Category Archives: Health-care Policy

More states demand notification of use of biosimilars

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Three red-and-white capsulesBy Michael Ollove
Stateline

Without the medicine Rachelle Crow takes for her rheumatoid arthritis, the 29-year-old Michigan woman’s face would frequently feel as if it were engulfed in flames. She would barely be able to crawl out of bed. She would have trouble opening or closing her fists or lifting her 3-year-old daughter.

Crow can do all those things thanks to Cimzia, one of a highly complex, usually expensive class of drugs known as biologics that derive from living organisms. Cimzia is recommended for women, like Crow, who are trying to get pregnant.

Notification laws require that patients and doctors are told whenever “biosimilar” imitations are substituted for brand-name biologics

.What keeps her up at night is a fear that a pharmacy could substitute a cheaper, not-quite identical drug for Cimzia without her or her doctor’s knowledge. It’s not only a return of her worst symptoms that she worries about. “If another medicine were substituted without telling me or my doctor, it could put my pregnancy at risk,” she said.

Fears like Crow’s have helped propel legislative attempts in many states this year to make sure that patients and doctors are notified whenever imitations deemed “interchangeable” by the US Food and Drug Administration (FDA) are substituted for brand-name biologics.

biosimilars

 

Already, Colorado has passed a notification law, and Utah has revised its earlier law. More than a dozen states are considering comparable measures.

Notification bills began popping up in states two years ago, but most were defeated in the face of opposition from manufacturers of biologic copies, which are called biosimilars, and from organizations representing pharmacists, who objected to the extra workload notification requirements might entail.  Continue reading

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Many entitled to hefty insurance subsidies still opt out

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turn-money-back-570By Michelle Andrews
KHN

The good news: Three-quarters of people who were eligible for the most generous financial subsidies on the federal health insurance exchange this year signed up for coverage, according to a new analysis by Avalere Health.

The puzzler: Enrollment dropped off substantially for people with only slightly higher incomes who would also have qualified for significant subsidies.

Stiffer penalties for not having coverage and redoubled efforts to reach out and educate people about the health law and their obligations may be keys to increasing enrollment for people in these income groups, says Caroline Pearson, a senior vice president at Avalere Health.

Subsidies alone aren’t enough, she says.

“The carrots as a standalone don’t work,” Pearson says, referring to subsidies that are available to make coverage more affordable for people with incomes between 100 and 400 percent of the federal poverty level. “You have to make people aware of the mandate, and as the mandate penalties increase that will strengthen the effect.”

Unless they qualify for an exemption, most people are required by the law to have health insurance or face fines. The penalty for not having health insurance in 2014 was the greater of $95 or 1 percent of annual income.

This year, the penalty increases to $325 or 2 percent of income, and in 2016 rises to $695 or 2.5 percent of income. Continue reading

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The health insurance industry looks…well, healthy | Marketplace.org

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Twenty-dollar bill in a pill bottleOn Thursday, a new report out from the Commonwealth Fund finds the health insurance industry is doing just fine, thank you very much.

That’s contrary to the deep-seated fears of some as the Affordable Care Act launched back in 2010. But with three years’ worth of data on the books now, and insurers’ stock prices soaring, those fears have faded.

via The health insurance industry looks…well, healthy | Marketplace.org.

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Gingrich: GOP really doesn’t want to repeal Obamacare

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Newt_Gingrich_by_Gage_Skidmore_7Former House Speaker Newt Gingrich doesn’t think Obamacare should be repealed, and congressional Republicans who say they want to repeal it really don’t want to either, he told a Washington, D.C. health conference Wednesday.

Instead, he thinks more minor parts of the law that aren’t working will be addressed because the core parts of the law have broader support than is often acknowledged.

PHOTO: Courtesy of Gage Skidmore

via Gingrich: GOP really doesn’t want to repeal Obamacare.

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Congresswoman McMorris Rodgers asked her Facebook followers for their Obamacare nightmare stories. She did not get the response she was expecting.

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like-thumb-facebookTo mark the 5th anniversary of the signing of the Affordable Care Act, Washington State Congresswoman Cathy McMorris Rodgers, a Republican, asked her Facebook followers to share with her their Obamacare nightmare stories.

She didn’t get the response she was expecting. Most responders are giving it a big “thumbs up.”

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High-deductible plans bring down costs now, but will they bring pricey problems later?

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Twenty-dollar bill in medicine bottleBy Jay Hancock
KHN

Got a high-deductible health plan? The kind that doesn’t pay most medical bills until they exceed several thousand dollars? You’re a foot soldier who’s been drafted in the war against high health costs.

Companies that switch workers into high-deductible plans can reap enormous savings, consultants will tell you — and not just by making employees pay more.

Total costs paid by everybody — employer, employee and insurance company — tend to fall in the first year or rise more slowly when consumers have more at stake at the health-care checkout counter whether or not they’re making medically wise choices.

Consumers with high deductibles sometimes skip procedures, think harder about getting treatment and shop for lower prices when they do seek care.

What nobody knows is whether low-cost, high-deductible plans will backfire, resulting in higher costs later on.

What nobody knows is whether such plans, also sold to individuals and families through the health law’s online exchanges, will backfire. If people choose not to have important preventive care and end up needing an expensive hospital stay years later as a result, everybody is worse off.

A new study delivers cautiously optimistic results for employers and policymakers, if not for consumers paying a higher share of their own health care costs. Continue reading

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Even in nursing, men earn more than women

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woman_doctor_surgeon_bigBy Julie Rovner
KHN

Women outnumber men in the nursing profession by more than 10 to 1. But men still earn more, a new study finds.

The report in this week’s Journal of the American Medical Association found that even after controlling for age, race, marital status and children in the home, males in nursing out-earned females by nearly $7,700 per year in outpatient settings and nearly $3,900 in hospitals.

Even as men flowed into nursing over the past decades, the pay gap did not narrow over the years studied: 1988 to 2013.

According to the Census Bureau, men made up about 9 percent of registered nurses in 2011, roughly a three-fold increase from 1970. And even though men were not permitted in nursing programs at some schools until the 1980s, they have overall earned more, just as in society at large.

The biggest disparity was for nurse anesthetists, with men earning $17, 290 more. Continue reading

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Kreidler announces examination of Premera data breach

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MKreidlerPhotoFrom the Office of the Insurance Commissioner

Insurance Commissioner Mike Kreidler announced Tuesday the launch of a multi-state “market conduct” examination of the Washington-based health insurer Premera Blue Cross in response the news that computer hackers were able to penetrate the company’s customer records.

“We take the recent cyberattack at Premera very seriously,” said Kreidler. “Insurance regulators across the country are on high alert given the recent breaches both at Premera and Anthem and we will use every resource within our authority to ensure that consumers are protected and to see that insurers are responding appropriately.”

 

“I remain seriously concerned at the amount of time it took Premera to notify its policyholders of the breach,” said Kreidler.

Market conduct exams on-site reviews of an insurer’s financial books, records, transactions and how they relate to a company’s activities in the marketplace.

The hackers gained access the records of 11 million customers – 6 million in Washington – including access to customers’: Continue reading

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Special enrollment period ends April 30

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Special Enrollment Period ends April 30

Don’t miss the chance to enroll in health coverage for 2015 if you owe the fee.

The Health Insurance Marketplace is providing individuals and families who owe 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 for the portion of the year you don’t have coverage. The fee for people who don’t have coverage increases in 2015. If you don’t have health coverage for 2015, the fee is $325 per person or 2% of your household income – whichever is higher.

hcgov get coverage with arrow


Millions of people have already signed up for 2015 coverage, and . . .

. . . 8 out of 10 who enroll are getting financial help.

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

The HealthCare.gov Team

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Another chance to enroll for coverage for 2015

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HCGOV Thin Marketplace header

HCGOV HHS Seal

Special Enrollment Period: March 15 – April 30

Don’t miss the opportunity to enroll in health coverage for 2015 if you owe the fee.

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

hcgov get coverage with arrow


Millions of people have already signed up for 2015 coverage, and 8 out of 10 who enroll are getting financial help.

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

The HealthCare.gov Team

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The Children’s Health Insurance Program debate

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insure kids now chip schipBy Christine Vestal
Stateline

The federal-state Children’s Health Insurance Program (CHIP) will run out of money on Sept. 30.

Until recently, Congress showed little interest in paying for it. But this week, the House agreed on a bill that would continue the $13 billion program in its current form through 2017.

In late February, Republicans in both houses issued a “discussion draft” outlining modifications they claimed would make the program more flexible for states, even though most governors say they don’t want any changes to what they consider a near-perfect health care program.

Most governors say they don’t want any changes to what they consider a near-perfect health care program.

The GOP proposal would have narrowed coverage to the lowest-income families currently served by CHIP and allowed states to cut back enrollment.

If CHIP is not renewed, advocates say more than 2 million of the 8 million kids currently covered by the program could wind up uninsured.  Continue reading

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Despite predictions, health law brings no drop in job-based insurance, study finds

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431px-Lewis_Hine_Power_house_mechanic_working_on_steam_pumpBy Michelle Andrews
KHN

There has been much hand wringing over the health law requirement that large employers this year offer insurance to workers who put in 30 or more hours a week or face penalties for not doing so.

The new rules would cost employers a bundle, some fretted, as part-timers clamored for company coverage previously unavailable to them. Others worried that employers would cut workers’ hours to get under the cap.

Average enrollment in company plans was essentially unchanged between 2014 and 2015 at 74 percent of all workers.

A new study found that so far there’s little cause for concern: Average enrollment in company plans was essentially unchanged between 2014 and 2015 at 74 percent of all workers.

The survey of nearly 600 employers by benefits consultant Mercer found that in 2015 the average percentage of employees who were eligible for coverage increased 1 point to 88 percent, but it was offset by a drop in the enrollment of eligible workers of 1 point on average, to 83 percent.

Part of the explanation for the stable results stems from the fact that most employers were already in compliance, says Beth Umland, Mercer’s director of research for health and benefits. Continue reading

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Washington state Obamacare premiums 12% cheaper this year – report

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ACA health reform logoThe average monthly premium of a the lowest cost “Silver” plan in Washington state offered through the health insurance exchange created by the Affordable Care Act fell from $269 in 2014 to $237 in 2015, according to a new study by the Robert Wood Johnson Foundation, a 12.0 percent decline.

In Seattle, the price of the average monthly premium fell even more from $267 to $233, a 12.2 percent decline.

The averages were calculated for the premiums on lowest cost Silver plans offered to a 40-year-old non-smoker.

Silver plans are designed to cover 70 percent of the cost of essential health benefits with the patient pays 30 percent.

About 87 percent of people obtaining insurance through the exchanges receive subsidies to help cover the cost of premiums.

To learn more go here.

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Many unaware that health care law subsidies may be banned – Poll

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ACA health reform logoWith a decision due by summer in a Supreme Court case that could unravel President Barack Obama’s health care law, a new poll finds many Americans have heard nothing about the case. But when the potential fallout is explained, most say it would hurt the country and they would look to Congress or the states to fix it.

via News from The Associated Press.

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Blue Shield Of California Loses Exemption From State Taxes : Shots – Health News : NPR

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Flag_of_CaliforniaCalifornia tax authorities have stripped Blue Shield of California, the state’s third largest insurer, of its tax-exempt status in California and ordered the firm to file returns dating to 2013, potentially costing the company tens of millions of dollars.

At issue in the unusual case is whether the company is doing anything different from its for-profit competitors to warrant its tax break. As a nonprofit company, Blue Shield is expected to work for the public good in exchange for the exemption from state taxes.

via Blue Shield Of California Loses Exemption From State Taxes : Shots – Health News : NPR.

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