Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Department of Health and Human Services' Office of Civil Rights
- Medical Residents
- EMTALA
- FDA
- Reproductive Rights
- Roe v. Wade
- SCOTUS
- Medical Spas
- medical billing
- No Surprises Act
- Mandatory vaccination policies
- Workplace health
- Coronavirus Aid, Relief and Economic Security Act
- Code Enforcement
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- COVID-19
- SB 150
- Acute Care Beds
- Clinical Support
- Coronavirus
- Emergency Medical Services
- Emergency Preparedness
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- KBML
- medication assisted therapy
- Department of Health and Human Services
- Legislative Developments
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Opioid Epidemic
- Sexual Harassment
- Health Resource and Services Administration
- Litigation
- Medical Malpractice
- House Bill 333
- Senate Bill 79
- locum tenens
- Senate Bill 4
- Physician Prescribing Authority
- Chronic Pain Management
- HIPAA
- Prescription Drugs
- "Two Midnights Rule"
- 340B Program
- Hospice
- Kentucky minimum wage
- Minimum wage
- Skilled Nursing Facilities (“SNFs”)
- Uncategorized
- Drug Screening
- EHR Systems
- Electronic Health Records (“EHR")
- ICD-10
- Mental Health Care
- Primary Care Physicians ("PCPs")
- Urinalysis
- Accountable Care Organizations (“ACO”)
- Affordable Insurance Exchanges
- Anti-Kickback Statute
- Certificate of Need ("CON")
- Compliance
- Department of Health and Human Services (HHS)
- Federally Qualified Health Centers (“FQHCs”)
- Fee for Service
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- HPSA
- KASPER
- Kentucky Board of Medical Licensure
- Kentucky’s Department for Medicaid Services
- Office for Civil Rights ("OCR")
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Part D
- Pharmacists
- Physician Assistants
- Qui Tam
- Rural Health Centers (“RHCs”)
- Stark Laws
- Telehealth
- Affordable Care Act
- Alternative Payment Models
- American Telemedicine Association (“ATA”)
- Centers for Medicare & Medicaid Services (“CMS”)
- Charitable Hospitals
- Data Breach
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Health Professional Shortage Area ("HPSA")
- Hospitals
- HRSA
- Kentucky Board of Nursing
- Limited Services Clinics
- Medicaid
- Medical Staff By-Laws
- Medically Underserved Area ("MUA")
- Medicare
- Mid-Level Practitioners
- Patient Protection and Affordable Care Act (“ACA”)
- Rural Health Clinic
- Telemedicine
- APRNs
- Criminal Division of the Department of Justice (“DOJ”)
- Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)
- Hydrocodone
- Kentucky Pharmacists Association
- Qualified Health Care Centers (“FQHC”)
- United States ex. Rel. Kane v. Continuum Health Partners
- Webinar
- Agreed Order
- Chain and Organization System (“PECOS”)
- Chiropractic services
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- Douglas v. Independent Living Center of Southern California
- Drug Enforcement Agency ("DEA")
- Emergency Rooms
- Enrollment
- Hinchy v. Walgreen Co.
- Jimmo v. Sebelius
- Kentucky Senate Bill 7
- Maintenance Standard
- Medicare Part D
- Minors
- Ophthalmological services
- Overpayments
- Physician Compare website
- Re-validation
- Texting
- Vitas Innovative Hospice Care
- 2014 Medicare Physician Fee Schedule (“PFS”)
- 501(c)(3)
- Affinity Health Plan
- All-Payer Claims Database ("APCD")
- Appeal
- Cadillac tax
- Centers for Disease Control and Prevention
- Chronic Care Management
- Community health needs assessment (“CHNA”)
- Compliance Officer
- Compounding
- CPR
- Denied Claims
- Dispenser
- Drug Quality and Security Act (“DQSA”)
- Essential Health Benefits
- Federation of State Medical Boards (“FSMB”)
- Food and Drug Administratio
- Form 4720
- Grace Period
- HealthCare.gov
- House Bill 3204
- ICD-9
- Individual mandate
- Kentucky Medical Practice Act
- Kindred v. Cherolis
- Kynect
- Long-term care communities
- Mobile medical applications ("apps")
- Model Policy for the Appropriate Use of Social Media and Social Networking in Medical Practice (“Model Policy”)
- National Drug Code ("NDC")
- National Institutes of Health
- New England Compounding Center ("NECC")
- Nonprofit hospitals
- Outsourcing facility
- Physician Payments
- Ping v. Beverly Enterprises
- Power of Attorney ("POA")
- Prescriber
- Qualified Health Plan ("QHP")
- Social Media
- Spousal coverage
- State Health Plan
- Sustainable Growth Rate (“SGR”)
- UPS
- "Plan of Correction"
- Advanced Practice Registered Nurses
- Arbitration
- Audit
- Business Associate Agreements
- Business Associates
- Call Coverage
- Condition of Participation ("CoP")
- Daycare centers
- Decertification
- Department of Medicaid Services’ (“DMS”)
- Division of Regulated Child Care
- Doe v. Guthrie Clinic
- EHR vendor
- Employer Group Health Plans
- Employer Mandate
- ERISA
- Fair Labor Standards Act (FLSA)
- False Billings
- Group Purchasing Organizations ("GPO")
- Health Professional Shortage Areas (“HPSA”)
- Health Reform
- Home Health Prospective Payment System
- Home Medical Equipment Providers
- Hospitalists
- House Bill 104
- Inpatient Care
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Kentucky House Bill 217
- Licensed practical nurses (LPN)
- Licensure Requirements
- List of Excluded Individuals and Entities
- LLC v. Sutter
- Long-Term Care Providers ("LTC")
- Low-utilization payment adjustment ("LUPA")
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Medicare Shared Saving Program (MSSP)
- Network provider agreement
- Nonroutine medical supplies conversion factor (“NRS”)
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Patient Autonomy
- Patient Privacy
- Payors
- Personal Health Information
- Personal Service Entities
- Physician Recruitment
- Physician shortages
- Provider Self Disclosure Protocol
- Quality reporting
- Registered nurses (RN)
- Residency Programs
- Self-Disclosure Protocol
- Senate Bill 39
- State Medicaid Expansion
- Statement of Deficiency ("SOD")
- Trade Association Group Coverage
- Upcoding
- “Superuser”
- Autism/ASD
- Center for Disease Control
- Compliance Programs
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Genetic Information Nondiscrimination Act ("GINA")
- Healthcare Information and Management Systems Society (HIMSS)
- Kentucky House Bill 159
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Medicare Audit Improvement Act of 2012
- Occupational Safety and Health Administration (“OSHA”)
- Recovery Audit Contractors (“RAC”)
- Senate Finance Committee Report
- Small Business Health Options Program (“SHOP”)
- Sunshine Act
- Abuse and Waste
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Employee Agreement
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 1
- House Bill 4
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Kentucky “Pill Mill Bill”
- Pain Management Facilities
- Health Care Law
- Health Insurance
- Healthcare Regulation
McBrayer Blogs
The Young and the Restless
HealthCare.gov’s technical woes are expected to be fixed by November 30th. But, those fixes might come too late for a certain subset of needed enrollees – the young and healthy. The purpose behind the Affordable Care Act’s individual health insurance mandate was to ensure that private insurers would get enough young, healthy people in the system who could offset the costs of covering older and sicker, Medicaid-eligible patients.
Younger people tend to have lower anticipated medical costs; without them in the system, the so-called insurance “risk pools” could become imbalanced and leave insurers with no option but to raise premiums. Higher premiums mean that the young and healthy would be even less likely to sign up, as many in this demographic would choose to pay higher out-of-cost pockets than premiums, hoping that no care is needed. This cycle is known to economists as “adverse selection.”
Even without the website problems, getting this demographic to buy health insurance presents a problem. The White House has relied on micro-targeting techniques (used in the 2008 and 2012 presidential campaigns) to reach young potential enrollees. According a survey by the Commonwealth Fund, a nonprofit research group, only about one in four 19-29 year-olds is even aware that they can use the exchange to find affordable insurance.
This lack of awareness coupled with online enrollment frustrations could lead to significant under-enrollment of young adults. Older and sicker adults have a stronger incentive to keep trying to enroll, despite site glitches, because they anticipate higher costs of care. The young and healthy, after all, could go without insurance and just pay the $95 penalty starting in January 2014.
Demographic information about enrollees is not being released by states or the federal government. Of course, there are alternatives to online enrollment on HealthCare.gov; people can complete the process by paper application or phone. Trying to promote those options to a generation who does everything (i.e., socializing, shopping, banking) online is not ideal. Let’s keep our fingers crossed for a quick fix.
Services may be performed by others.
This article does not constitute legal advice.
