Federal Health Care Access Grants

Friday, December 04, 2009

The Affordable Health Care for America Act provides for grants (states have to match 20% of the grant) from the Secretary of Health and Human Services to establish health care programs for uninsured individuals within the respective states as a means of delivering affordable health care. States will have to demonstrate their ability to maintain these programs once the grants are exhausted.

Several different types of delivery programs are mentioned within the Act including: state insurance exchanges, community coverage, reinsurance plans, transparent marketplaces, automated enrollments, innovative strategies, and purchasing collaboratives.

1. State Insurance Exchanges: These are intended to design and develop new, hopefully less expensive, portable health care benefits for small employers and part-time/ seasonal workers.

2. Community Coverage Program: Intended to foster shared responsibility between employers, governmental or nonprofit entity, and the individual. Who or what are the nonprofit entities? Will there be a mix of charitable, religious, community service and/or philanthropic organizations?

3. Reinsurance Plan Program: Stop-Loss coverage designed to offset a portion of carrier losses in a certain “risk corridor”. What is a risk corridor? Will it work like a traditional stop-loss policy and reimburse losses at the individual and/or the aggregate levels? Will stop-loss premiums be paid by the sates, carriers, employers, members or some combination?

4. Transparent Marketplace Program: Designed to provide for a structured means for the sale of health insurance, possibly via a Web portal. Will it work like Massachusetts’ Health Connector website? (https://www.mahealthconnector.org/) For that segment of the population that does not have access or knowledge of the Internet, how will access be provided?

5. Automated Enrollment Program: Statewide or automated enrollment systems for public assistance programs. By “public assistance programs”, is the Act addressing AFDC, Food Stamps, and other “welfare” programs or is it directed at health insurance for the uninsured?

6. Innovative Strategies: Innovative strategies to provide low-income childless adults with health care. How are the health needs of “childless adults” different than adults with children, other than the fact they have children?

7. Purchasing Collaboratives: Business & consumer relationships that provide for direct contract purchase of health care services plan sponsors. Does this mean that a plan sponsor can purchase services directly from a specific medical provider(s) for their covered members? Would each plan sponsor have to negotiate independently of other plan sponsors with providers? Will this dilute the ability of insurance carriers to build and maintain discounted provider networks?