Category Archives: Health-care Policy

Even with insurance, language barriers could undermine Asian Americans’ access to care

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Efforts to enroll Asian Americans in the health law’s marketplace plans have generally been touted as a success, but because coverage details are provided primarily in English or Spanish, those who depend on their native languages have encountered roadblocks as they try to use this new insurance.

About 35 percent of Asian Americans have limited English proficiency, according to a September report from the Center for American Progress, a left-leaning think tank.

The issue of language access gained attention last summer when the Obama administration notified thousands of people that their health insurance subsidies were at risk unless they updated their citizenship documentation because information on their initial applications could not be verified.

Advocates said many of those in jeopardy did not speak English well and did not understand the paperwork they received.

If people who face English language challenges don’t understand their coverage, maneuvering the health care system could prove unwieldy.

This example is not an isolated one.

Asian Americans, with limited English who enrolled in plans with the help of bilingual navigators and in-person assisters, are now trying to understand a slew of documents – things like explanations of benefits packages or notifications about paperwork deadlines – that often are not translated. Continue reading

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Modest premium hikes, higher consumer costs likely for job-based plans

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Fall is enrollment season for many people who get insurance through their workplace. Premium increases for 2015 plans are expected to be modest on average, but the shift toward higher out-of-pocket costs overall for consumers will continue as employers try to keep a lid on their costs and incorporate health law changes.

Experts anticipate that premiums will rise a modest 4 percent in 2015, on average, slightly higher than last year but lower than typical recent Increases.

Experts anticipate that premiums will rise a modest 4 percent in 2015.

“That’s really low,” says Tracy Watts, a senior partner at benefits consultant Mercer.

Even so, more employers say they’re making changes to their health plans in 2015 to rein in cost growth; 68 percent said they plan to do so in 2015, compared with 55 percent just two years earlier, according to preliminary data from Mercer’s annual employer benefits survey.

They are motivated in part by upcoming changes mandated by the health law. Starting in January, companies that employ 100 workers or more generally have to offer those who work at least 30 hours a week health insurance or face penalties.

“The more people you cover, the more it’s going to cost,” says Watts.

In addition, experts say, employers are ramping up efforts to avoid a 40 percent excise tax on expensive health plans—those with premiums that exceed $10,200 for individuals or $27,500 for families–that will take effect in 2018. Continue reading

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Even if you think you know what your policy covers, read it again

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MKreidlerPhotoBy Mike Kreidler, Washington State Insurance Commissioner 

We’ve said this before and we will keep saying this … you must read your policies, the sooner after you purchase them the better.

We receive calls daily from frustrated and often distraught consumers because they are having a problem with their coverage, premiums or outcomes of their claims because they thought they had a certain type of coverage that they did not actually have.

We can’t overemphasize the importance of this sentence: When you sign up for coverage of any kind, be sure to check the policy when you receive it!

This is your responsibility as a policyholder. Read it, look at the coverage and prices, and ask your agent or insurance company any questions immediately before you have a claim or policy payment issue.

It’s much easier to make a correction early in the process rather than after you have a claim and things aren’t correct.

Read more about your insurance on our website.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

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Washington Healthplanfinder promises streamlined health plan renewal process

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From Washington Healthplanfinder

Washington MapOLYMPIA, Wash. –  Starting Nov. 15, Washington Healthplanfinder customers who signed up for a Qualified Health Plan last year will be eligible to renew their health coverage for 2015 plans.

Most customers may be eligible to automatically renew their current health plan, but customers also have the option to update their application and shop for new plan options.

Approximately 80 percent of Qualified Health Plans offered in 2014 will be offered again during the next open enrollment period.

EDITOR’S NOTE: Before you auto-renew be sure to check whether there are better plans available. For more read Michael Ollove’s article: Automatically renewing your Obamacare policy could cost you thousands

Current customers should be on the look-out for “Open Enrollment Renewal” notices from Washington Healthplanfinder as early as this week. Continue reading

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Got insurance? You still may pay a steep price for prescriptions

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This KHN story also ran in .

Sandra Grooms recently got a call from her oncologist’s office. The chemotherapy drugs he wanted to use on her metastatic breast cancer were covered by her health plan, with one catch: Her share of the cost would be $976 for each 14-day supply of the two pills.

“I said, ‘I can’t afford it,’ ” said Grooms, 52, who is insured through her job as a general manager at a janitorial supply company in Augusta, Ga. “I was very upset.”

Insurers and employers shifting more of the cost of high-priced pharmaceuticals to the patients who take them.

.Even with insurance, some patients are struggling to pay for prescription drugs for conditions such as cancer, arthritis, multiple sclerosis or HIV/AIDS, as insurers and employers shift more of the cost of high-priced pharmaceuticals to the patients who take them.

Increasingly, health plans – even those offered to people with job-based coverage–require hefty payments by patients like Grooms.

In some plans, patients must pay 20 to 40 percent or more of the total cost of medications that insurers deem to be specialty drugs and place in the highest tiers of patient cost sharing. Continue reading

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Price tags on health care? Now in Massachusetts

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Twenty-dollar bill in a pill bottleBy Martha Bebinger, WBUR
KHN / OCT 09, 2014

This story is part of a reporting partnership that includes WBUR, NPR and Kaiser Health News.

Without much fanfare, Massachusetts launched a new era of health care shopping last week.

Anyone with private health insurance in the state can now go to his or her health insurer’s website and find the price of everything from an office visit to an MRI to a Cesarean section. For the first time, health care prices are public.

“Let the light shine in on health care prices.”

It’s a seismic event. Ten years ago, I filed Freedom of Information Act requests to get cost information in Massachusetts—nothing.

Occasionally over the years, I’d receive manila envelopes with no return address, or secure .zip files with pricing spreadsheets from one hospital or another.

Then two years ago, Massachusetts passed a law that pushed health insurers and hospitals to start making this once-vigorously guarded information more public.

Now as of Oct. 1, Massachusetts is the first state to require that insurers offer real-time prices by provider in consumer-friendly formats.

“This is a very big deal,” said Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”

There are caveats. Continue reading

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One in four Latinos remain uninsured

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By Teresa Wiltz
Stateline

In the “sala de espera,” or waiting room, at La Clinica del Pueblo, a community health center in Washington, D.C., signs in Spanish encourage patients to “Empower yourself!” and sign up for insurance coverage through the Affordable Care Act.

Adults slump in chairs, scribbling on application forms, texting friends, waiting. In a tiny office a few feet away, William Joachin, the center’s patient access manager, faces down the frustrations of trying to navigate the federal health care program for the thousands of mostly Central American immigrants who flood the clinic each year. He’s not alone.

A year after open enrollment for the ACA began, one in four Latinos living in the U.S. does not have health insurance, according to new census data, more than any other ethnic population in the country—and most states have few backups in place to help those in the coverage gap.

Latino health insurance graphic

 

Latino immigrants are the hardest hit: Foreign-born Hispanics are more than twice as likely to be uninsured than are U.S.-born Hispanics, according to census data compiled by the Pew Research Center. (Pew also funds Stateline.) Continue reading

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Despite health law, long-acting contraceptives still often not free for women

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New research suggests that teenagers are more likely to choose long-acting contraceptives when cost is removed from the equation. And free coverage of such methods is required by the health law.

But now, a study has found that free coverage of such methods too often still falls short.

Why is free coverage of long-acting contraceptives—which can prevent pregnancy from three months up to 10 years—still lacking for roughly 40 percent of women?

The study, published in the journal Contraception by the Guttmacher Institute, found that insurance coverage of contraceptives without cost sharing has improved markedly since the health law’s requirement became effective for most women in 2013.

But gaps in coverage remain. The Guttmacher researchers analyzed the experiences of 892 privately insured women who used prescription contraceptives between the fall of 2012, before the law’s provisions took effect for most women, and the spring of 2014.

It found that the proportion of women who paid nothing for their intrauterine devices increased from 45 percent to 62 percent during that time.

The proportion of women who had no cost sharing for injectable contraceptives grew from 27 percent to 59 percent. (There weren’t enough women using hormonal implants to include in the study.)

Some long-acting contraceptives such as IUDS can cost hundreds of dollars up front, putting them out of reach financially for some women unless insurance covers the cost. Continue reading

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2015 Medicare Part B premiums and deductibles to remain the same as last two years

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Center for Medicare & Medicaid ServicesNext year’s standard Medicare Part B monthly premium and deductible will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.  For the approximately 49 million Americans enrolled in Medicare Part B, premiums and deductibles will remain unchanged in 2015 at $104.90 and $147, respectively.

via 2015 Medicare Part B premiums and deductibles to remain the same as last two years.

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States negotiate for better drug prices

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Because of skyrocketing prescription drug prices, some state Medicaid programs and prison systems are limiting certain drugs to only the sickest patients. Some states are negotiating better pricing.

By Michael Ollove
Stateline

Twenty-dollar bill in medicine bottleThe new hepatitis C drug Sovaldi promises a cure rate of well over 90 percent, compared to 45 percent (at best) for older drugs. But when Sovaldi went on the market earlier this year for as much as $84,000 for a single course of treatment, critics blasted the cost as “exorbitant” and “gouging.”

It is estimated that between 3.2 million and 5.2 million Americans have hepatitis C, an infectious illness that can eventually compromise the liver.

The disease falls disproportionately on the poor and the incarcerated, which makes it a particular challenge for Medicaid, the federal-state health plan for the poor, and for state prison systems.

One study by Express Scripts, a drug benefits management company, estimated it would cost states $55 billion to provide Sovaldi to all prisoners and Medicaid beneficiaries with hepatitis C.

Because of its high cost, some state Medicaid programs and prison systems are refusing to provide Sovaldi to any but the sickest patients. Most recently, Oregon last month threatened to limit access to the drug unless it can get Sovaldi at a deeply discounted price.

“Sovaldi is a seminal event,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It’s clear that states are not equipped to handle this. They simply do not have the tools to maintain control.”

But Sovaldi is only the beginning. Expensive new treatments for certain cancers, rheumatoid arthritis and other conditions also have rattled Medicaid officials, patients and health care providers.

What can states do to hold down drug costs? Drug pricing is a complicated and opaque process. Here are some of the basics.

Question: Is each state Medicaid program on its own when it comes to drug pricing?

Answer: Not completely. The federal Omnibus Budget Reconciliation Act of 1990 mandates that drug makers give all Medicaid programs a 23 percent rebate off the Average Manufacturers Price (AMP) for all prescription drugs purchased, or the difference between the AMP and the best price given to a private payer. (Prisons aren’t covered by this discount provision and have to negotiate drug prices as any retailer does.)

In return for the rebates, Medicaid programs must carry all drugs approved by the U.S. Food and Drug Administration on their “formularies,” which is the list of the medications each health plan will pay for.  That guarantee means that the drug makers get access to substantial markets in all 50 states and the District of Columbia. Continue reading

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Wal-Mart adds in-store program to help customers compare insurance offerings – The Washington Post

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Walmart logoWal-Mart is teaming with DirectHealth.com, an online insurance comparison site and independent health insurance agency, to set up counters in its stores where consumers can talk to licensed agents about plan options.

via Wal-Mart adds in-store program to help customers compare insurance offerings – The Washington Post.

 

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Obamacare Enrollment: Second year a tougher challenge

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Miles Alva 176

This KHN story also ran in wapo

LOS ANGELES — As states gear up for round two of Obamacare enrollment next month, they have their sights set on people like Miles Alva.

Alva, 28, works part-time at a video store and is about to graduate from Cal State Northridge. Getting insured is about the last thing on his mind.

“It’s not a priority,” the television and cinema arts student said. “I am not interested in paying for health insurance right now.”

The second round of enrollment under the nation’s Affordable Care Act promises to be tougher than the first. Many of those eager to get covered already did, including those with health conditions that had prevented them from getting insurance in the past.

About 30 million to 40 million people remain uninsured in the United States.

About 30 million to 40 million people remain uninsured in the United States, according to various surveys.

“When you look at those who remain uninsured, they are in many ways harder to reach,” said Anne Filipic, president of Enroll America, a nonprofit group that signs up consumers for new health coverage. “This is really about doubling down and reaching those folks who didn’t get the message the first time.” Continue reading

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One proton center closes, but that doesn’t slow new construction

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proton therapy baltimore 300

In this May 2013 photo, construction continues at the Maryland Proton Treatment Center. (Photo by Jenny Gold/KHN).

This KHN story also ran on NPR

Proton therapy has been touted as the next big thing in cancer care. The massive machines, housed in facilities the size of football fields, have been sprouting up across the country for a decade.

There are already 14 proton therapy centers in the U.S., and another dozen facilities are under construction even though each can cost $200 million to build.

But Indiana University shocked experts who watch the industry last month when it announced that it plans to close down its facility in Bloomington, as reported by Modern Healthcare.

“I never thought that in my lifetime I would see a proton center close,” says Amitabh Chandra, a professor at Harvard’s Kennedy School of Government who studies the cost of American medical care.

He’s surprised because until now, industry growth has been entirely in the other direction, even though there’s little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.

“But we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology,” Chandra says.

In the Washington, D.C., area alone, three proton therapy centers are under construction — one at Johns Hopkins Medicine Sibley Memorial Hospital, another at MedStar Georgetown University Hospital, and a third, the Maryland Proton Treatment Center, is slated to open at the University of Maryland in Baltimore next year.

All three say they are continuing to build their centers, despite the news out of Bloomington. In email statements, two said that the larger population of the DC-Baltimore area can support a proton facility better than a small city like Bloomington. The third said it’s building a smaller, one room center that will be more cost effective.

Proton Therapy Baltimore 2 300

Dr. Minesh Mehta, medical director of the Maryland Proton Therapy Center stands with Dr. William F. Regine, radiation oncologist at the University of Maryland and James DeFilippi, vice president of project development at the construction site of the Maryland Proton Treatment Center in this May 2013 photo (Photo by Jenny Gold/KHN).

But in Indiana, a review committee determined that it just wasn’t worth spending the money that would be necessary to update their proton facility.

One reason for the closure is that insurers have been refusing to cover the treatment for common diseases such as prostate and breast cancer.

Cigna, for example, only covers proton therapy for a single rare eye cancer, says Dr. David Finley, the insurer’s national medical officer.

“When it’s used, however, for all other tumors, it’s not been shown to be any more effective than other forms of radiation therapy,” says Finley.

Proton beam therapy costs three to six times as much as standard radiation therapy for illnesses like prostate cancer, according to Finley. He adds that when insurers pay for expensive care that isn’t any better than the cheaper options, it can increase the cost of everyone’s health care.

“We said if two services offer the same result and one is much more expensive than the other one, we’re only going to pay for the one that is less expensive,” Finley says.

Other major insurers have also limited what they’ll cover with proton therapy, including Aetna and Blue Shield of California.

One health care payer that has not put any restrictions on proton therapy is Medicare. And Medicare pays much more for the treatment than it pays for standard radiation therapy.

“That’s the problem with Medicare payment policy,” says Harvard’s Chandra, “it not only covers treatments that are dubious treatments, it also covers dubious treatments extremely generously.”

But the doctors and researchers involved with building new proton beam facilities don’t think the treatment is dubious. They point to proton therapy’s potential to kill cancer without damaging surrounding tissue, and they say that it’s just a matter of time before clinical trials prove that proton therapy is worth the extra money.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

 

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After reprieve, thousands face health plan cancellations

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This KHN story also ran in wapo.

Thousands of consumers who were granted a reprieve to keep insurance plans that don’t meet the federal health law’s standards are now learning those plans will be discontinued at year’s end, and they’ll have to choose a new policy, which may cost more.

Cancellations are in the mail to customers from Texas to Alaska in markets where insurers say the policies no longer make business sense.

In some states, such as Maryland and Virginia, rules call for the plans’ discontinuations, but in many, federal rules allow the policies to continue into 2017.

Insurers sending the notices to some customers include Anthem, one of the largest insurers in the country, Baltimore-based CareFirst, Health Care Services Corporation in Chicago, Kaiser Permanente in Oakland, Calif., Humana in Louisville, Ky., and Golden Rule, an Indianapolis subsidiary of UnitedHealth Group.

One reason behind the switch is that insurers determined they can make more money selling plans that comply with the Affordable Care Act, often at higher premiums that may be subsidized by the government.

“They’re getting a lot more revenue, often for the same person,” said consultant Robert Laszewski, a former insurance executive.

Last year, similar cancellation letters sent to more than 2 million customers created a political firestorm for President Barack Obama, who had repeatedly promised that “if you like the plan you have, you can keep it.” Continue reading

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