The Commonwealth Fund is out with a new report examining why enrollment trends in the Affordable Care Act’s high risk insurance pools — temporary coverage programs for uninsured people who can’t find coverage in the individual market — have generally fallen below expectations. Besides the obvious structural challenges, Jean P. Hall and Janice Moore also suggest that the GOP’s efforts to repeal the law may already be undermining the high risk insurance program:

– SHORT IMPLEMENTATION PERIOD: “Given the short implementation timeline, PCIP administrators did not have ample resources available to conduct extensive outreach at the outset of the program.”

– UNINSURED HAVE STOPPED LOOKING: “[P]eople with preexisting conditions who have been uninsured for a long time may have stopped looking for insurance and may therefore be harder to reach via traditional outreach campaigns.”

– UNAFFORDABLE: “Because the PCIP coverage is based on the individual insurance market, premiums and out-of-pocket costs are generally higher than for people enrolled in group insurance plans.”

– MISCONCEPTIONS ABOUT THE LAW: “In late 2010, for example, many heated election campaigns were declaring that health reform would soon be repealed and/or replaced, or at least de-funded…. Indeed, a February 2011 poll by the Kaiser Family Foundation found that almost one-quarter of the American public believed that the Affordable Care Act had been repealed, while another quarter did not know the status of the law.”

Enrollment finally topped 20,000 in April and is expected to increase in the months ahead. Recently, the Department of Health and Human Services “announced that it would lower premiums in the 23 states where high-risk pools are operated by HHS. The remaining 27 sates run their own plans.”

Via Julian Walker at the Virginia Pilot:

Virginia officials are planning for the creation of a state health insurance exchange to comply with the federal health care act, even as Gov. Bob McDonnell supports a state legal challenge that could overturn the law.

A meeting Tuesday of the Joint Commission on Health Care included an update on the process of setting up an exchange. The panel also heard from a think tank scholar who spoke against that approach.

Health insurance exchanges are marketplaces through which individuals without insurance and small businesses without group insurance plans can buy coverage. Those who meet income eligibility guidelines could receive subsidies.

Dr. Bill Hazel Jr., Virginia’s secretary of Health and Human Resources, said it’s prudent to be prepared, given the uncertain outcome of the lawsuits over the Patient Protection and Affordable Care Act, a signature policy initiative of President Barack Obama.

As the CBPP’s Dave Chandra pointed out last week, “virtually every state has made at least some progress toward setting up [the] health insurance marketplaces,” including states like Indiana, Mississippi and Alabama — which are also challenging the the constitutionality of the health law. Last week, the Texas Tribune’s Emily Ramshaw reported that Gov. Rick Perry (R-TX) has also given state health officials the green light to work towards enacting a state-based exchange. Under the reform law, any state that does not build its own program will be required to hand over its operations to the federal government.

In total, 16 states have “passed exchange-related legislation,” 39 states have introduced exchange legislation this year, and “48 states (all except Louisiana and Florida) plus the District of Columbia are engaged in some level of exchange planning.” So far, “only Louisiana has publicly announced that it won’t set up an exchange.”

Lawmakers in Florida are touring the Sunshine State promoting a new law that, if approved by the federal government, would require “most of the state’s 3 million Medicaid enrollees to join private health plans after July 1, 2012.” The proposal “gives managed care companies more control over the program that’s paid for with federal and state money,” a shift the state GOP claims will “hold down spiraling costs in the $20 billion program.”

During yesterday’s town hall meeting in West Palm Beach, Florida lawyers argued that the initiative would encourage private nursing homes to dump granny:

A little-known incentive buried in Florida’s new Medicaid reform law will reward health plans for cutting numbers of seniors in nursing homes, several speakers said during a highly charged hearing on the law Tuesday.

Calling it the “granny dumping bonus,” elder law attorney Ellen Morris warned that the law could result in eviction of seniors from nursing home care after 2012. ….

“Florida is poised to put thousands of long term care patients out into the cold without services,” she predicted. “There is no verifiable system to ensure that vulnerable elders are not evicted inappropriately.” [...]

Morris said the new law does away with longstanding, effective rules on who has recovered enough to be discharged from a nursing home, and replaces them with vague terms insurance companies will ultimately decide.

“Managed care companies will be paid bonuses for evicting seniors from nursing homes,” she predicted.

Florida Gov. Rick Scott (R) has also come under criticism since signing the law after it was revealed that one of the private managed-care companies that stand to gain from the measure is Solantic, “a chain of urgent-care clinics aimed at providing emergency services to walk-in customers. Solantic was founded in 2001 — by none other than Rick Scott.

Before being elected to the governorship, Scott was fired as head of Columbia/HCA just as the for-profit hospital chain pled guilty to a massive array of fraud charges — which resulted in a fraud settlement of $1.7 billion dollars, the largest in U.S history.

A new report finds that health care spending in Massachusetts continues to increase, with private payer costs outpacing national health care spending and spending by Medicare and MassHealth — the state’s Medicaid and CHIP program:

Spending per privately insured member grew 6 percent from 2007 to 2008 and another 10 percent from 2008 to 2009. This rate of growth was substantially higher than the increase in national personal health care expenditures per capita from 2008 to 2009. In 2009, national personal health care spending per capita increased 4.6 percent—a deceleration from 4.9 percent growth in 2008.

Spending by private payers grew faster than spending by public payers. The rate of growth for spending on privately insured people from 2007 to 2008 also outpaced the growth in spending for Massachusetts residents in Medicare (4.8 percent) or MassHealth (2.8 percent) during the same time period (Figure A). The rates of growth for both private and public payers in Massachusetts continued to outpace increases in per capita state gross domestic product and wages.

Rising prices played a significant role in increasing private spending for inpatient and
outpatient hospital services, as well as physician and other professional services. Higher
prices explained virtually all of the increase in private inpatient spending from 2007 to 2009.

Kevin Outterson explains that “the report is best understood as additional evidence of provider market power in Massachusetts” — a problem the state has been grappling with for some time. Insurance companies are paying some hospitals “significantly more than others for providing similar care,” even though the higher paid hospitals are not producing better outcomes. Disparities in payments were first documented by Attorney General Martha Coakley’s staff last year, “which concluded after an investigation that the highest paid hospitals had more market clout, some because of their brand names, but that they were not necessarily providing better care.”