Welcome to the second issue of Headlines in Health Policy, a roundup of recent news about health coverage, health delivery system reform, and more.

• Rates Up 22 Percent For Obamacare Plans, But Subsidies Rise, Too NPR by Alison Kodjak—The cost of health insurance under the Affordable Care Act is expected to rise an average of 22 percent in 2017, according to information released by the Obama administration Monday afternoon. Still, federal subsidies will also rise, meaning that few people are likely to have to pay the full cost after the rate increases to get insurance coverage.
  
  
• A Quick Guide to Rising Obamacare Rates New York Times by Reed Abelson and Margo Sanger-Katz—Obamacare customers will begin shopping for new plans next week, just a few days before the presidential election. … here’s our quick guide to what’s happening and who will be affected… Obamacare rates are going way up...This is not a huge surprise…These increases really matter only for those who buy their own insurance….If you get a subsidy, and you’re willing to switch plans, you won’t have to pay these big increases...Customers may have to switch plans to save money, and switching health plans can be a big deal.
  
  
• "PBS NewsHour" Video (11:26)— How Obamacare premium hikes affect politics and your wallet

• The Slowdown in Employer Insurance Cost Growth: Why Many Workers Still Feel the Pinch The Commonwealth Fund by Sara R. Collins, David Radley, Munira Z. Gunja, Sophie Beutel. Press Release - Issue Brief - State-by-State Cost Data
  
  
• Health care costs rise slowly for those who get insurance at work SFGate by Victoria Colliver—Health insurance costs for Americans who get their coverage through their jobs have seen only small annual increases since the federal Affordable Care Act went into effect, despite soaring premiums in the new marketplaces. Employee contributions to their health expenses rose more slowly between 2010 and 2015 in most states, including California, than they did in the previous five years, according to a report released Wednesday by the Commonwealth Fund. Still, employee salaries haven’t kept pace with health costs.... “There just hasn’t been the large-scale disruption in the employer market that was anticipated before the Affordable Care Act went into place,” said Sara Collins, the report’s lead author and vice president of health care coverage and access for the Commonwealth Fund, a foundation supporting research on health care… “While the amount that employees are being asked to contribute to their health insurance grew more slowly for most between 2010 and 2015 than the previous five years, that share still hurt. That’s because the amount accounted for a larger share of their incomes.”
  
  
• Why employees feel so pinched by health-care costs New York Times by Carolyn Y. Johnson—In fact, the growth in health-insurance premiums and deductibles has moderated since the Affordable Care Act was passed, a trend the authors attribute to a nationwide slowdown in health care costs. About 10.4 million Americans had health insurance through the Affordable Care Act exchanges in the first half of the year, and about 154 million use coverage through their employer or a relative’s employee.

• Despite Being Shamed For Overcharging Patients, Hospitals Raised Their Prices, Again Washington Post by Lena H. Sun—A year ago, a study about U.S. hospitals marking up prices by 1,000 percent generated headlines and outrage around the country. Twenty of those priciest hospitals are in Florida, and researchers at the University of Miami wanted to find out whether the negative publicity put pressure on the community hospitals to lower their charges. Hospitals are allowed to change their prices at any time, but many are growing more sensitive about their reputations.  What the researchers found, however, was that naming and shaming did not work. .. “We were thinking we would see a drop or lowering of some charges,” said Karoline Mortensen, one of the authors of the study published in the Journal of Health Care Finance earlier this year. “There’s nothing stopping them,” she said, referring to the hospitals. “They’re not being held accountable to anyone.”

• As Medicaid Loses Stigma, Its Fate Rides On Stormy Election AP by By Ricardo Alonso-Zaldivar—Medicaid, often stigmatized among government healthcare programs, is finally coming into its own. The federal–state program for low-income people has been scarcely debated in the turbulent presidential election, but it faces real consequences depending on who wins the White House in the Nov. 8 vote. Under President Barack Obama, Medicaid has expanded to cover more than 70 million people and shed much of the social disapproval from its earlier years as a welfare program. Two big industries—insurers and hospitals—have a declared stake in the future of the program, which costs more than $530 billion a year…."It is no longer a program that is seen as exclusively for people who are not working," said Robert Blendon, a public opinion expert at the Harvard T.H. Chan School of Public Health. "Medicaid now covers so many people from different income backgrounds that it is seen as much broader program that provides health insurance to people of modest incomes."
  
  
• Medicaid Expansion Enrollment Exceeds 326,000 New Members New Orleans Times-Picayune by Jed Lipinski—More than 326,000 people have enrolled in Louisiana Medicaid Expansion since it went into effect July 1, marking a new milestone for the program, Louisiana Department of Health announced Thursday (Oct. 20). More than 24,000 of those new members have received preventative care visits with a provider. Such visits allow health care providers to preempt costly illnesses and other health problems through immunizations, lab tests, physical exams and prescriptions. They also allow physicians to educate patients about possible health risks. "The primary goal of expansion is to ensure better health outcomes for the working poor of Louisiana," said Gov. John Bel Edwards. "Early data show that expansion is working, and our people are getting the health care services they need."

• Doctors cut costs by getting to know their patients "Marketplace" by Dan Gorenstein—The healthcare landscape is changing, even as Obamacare bumps along. In the past six years, we’ve seen the rise of accountable care organizations (ACOs), now numbering more than 800, where doctors or hospitals work together to streamline care. For physicians that means they now get some compensation through contracts that reward improving health and controlling costs, as opposed to simply making money for every service provided regardless of the outcome or expense. There are now an estimated 28 million Americans enrolled in these ACOs, and that means, at least for some, their care looks radically different than even just a few years ago. That’s particularly true for some of the sicker people in the country...When ACOs hit the scene around 2010, people hoped they’d cut spending by 30 percent. Chernew said the best data show these efforts have saved more like somewhere between 2 and 10 percent, primarily because hands-on care isn’t a cure-all.

• Vermont's all-payer ACO will begin in January Modern Healthcare by Shannon Muchmore—In January, Vermont will become the first state in the nation to move to a voluntary all-payer accountable care organization model, CMS announced Wednesday.  The Vermont program is modeled after a similar one from Maryland, but the Maryland program covers only hospitals. The Vermont ACO will cover Medicare, Medicaid, and commercial payers, requiring those who participate to pay similar rates for all services. CMS is giving Vermont $9.5 million in start-up funding to support the transition. The demonstration, funded through a 1115 waiver, will last five years.

"The good news is that premiums in employer plans are growing more slowly on average, as is the amount employees are being asked to contribute. Unfortunately, many employees with moderate incomes aren’t feeling the benefits of these slowdowns, because they haven’t yet experienced the sustained growth in their income needed to keep up with health costs.” 

—Sara Collins, Vice President for Health Care Coverage and Access, The Commonwealth Fund