Category Archives: Health-care Policy

Insurers and hospitals complain to Kreidler about new rules

Share

MKreidlerPhotoBy Carol Ostrom, Seattle Times
APR 23, 2014

This story was produced in partnership with 

Health insurers and hospitals, usually on opposite sides, lined up together Tuesday to give Insurance Commissioner Mike Kreidler an earful about his proposed new rule for insurance-provider networks.

Kreidler proposed the rule after complaints that consumers have been taken by surprise about narrower networks in insurance plans offered in the Affordable Care Act.

Those networks exclude some of the region’s prominent hospitals and medical centers, meaning some consumers don’t have access to providers they expected to use. Continue reading

Share

Most states to sick with Healthcare.gov for 2015 sign ups

Share

By Phil Galewitz
KHN

Only two of the 36 states that relied on the federal insurance exchange this year — Idaho and New Mexico — plan to set up their own online marketplaces in time for the next open enrollment beginning Nov. 15.

Both those states had moved to run their own exchanges last year but couldn’t get them working in time for the 2014 enrollment season so they used the federal exchange instead.

No other states have announced similar plans and analysts say none is likely to be able to develop a detailed plan before the deadline in a little more than five weeks.

Election-year politics, tight deadlines and problems with health insurance exchanges in Oregon, Maryland and Hawaii dampened the interest of lawmakers in other states to form their own exchanges, despite the millions in federal funding that would be available under the Affordable Care Act.

The success of the federal exchange website, www.healthcare.gov, in enrolling millions of people after a notoriously rocky rollout also limited demand for state-run marketplaces, experts said. Continue reading

Share

Enrollment in Washington exchange tops one million

Share

Coverage is hereMore than 1 million Washington state residents enrolled in health insurance plans during the open enrollment period that began October 1 and ran through March 31st, Washington state officials said Wednesday.

The staff at the exchange, wahealthplanfinder.org, worked with thousands of customers over the past few weeks to help individuals finalize their applications after the March 31 deadline, many of whom were unable to complete their applications due to technical reasons or experienced other barriers to enrollment, officials said.

The Exchange continues to work with a small percentage of customers to finalize any remaining applications, officials said.

Here is a breakout of the enrollment numbers: Continue reading

Share

Swedish and Country Doctor team up

Share

 This story was produced in partnership with 

At Swedish Medical Center’s Cherry Hill hospital, the “EMERGENCY” sign glows bright in the dusk above the emergency-room entrance. Some 18,000 people sought help here last year.

Right next to the sign, there’s another one on the building: “After-Hours Clinic.” Operated by Country Doctor Community Health Centers, this clinic — like Swedish’s ER — is open evenings and weekends.

This isn’t competition, but a partnership few would have predicted before the Affordable Care Act, also known as Obamacare. Swedish, a huge, specialty-oriented medical center, has plunked down startup money and a cheap lease to help tiny Country Doctor, whose two clinics were started by idealistic community activists in the late 1960s and early ’70s. Continue reading

Share

Qs: Who is responsible for an adult child’s coverage? Must insurers notify smokers of ways to lower premiums?

Share

Question markBy Michelle Andrews

Q. Do we have to carry our 24-year-old daughter on our health insurance policy? She is employed and has two degrees. We informed her that we would be dropping her at the end of the year because it’s costing us a fortune, and she told us today that we are required by law to cover her. We do not claim her on our taxes. Continue reading

Share

Washington enrolls more than 285,000 in Medicaid. Now how to provide the care?

Share

Washington Map
Lisa Stiffler, The Seattle Times
APR 18, 201

This story was produced in partnership with 

Washington state has blown past its targets for signing up new Medicaid participants under the Affordable Care Act (ACA).

The program’s ranks have grown roughly 25 percent in the past six months, helping fulfill one of the act’s key goals to provide health care to nearly all Americans.

By the end of March, more than 285,000 adults who are newly eligible to participate in Medicaid had signed up for coverage.

That’s twice the number officials had hoped to reach by then, and a target they hadn’t expected to hit for three more years.

But with enrollment success comes the challenge of serving more people in a $10 billion program that’s already stretched thin in places. Continue reading

Share

Obama sharply criticizes Republicans as he announces 8 million have enrolled

Share

Enrollment in private health insurance on federal and state marketplaces has surged in recent weeks and now totals 8 million, a feisty President Barack Obama said Thursday.

“This thing is working,” Obama said at a White House news conference in which he lambasted Republican critics of the health law, especially those in states that did not expand Medicaid eligibility, as the law allows.

“I’m sorry. I’m going to say one last thing about this — just because this — this does frustrate me, states that have chosen not to expand Medicaid for no other reason than political spite,” Obama said. “You got 5 million people who could be having health insurance right now, at no cost to these states — zero cost to these states – [yet] other than ideological reasons, they have chosen not to provide health insurance for their citizens.” Continue reading

Share

High-cost hepatitis C treatments hits big insurer

Share

$100-dollar bill inside a capsuleBy Jay Hancock
KHN

UnitedHealth Group spent $100 million on hepatitis C drugs in the first three months of the year, much more than expected, the company said Thursday.

The news helped drive down the biggest insurance company’s stock and underscores the challenge for all health care payers in covering Sovaldi, an expensive new pill for hepatitis C.

“We’ve been surprised on the volume — the pent-up demand across all three businesses” — commercial insurance and private Medicare and Medicaid plans, said Daniel Schumacher, chief financial officer of UnitedHealth’s insurance wing. Continue reading

Share

Obama announces 8 million have enrolled in Marketplace plans

Share

In a White House news conference Thursday, President Barack Obama announced that 8 million people have enrolled in health plans through the health insurance exchanges created by the Affordable Care Act and that 35 percent of people who enrolled on the federally run healthcare.gov marketplace are under age 35.

A transcript follows. Continue reading

Share

Nearly 350,000 in Washington have enrolled in private plans since Oct. 1

Share

ACA health reform logoSince October 1, when the open enrollment began under the Affordable Care Act, 324,900 people in Washington state have signed up for private insurance, according to updated enrollment information reported by health insurers to the Office of the Insurance Commissioner this week.

This number includes 178,981 enrolled outside the Exchange and 146,000 enrolled inside the Exchange, Washington Healthplanfinder, as of March 31. The total is expected to increase as late enrollments through the Exchange are processed and reconciled.  Continue reading

Share

Health law’s free contraceptive coverage saved US women $483 million in 2013

Share

Twenty-dollar bill in a pill bottleThe Affordable Care Act provision that requires insurers to cover contraceptives with zero co-pay saved US women $483 million last year — $269 on average, according to a new report from the IMS Institute for Healthcare Informatics.

Overall, 24 million more prescriptions for oral contraceptives were filled in 2013, the first full year the health law’s contraceptive provision was in force, compared to 2012.

“The share of women with no out-of-pocket cost for these forms of birth control increased to 56% from 14% one year ago,” the report says.

To learn more read: 

IMS Institute for Healthcare Informatics. Medicine use and the shifting costs of healthcare: A review of the use of medicines in the United States in 2013. April 2014. LINK:

Share

FAQ on ACOs: Accountable Care Organizations, explained

Share

Accountable care organizations are practically a footnote in the health law, but advocates say they’ll be critical to holding down the cost of care while improving quality

By Jenny Gold
KHN Staff Writer
APR 16, 2014

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

A doctor walking through a mazeThe law takes a carrot-and-stick approach by encouraging the formation of Accountable Care Organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy. About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up.

An estimated 14 percent of the U.S. population is now being served by an ACO. You may even be in one and not know it.

While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town.  

ACOs have become one of the most talked about new ideas in Obamacare. Here are answers to some of the more common questions about how they work:  Continue reading

Share

Patients often win if they appeal a denied health claim

Share

The health law set national rules for appealing a denied claim, and advocates say consumers should take advantage of them

rejected

Image: sundesigns

By Pauline Bartolone, Capital Public Radio

APR 14, 2014

This KHN story was produced in collaboration with NPR

SACRAMENTO, Calif. — Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.

To help make sure a patient’s claims aren’t improperly denied, the Affordable Care Act creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer.

For Tony Simek, a software engineer in El Mirage, Ariz., appealing was the only way he was able to get additional treatment for sleep apnea.  Continue reading

Share

Focus one exchange enrollment overlooks millions who bought private insurance

Share

ACA health reform logoBy Annie Feidt, APRN

Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is exceedingly complicated.

The Obama administration is tracking the number of plans purchased on the federal website healthcare.gov and on the state marketplaces, and this month reported that It had exceeded expectations by signing up 7.5 million people. In addition, federal officials have said that 3 million people have enrolled in Medicaid since October.

But often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers — and that number could be substantial. Continue reading

Share

Q: Do I face a penalty if my kids’ CHIP coverage starts in April?

Share

Cute Baby Boy Isolated on WhiteBy Michelle Andrews

Q. I understand that I won’t have to pay a penalty for not having insurance because I signed up for coverage before the end of open enrollment.

But what about my kids? Their CHIP coverage didn’t start until April.  Continue reading

Share