, outpatient pediatric rehabilitation and early intervention, music therapy in physician offices, clinics, and/or day-care for medically fragile children. Counselling methods for stressed parents and teens with serious illnesses will be included. Program development and reimbursement issues for medical music therapy services will be reviewed. 

* I will participate in this institute by explaining some of the effects of the Affordable Care Act on healthcare for Women and Children. 

Friday, November 22, 2013  

7:30 AM to 9:00 AM

Deciphering the Affordable Care Act: Implications, Perceptions, and Current Knowledge within Music Therapy 

Elisa Aven, MT-BC; Daniel Tague, PhD, MT-BC

Saturday, November 23, 2013 

10:45 AM to 12:15 PM

21st Century Tools for Educators and Supervisors: There's an App for That!

Abbey Dvorak, PhD, MT-BC; Daniel Tague, PhD, MT-BC

I hope to see you there!
 


 

Countdown to AMTA 2013! Obamacare and Music Therapy Updates

Sunset or Sunrise for Obamacare?

Here we are on "Government Shutdown Eve."  I thought it appropriate that I get back to my task of outlining not only the pros and cons of the Affordable Care Act, but also its potential impacts on music therapy.  I will be presenting regarding different aspects of Obamacare at two different sessions of the 2013 National Conference of the American Music Therapy Association this November in Jacksonville, Florida.  I will continue to post on various developments over the next few weeks in the run up to our national conference.  I hope you will join in the reading and the discussion!

Let's start with one of the most important ways I think the new law could impact music therapy services.  Music therapy in the last decade has made huge strides in becoming part of the wellness industry.  Music assisted relaxation, community drum circles and music-based team-building for corporate programs are now common across the country.

In June 2013, new rules and guidelines were released regarding wellness programs in the workplace.  Basically, Obamacare is promoting employer-based wellness programs by providing guidelines for discounts and punishments for employee participation in wellness programs.

Beginning in January 2014, employers will be able to increase insurance premiums for certain employee groups such as smokers, but will be able to offer up to a 30% discount for employees who decrease their cholesterol or participate in health seminars or exercise programs.

This is a huge change for employers!  Most of the wellness programs already in existence were voluntary programs set up by large corporations to decrease company-wide medical costs.  Now these programs will be part of the law.  This is a potentially huge new market for music therapy!  Since music therapy is already well-positioned in the wellness market, we should look for more companies to start wellness programs in order to take advantage of the money-saving incentive contained in the new law.

Although music therapy is not specifically mentioned in some of the approved wellness incentive programs, the regulations do allow for rewards for participation in exercise programs and "educational seminars."  Music therapy based activities and instruction will fit perfectly into these roles!  In addition, music therapy in corporate wellness programs can easily be done in cost-effective group settings.

Here are two places you can find additional readings regarding the effect of Obamacare on wellness programs:

Nolo.com and CNBC. 

And here is a link to the actual government regulations regarding wellness programs (dry reading, but just in case you want the details!):

Incentives for Nondiscriminatory Wellness Programs in Group Health Plans

In addition, here are the links to my primer lessons regarding Obamacare:

Part I
Part IA
Part II

  

Obamacare: The Effect of the Affordable Care Act on Music Therapy, Part Ia

If you haven't read Part I, you can find it here.  

(...my apologies in advance-- while I am trying to clear away the mud so that we can figure out the essence of what exactly is the ACA, there are so many facets to the proposal that it looks like it will take me more than a three part series to simplify what is going on.  I realize this may be disheartening(!), but I hope you will stick with me through this process as it is an extremely important topic.  I promise to keep things as simple as possible, yet provide links for more in depth study.  I am also trying to steer away from the politics or linking to multiple opinions about projected outcomes.) 
  

Part I update:

Here is my answer to a reader's question (Please explain #15 further, since this applies to myself and many Music Therapists like me) about item #15 ($716 billion in cuts to Medicare):

Here is a very good explanation from the Washington Post, although I don't think it will necessarily answer your question about how specific therapies might be impacted:

• The Washington Post

The big chunks are basically taken out of Medicare by lowering the annual increase of payments to hospitals and facilities and eliminating overpayments to the Medicare Advantage program (a private insurance program some seniors can choose to join instead of being served by the Medicare program itself.) 

A little more detail is here:

• The Incidental Economist

You will notice that Mr. Frakt is also worried about the large cut to annual increases in Medicare to hospitals and other facilities. I would suspect that this might be the most important one for us to consider since music therapy services are sometimes lumped into the billing of services "per day" for a patient in order to receive a slightly higher reimbursement "per day" for a patient. So, even though music therapy is not often directly billed to Medicare, it can increase the reimbursement amount by a little bit per day if it is included correctly in the billing. Since most facilities don't rely on this reimbursement to fund music therapy, it is unlikely that music therapy would be cut as a result of the decrease in money from the ACA. However, it has been nice to be able to show that music therapy does sometimes contribute to a higher pay out in reimbursement.

And just in case it is not confusing enough, some people say that the cuts are not really "cuts" and that they will save Medicare rather than hurt it:

• The Tuscon Citizen

Let's keep investigating! The scary thing is that nobody seems to know what is really in the law or what is going to happen! Maybe next time they can get this all figured out before passing it into law.

Understanding the "doc fix."  (Don't you just love all the little nicknames for things!  e.g., Obamacare, fiscal cliff, ...doc fix, etc.!  What will they come up with next??!)
The "doc fix" is really a yearly "fix" of the problem created by Medicaid only paying about 34% less than Medicare to doctors and hospitals.  As you can imagine, this would lead to many physicians not wanting to treat patients on Medicaid.  So every year, congress passes a temporary law to increase Medicaid payments to match the levels in Medicare.  (Note: Medicare payments to doctors and hospitals are still generally lower than private insurance payments).  The ACA has put in place a temporary "doc fix" for 2013 and 2014.  After that, individual states would be responsible for the additional cost to keep Medicaid from scaling back its payments.  (For details about the "doc fix" issue you can go here.)  

Incidentally, since I mentioned the so-called "fiscal cliff", we will have to keep an eye on the negotiations between the President and the House of Representatives.  It has been reported that the ACA has been put on the table as a bargaining chip in the process.   

In timely fashion (only 32 months after passing Obamacare!) the department of Health and Human Services (HHS) has released the guidelines for states to set up the new health care exchanges.   

Basically, these guidelines lay out what insurers will be allowed to charge for people who smoke or who are older.  The guidelines also explain minimum coverage rules and explanations about the new push for preventative healthcare and wellness programs. Specific lists are in links below:

• Essential Benefits (Including rehabilitative services and devices, wellness services and pediatric oral and vision care.)
• Tiered Benefit Plans (Platinum, Gold, Silver, Bronze: Platinum pays 90%, Gold 80%, Silver 70%, Bronze 60%)
• Wellness Programs 

Okay, this should be enough of a groundwork for us to tackle next time what the impact of ACA might be on music therapy.  I'll be back later this week with that analysis! As always, please let me know if I have missed something important, and keep the personal stories and questions coming here and on Facebook.  Thanks for reading and I hope you had a Happy Thanksgiving!