Category Archives: Health-care Policy

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Special Enrollment Period: Time is running out

The Special Enrollment Period ends next week.

The Health Insurance Marketplace is providing individuals and families who paid the fee for not having health coverage when they filed their 2014 taxes with one last chance to get covered for 2015.

Get covered, avoid the fee. The fee for people who don’t have health coverage increases in 2015 to $325 per person or 2% of your household income – whichever is greater. The good news is you have until April 30 to learn about the options and financial assistance that is available and to enroll in a plan that meets your needs.

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Join the millions who are saving: 8 out of 10 people can find coverage for $100 or less a month with tax credits through the Marketplace.

We hope you take advantage of this extended opportunity to get quality coverage this year.

The HealthCare.gov Team

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Few using quality and price information to make health decisions

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Shopping cart redBy Jordan Rau
KHN

Despite the government’s push to make health information more available, few people use concrete information about doctors or hospitals to obtain better care at lower prices, according to a poll released Tuesday.

Prices for the health care industry have historically been concealed and convoluted, unlike those for most other businesses. The 2010 health law aimed to make such information more transparent.

Only one in five people say they had seen specific cost or quality information about a hospital, insurer or doctor.

People shopping for insurance can now compare the prices of competing plans through online marketplaces, including premiums, deductibles and their share of any medical expenses.

The federal government also publishes more than 100 quality ratings about hospitals, as do some large private insurers.

Private groups such as Consumer Reports and U.S. News & World Report also rate providers, and Internet forums such as Yelp are now littered with easily accessible opinions.

The poll from the Kaiser Family Foundation found that about two of three people say it is still difficult to know how much specific doctors or hospitals charge for medical treatments or procedures. (KHN is an independent program of the foundation.)

Only about one in five people said they had seen specific cost or quality information about a hospital, insurer or doctor.

The poll found that this information rarely makes a difference. About 6 percent of people ever used quality information in making a decision regarding an insurer, hospital or doctor. And fewer than 9 percent used information about prices, most commonly in relation to health plans. Only 3 percent said they used price information about physicians, the poll found. Continue reading

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Medicare & Medicaid at 50 – Video

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With Medicare and Medicaid turning 50 this year, the Kaiser Family Foundation produced an updated video that provides a brief history of both programs, including an examination of the health care, social and political landscapes that gave rise to them, the significant ways each program has evolved over five decades and the important roles they play in the U.S. health care system today.

The video includes archival footage, as well as commentary and perspective from policymakers, government officials and experts.

To learn more about Medicare go to the Kaiser Family Foundation Medicare webpage.

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Bloomberg Politics Poll: Majority of Americans Say Obamacare Should Get Time to Work

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-1x-1Fifty-one percent of U.S. adults say that while the Affordable Care Act may still require small changes, “we should see how it works,” according to a new Bloomberg Politics poll.

Twelve percent said President Barack Obama’s signature legislative accomplishment should be left alone, 35 percent said it should be repealed, and two percent said they weren’t sure.

via Bloomberg Politics Poll: Majority of Americans Say Obamacare Should Get Time to Work – Bloomberg Politics.

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Administration proposal for workplace wellness programs earns business praise, consumer concerns

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431px-Lewis_Hine_Power_house_mechanic_working_on_steam_pumpBy Michelle AndrewS
KHN

Business groups praised a proposed new rule from the Equal Employment Opportunity Commission clarifying how employers can construct wellness programs, but consumers advocates said the new policy could harm workers.

The EEOC published the long-awaited rule Thursday.

“This is a big step forward, primarily because the EEOC has defined what it means for a wellness program to be voluntary,” says Steve Wojcik, vice president for public policy at the National Business Group on Health, which represents large employers.

The Americans With Disabilities Act prohibits employers from discriminating against workers based on their health. But they can ask workers for details about their health and conduct medical exams as part of a voluntary wellness program.

Before this proposal was unveiled, employers and consumer advocates alike had been uncertain how the commission defined voluntary. Continue reading

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Some states pay doctors more to treat Medicaid patients

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Blue doctorBy Michael Ollove
Stateline

Fifteen states are betting they can convince more doctors to accept the growing number of patients covered by Medicaid with a simple incentive: more money.

The Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services—but only temporarily. The federal spigot ran dry on Jan. 1.

Fearing that lowering the rates would exacerbate the shortage of primary care doctors willing to accept patients on Medicaid, the 15 states are dipping into their own coffers to continue to pay the doctors more.

It seems to be working. Continue reading

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You may still have time to get coverage . . .

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The tax filing deadline is today

Today is the last day to file your taxes!

If you owe a fee on your taxes for not having health coverage in 2014 and don’t yet have health coverage for 2015, you may still be able to get covered for 2015.

The Health Insurance Marketplace is providing individuals and families who need to pay the fee when they file their 2014 taxes with one last chance to get covered for 2015.

In order to take advantage of this Special Enrollment Period to get health coverage, you must meet all of the following requirements:

  • You didn’t know that the health care law required you and your household to have health coverage until after February 15, 2015, or you didn’t understand how that requirement would affect you or your family.
  • You owe the fee for not having coverage in 2014.
  • You aren’t already enrolled in 2015 qualifying health coverage.

Good news: If you qualify, you don’t need to restart your application. Simply log in to your account and select your application. Then navigate to the question about Special Enrollment Periods and update your information.

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Important: If you don’t have coverage for the remainder of 2015 you’ll risk having to pay the fee again next year. The fee for people who don’t have coverage increases in 2015 to $325 per person or 2% of your household income – whichever is greater.

Don’t miss out on potential savings: 8 out of 10 people can find coverage for $100 or less a month with tax credits through the Marketplace.

We hope you take advantage of this extended opportunity to get quality coverage this year.

The HealthCare.gov Team

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One day left. Avoid the tax penalty and get covered!

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The Tax Deadline and Your Coverage

April 15 is the deadline to file your taxes. There is only 1 day left!

If you owe a fee on your taxes for not having health coverage in 2014 and don’t yet have health coverage for 2015, you may still be able to get covered for 2015. The Health Insurance Marketplace is providing individuals and families who need to pay the fee when they file their 2014 taxes with one last chance to get covered for 2015.

This is too important to put off. If you don’t have coverage for the remainder of 2015 you’ll risk having to pay the fee again next year. The fee for people who don’t have coverage increases in 2015 to $325 per person or 2% of your household income – whichever is greater.

hcgov get coverage with arrow


Don’t miss out on potential savings:  Millions of people have already signed up, and 8 out of 10 can find coverage for $100 or less a month with tax credits through the Marketplace.

We hope you take advantage of this extended opportunity to get quality coverage this year.

The HealthCare.gov Team

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Hospitals leave downtown for more prosperous digs

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A sign marks the location of a proposed new St. Elizabeth’s hospital in O’Fallon, Mo., on 114 acres of farmland just off Interstate 64. (Photo by Phil Galewitz/KHN)

By Phil Galewitz
KHN

BELLEVILLE, Ill. – Nearly as old as the railroad that slices through this southern Illinois city just east of the Mississippi River, St. Elizabeth’s Hospital has been a downtown bedrock since 1875.

Started by three nuns from a Franciscan order in Germany, the Catholic hospital still seeks “to embody Christ’s healing love” to the sick, the aged and the poor, according to its mission statement.

It is so tied to the city that when the local economy slumped in 2009, the nonprofit St. Elizabeth’s gave $20 to every employee to spend on Main Street, sending hundreds of shoppers out to the mostly mom- and pop-owned stores.

But St. E’s, as locals call it, now faces its own financial troubles, largely a result of the costs of maintaining an obsolete facility and of treating more low-income and uninsured patients from Belleville and neighboring East St. Louis, one of the poorest cities in the Midwest.

After a decade of losing money, St. Elizabeth’s officials are taking a radical step: Like a small but growing number of hospitals around the country, they plan to close the 303-bed hospital and move elsewhere.

They are seeking state approval to build a $300-million facility seven miles northeast, in O’Fallon, a wealthier city that is one of the fastest-growing communities in the St. Louis region with new subdivisions, proximity to a regional mall and quick access to Interstate 64.

Describing plans to leave behind some services, including a walk-in clinic, St. Elizabeth’s CEO Maryann Reese insists the hospital is not abandoning the city or the poor. Continue reading

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FAQ: What are the penalties for not getting insurance?

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IRS logoIf you’re uninsured, you may have questions about possible penalties for not having coverage. The fine may be bigger than you expect. Here are the details:

Is everyone required to have health insurance or pay a fine?

Most people who can afford to buy health insurance but don’t do so will face a penalty, sometimes called a “shared responsibility payment.”

The requirement to have health insurance, which began in 2014, applies to adults and children alike, but there are exceptions for certain groups of people and those who are experiencing financial hardship.

What kind of insurance satisfies the requirement to have coverage?

Most plans that provide comprehensive coverage count as “minimum essential coverage.” That includes job-based insurance and plans purchased on the individual market, either on or off the exchange.

Most Medicaid plans and Medicare Part A, which covers hospital benefits, count as well, as do most types of Tricare military coverage and some Veterans Affairs coverage. Continue reading

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Coalition pushes for health care cost and quality transparency

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Twenty-dollar bill in a pill bottleBy Lisa Gillespie
KHN

As consumers increasingly are being asked to pay a larger share of their health bills, a coalition of insurers, pharmaceutical companies, and provider and consumer advocacy groups launched Thursday a new push for greater transparency regarding the actual costs of services.

The group includes AARP, Novo Nordisk, the National Consumers League, the Ambulatory Surgery Center Association, the National Council for Behavioral Health and Aetna.

Transparency means all consumers have the information they need to estimate cost and quality of health services.

Health care transparency, long a buzz word, means all consumers — whether they are covered by Medicare, work-based insurance or without coverage at all — have access to information enabling them to estimate accurately the cost of health services, and compare physician quality rankings and outcomes.

The initiative, “Clear Choices,”  will add to private and government efforts already underway to get more such information to patients, including Medicare’s Physician Compare, and the Health Care Cost Institute’s ‘Guroo,’ which culls data from private insurers to provide average prices regionally.

The group’s first priority is advancing the Medicare doctor payment legislationp ending in the Senate because it includes a provision requiring Medicare to release for broader use a substantial amount of data on claims at the provider level.

The group’s other objectives include:

  • Improving quality measures for doctors and hospitals so that patients will be armed with more comparative information.
  • Requiring hospitals to be clearer regarding what may or may not be included in their cost estimates for care.
  • Creating better tools for consumers to make medical decisions based on price, quality and safety of medical services.

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US proposes rule for providing mental health ‘parity’ in Medicaid program

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Photo courtesy of Sanja Gjenero

By Jenny Gold
KHN

A federal law that passed in 2008 was supposed to ensure that when patients had insurance benefits for mental health and addiction treatment, the coverage was on par with what they received for medical and surgical care.

But until now, the government had only spelled out how the law applied to commercial plans.

That changed Monday, when federal officials released a long-awaited rule proposing how the parity law should also protect low-income Americans insured through the government’s Medicaid managed care and the Children’s Health Insurance Program (CHIP) plans. The proposed regulation is similar to one released in November 2013 for private insurers.

“Whether private insurance, Medicaid, or CHIP, all Americans deserve access to quality mental health services and substance use disorder services,” said Vikki Wachino, acting director at the Center for Medicaid and CHIP Services.

Medicaid and CHIP programs are funded jointly by the federal and state governments.

Even if the state has carved out some benefits under a separate behavioral health plan, patients would be protected under the rule. Medicare patients are generally not affected by the regulation, nor are those in Medicaid fee-for-service plans .

But the rule does affect the majority of the 70 million people on Medicaid who are in managed care plans, and the 8 million children covered by CHIP plans.

Insurers, advocates and the general public will have a chance to comment on the proposed rule. The government will then release a final version.

Photo courtesy of Sanja Gjenero

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Wanting mental health treatment and not getting it

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Jigsaw puzzle with one piece to add

By Michael Ollove
Stateline

More than a half-million adults who said they wanted help with their serious mental conditions last year couldn’t get it because they lacked the resources and weren’t eligible for Medicaid to pay for treatment, a new study finds.

Those people — an estimated 568,886 adults ages 18 through 64 diagnosed with a serious mental illness, serious psychological stress or substance use disorder at the start of last year — lived in 24 states that didn’t expand Medicaid eligibility under the Affordable Care Act in 2014, according to a study published this week from the American Mental Health Counselors Association (AMHCA).

More than a half-million adults who said they wanted help with their serious mental conditions last year couldn’t get it.

In contrast, 351,506 adults with those same mental health problems got treatment paid for by Medicaid in the 26 states and the District of Columbia, which did expand coverage of the state-federal health insurance program to eligible adults living on low incomes.

The upshot, said Joel Miller, AMHCA’s executive director, is “the health of hundreds of thousands of people would be improved” if all states provided Medicaid coverage as they were given the option to under the Affordable Care Act (ACA).

Photo: Willi Heidelbach
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Battle for mental health parity produces mixed results

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Illustration of the skull and brainBy Jenny Gold
KHN

By law, many U.S. insurance providers that offer mental health care are required to cover it just as they would cancer or diabetes treatment.

But advocates say achieving this mental health parity can be a challenge.

report released last week by the National Alliance on Mental Illness found that “health insurance plans are falling short in coverage of mental health and substance abuse conditions.”

Jenny Gold of Kaiser Health News spoke with NPR’s Arun Rath over the weekend about the issue.

Rath noted that many patients have trouble getting their mental health care covered, and she outlined some of the issues confronting both patients and the insurance industry. Here is an edited transcript of her comments.

Where does parity stand?

It’s been a mixed bag so far. Insurance companies often used to have a separate deductible or a higher copay for mental health and substance abuse visits.  Right now, that usually isn’t the case. In that way, insurers really have complied. Continue reading

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