Journal of Urgent Care Medicine

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. …

ACA: A Bust for Insurers, a Boon for Big Hospital Systems

Where the Affordable Care Act (ACA, or “Obamacare”) is proving to be a major financial challenge for insurers, some large hospital systems are experiencing a windfall since it launched. Tenet and HCA Holdings each say that ACA member admissions were up significantly over the previous fiscal year’s results. Tenet reports a 28% increase in inpatient admissions for that segment, with overall patient revenue going up 6%; HCA’s ACA inpatient hospitalizations were up 27%. The companies have …

Update: Humana’s Four-State Exodus Leaves Alabama in a Tough Spot

Last week we told you about Humana’s plans to drop out of Affordable Care Act (ACA, or “Obamacare”) insurance exchanges in certain states. Now the company has revealed that one of those states is Alabama—leaving just one ACA exchange in the entire state, effective Dec. 31, 2016. The other states (so far) are Kansas, Wisconsin, and Virginia, though news regarding more states may still be ahead. The company first said it would consider exiting certain …

Humana Follows United Out the ACA Exit Door

In advance of formal approval of its merger with Aetna, Humana plans to stop participating in some state insurance exchanges constructed under the Affordable Care Act (ACA, or “Obamacare”). The company says its member base dropped 21% compared with the first quarter of 2015. That includes those who bought policies under the ACA exchanges, which many insurers say are hard on their bottom lines to begin with. UnitedHealth Group was the first major insurer to …

Will New CMS Program Boost Medicare Quality Bonuses?

The Centers for Medicare and Medicaid Services (CMS) calls it a brand-new platform, while skeptics are saying it’s just the same-old structure with a fresh coat of paint. Either way, CMS is rolling out the Quality Payment Program, which it says will ease documentation requirements for physicians while also providing new opportunities to earn bonuses by providing quality care. Under the program, physicians can receive Medicare reimbursement by participating in either the Merit-Based Incentive Payment …

UnitedHealth Abdicating Almost All ACA Exchanges

No longer satisfied with revealing states in which it plans to stop offering insurance under the Affordable Care Act (ACA, or “Obamacare”) a few at a time, UnitedHealth Group has acknowledged it will drop out of all but a “handful” of states by the end of this year. Right now, it participates in exchanges in 34 states; the dawn of 2017 will see it offering health coverage in just 12, as now planned. The market …

Michigan is Next Exit for UnitedHealth

Just a week after revealing it will no longer participate in Affordable Care Act plans in Arkansas and Georgia, UnitedHealth Group says it is bowing out of Michigan plans backed by the ACA (or “Obamacare”), as well. The company, which started warning that low profitability associated with ACA exchanges made doing business through them untenable months ago, will cease to carry such plans in the three states at the end of this year. Anyone currently …

UnitedHealth Starts Making Good on Threats to Leave ACA Programs

UnitedHealth Group has been saying for months that it may opt to not participate in insurance exchange programs set up under the Affordable Care Act (ACA, or “Obamacare”). Apparently it was no idle threat, as the biggest insurer in the country says it will not sell plans in Arkansas or Georgia next year. The company has said the ACA plans are not profitable enough to justify their participation. UnitedHealth and Aetna both saw losses on …

Pilot Program Allows Tricare Members to Report Directly to Urgent Care

Military members and their families covered under Tricare Prime, Tricare Prime Remote, or Tricare Young Adult–Prime will be allowed two urgent care visits without a referral per year, thanks to a pilot program starting May 23. Right now, beneficiaries need a referral before going to urgent care. Delays in getting appointments with a primary care provider have been a common complaint among military families for years, putting pressure on the Department of Defense to reconsider …

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 …