RISE summarizes recent regulatory headlines.

Commonwealth Fund: Care experiences are similar among Medicare Advantage, Medicare members

Beneficiaries in traditional Medicare and Medicare Advantage have similar demographics, report comparable levels of chronic illness, and experience the same monthlong wait times for medical care, a new Commonwealth Fund analysis finds.

The research brief assessed the characters and experiences of beneficiaries in Medicare Advantage and traditional Medicare by analyzing data from the 2018 Medicare Current Beneficiary Survey and the Commonwealth Fund 2021 International Health Policy Survey of Older Adults. Researchers examined beneficiaries in Special Needs Plans separately when there were sufficient sample sizes.

Among the key findings:

  • Medicare Advantage enrollees and those in traditional Medicare enrollees are similar in terms of their age, race, income, chronic conditions, satisfaction with care, or access to care, after excluding SNP enrollees
  • Both groups reported waiting more than a month for physician office visits
  • Similar shares of Medicare Advantage and traditional Medicare enrollees report that their out-of-pocket costs make it difficult to obtain care

The study concludes that Medicare Advantage and traditional Medicare not only serve similar populations, but beneficiaries have comparable health care experiences. Medicare Advantage plans offer care management services, but the benefit doesn’t appear to impede access to care or reduce concerns about costs. Overall, researchers said, the analysis highlights substantial barriers to care that all beneficiaries seem to be experiencing.

New study: Permanent enhanced ACA subsidies could extend coverage to nearly 1M

A research report by Urban Institute determines that extending temporary provisions of the American Rescue Plan Act (ARPA) could benefit nearly one million uninsured children and parents. The ARPA included temporary changes to premium subsidies to make health insurance coverage more affordable. Researchers looked at the impact of extending the enhanced subsidies on all children and their parents in 2022. They determined that nearly 1 million uninsured children and parents, including an estimated 300,000 uninsured children, would gain insurance coverage if ARPA subsidy enhancements were made permanent. Though only about 67,000 children under age six would gain coverage, approximately 267,000 uninsured parents who would gain coverage have a child under age six, which suggests that even more young children could benefit when their parents gain coverage. Other findings:

  • Nearly two-thirds of the coverage gains for families would impact children and parents with incomes between 200 and 400 percent of the federal poverty level
  • Approximately 4.5 million children and parents who had nongroup coverage before the ARPA would experience combined household premium and OOP spending reductions of 18 percent per person, on average
  • Families with incomes below 200 percent of federal poverty level would save even more, 25 percent per person

Despite those gains, the analysis finds that approximately 3.3 million children and 6.3 million parents would remain uninsured in 2022. Most of the remaining uninsured children would be eligible for Medicaid or the Children’s Health Insurance Program (or tax credits). But about 41 percent of parents would be ineligible for subsidized coverage because of their immigration status or residence in a state that has not expanded Medicaid under the Affordable Care Act.

Feds to invest $100M to boost primary care workforce

The U.S. Department of Health and Human Services (HHS) this week announced it would make $100 million available from the American Rescue Plan funding for state-run programs that support, recruit, and retain primary care clinicians who live and work in underserved communities.

The funds include new flexibilities to make it easier for states to operate these programs:

  • No cost-sharing requirement: States will not be required to demonstrate a specific matching amount for the federal funding, although states are encouraged to secure some level of funding match through public or private entities. 
  • Administrative costs: States can use up to 10 percent of their award for administrative costs in order to ensure they have the capacity to administer these programs, especially those new to the grant program,

Applications will be accepted through Friday, April 8, 2022.  Award winners will be announced prior to the project start date of September 1, 2022.