Category Archives: Health-care Policy

Automatically renewing your Obamacare policy could cost you thousands

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Twenty-dollar bill in a pill bottleBy Michael Ollove
Stateline

For the 8 million people who persevered through all the software trapdoors in the new health insurance exchanges and managed to sign up for coverage in 2014, their policies will probably automatically renew come November when open enrollment begins.

Seems like good news after all the headaches consumers endured after the program’s launch last year.

Except that renewing the same policy may not be the best choice. Many may end up paying far more than they need to and with policies that don’t best fit their individual circumstances.

“(Automatic re-enrollment) could conceivably mean people will pay more in premiums unless they proactively take steps to comparison shop.”

“(Automatic re-enrollment) could conceivably mean people will pay more in premiums unless they proactively take steps to comparison shop,” said Jenna Stento, a senior manager at Avalere Health, a health care research and consulting firm.

If you made a good choice last year, what could be so wrong about re-upping with the same plan? Continue reading

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How can I get health coverage for my grandchildren?

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Q. My son has lost his job and my grandchildren, ages 5 and 6, are without health insurance. I am a retired schoolteacher and might be able to afford coverage for them. What are my options?

A. Your grandchildren have a couple of coverage possibilities. Continue reading

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Are patient privacy laws being misused to protect medical centers?

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A 1996 law known as HIPAA has been cited to scold a mom taking a picture of her son in a hospital, to keep information away from police investigating a possible rape at a nursing home, and to threaten VA whistleblowers.

By Charles Ornstein
ProPublica

This story was co-published with NPR’s “Shots” blog.

In the name of patient privacy, a security guard at a hospital in Springfield, Missouri, threatened a mother with jail for trying to take a photograph of her own son.

In the name of patient privacy , a Daytona Beach, Florida, nursing home said it couldn’t cooperate with police investigating allegations of a possible rape against one of its residents.

In the name of patient privacy, the U.S. Department of Veterans Affairs allegedly threatened or retaliated against employees who were trying to blow the whistle on agency wrongdoing. Continue reading

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Signups remain brisk on federal health exchange

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New federal data, obtained by ProPublica under the Freedom of Information Act, shows nearly 1 million insurance transactions since mid-April

ACA health reform logoBy Charles Ornstein
ProPublica, July 23, 2014

This story was co-published with NPR’s “Shots” blog.

For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act.

It turned out that more than 5 million people signed up using Healthcare.gov by April 19, the end of the open-enrollment period.

 

But perhaps more surprising is that, according to federal data released Wednesday to ProPublica, there have been nearly 1 million transactions on the exchange since then.

There have been nearly 1 million transactions on the exchange since the end of the open enrollment period.

People are allowed to sign up and switch plans after certain life events, such as job changes, moves, the birth of a baby, marriages and divorces.

The volume of these transactions was a jolt even for those who have watched the rollout of the ACA most closely. Continue reading

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Study estimates 10 million Americans gained health coverage due to Obamacare

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ACA health reform logoBy Phil Galewitz
KHN / JULY 24TH, 2014

About 10.3 million Americans gained health coverage this year, primarily as a result of the Affordable Care Act, according to a study by the federal government and Harvard University, published Wednesday in the New England Journal of Medicine.

The estimate of newly insured adults — the largest to date — is the first published in a major medical journal and authored by some federal health researchers.

The number of uninsured adults fell by a little over 5 percent nationally, from 21 percent in September 2013 to 16.3 percent in April 2014.

The federal government had previously reported that about 8 million people bought private health plans on the state and federal exchanges and 6.6 million additional people enrolled in Medicaid since last October. But it has not estimated how many of those had been previously uninsured.

The Obama administration took pains yesterday to say that the views of the study’s authors are not those of the administration – even as it hailed their findings. Continue reading

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Business groups, patient advocates draw lines in the sand about essential benefits

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MedicineBy Shefali Luthra
KHN

The essential health benefits (EHBs) countdown is on for 2016.

That’s when this provision of the Affordable Care Act, which sets out 10 specific health services that must be covered by plans sold on the exchanges, will likely be  reviewed by the Department of Health and Human Services.

Business interests and consumer advocates are already making their positions clear – the former pushing for greater consciousness of premium costs and the latter looking to safeguard consumers’ coverage. Continue reading

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Consumer’s guide to recent court decisions

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On Tuesday two U.S. appeals courts issued conflicting rulings on a subject that’s important to millions of people:  the availability of subsidies to help purchase coverage under the health-care law.

KHN’s Mary Agnes Carey answers some frequently asked questions about those court decisions and how they impact consumers.

Q: What did the courts decide? Continue reading

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Courts split on legality of subsidies for Affordable Care Act

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Two U.S. Appeals Courts Tuesday reached opposite conclusions about the legality of subsidies in the Affordable Care Act, a key part of the law that brings down the cost of coverage for millions of Americans.

In Washington, a three-judge panel at the U.S. Appeals Court for the D.C. Circuit ruled that the Internal Revenue Service lacked the authority to allow subsidies to be provided in exchanges not run by the states.

That 2-1 ruling in Halbig v. Burwell could put at risk the millions of people who bought insurance in the 36 states where these online insurance marketplaces are run by the federal government.

Judge Thomas Griffith, writing the majority opinion, said they concluded “that the ACA unambiguously restricts” the subsidies to “Exchanges ‘established by the state.’ ”

But within hours, a unanimous three-judge panel for the Fourth Circuit in Richmond, Va., ruled exactly the other way in King v. Burwell – that Congress always intended to allow subsidies to be provided in both state and federally run exchanges. Continue reading

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Arkansas weighs plan to make Medicaid enrollees fund savings accounts

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Arkansas_population_map

Map by JimIrwin via Wikipedia/GNU Free Documentation License

By Michelle Andrews
KHN

If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts.

Those that don’t may have to pay more of the cost of their medical services, and in some cases may be refused services.

Supporters say it will help nudge beneficiaries toward becoming more cost-conscious health care consumers.

Patient advocates are skeptical, pointing to studies showing that such financial “skin-in-the-game” requirements discourage low-income people from getting care that they need. Continue reading

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Biggest insurer in US drops caution, embraces Obamacare

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Dye with Yes, No and Maybe of the three visible sidesBy Jay Hancock
KHN

UnitedHealthcare, the insurance giant that largely sat out the health law’s online marketplaces’ first year, said Thursday it may sell policies through the exchanges in nearly half the states next year.

“We plan to grow next year as we expand our offering to as many as two dozen state exchanges,” Stephen Hemsley, CEO of UnitedHealth Group, the insurance company’s parent, told investment analysts on a conference call. He was referring to coverage sold to individuals.

A study found that if UnitedHealthcare had sold policies through the exchanges this year in every state where it already does business, premiums would have been 5 percent lower.

The move represents a major acceleration for the company and a bet that government-subsidized insurance, sold online without regard for pre-existing illness, is here to stay. UnitedHealthcare sells individual policies through government exchanges in only four states now.

Even analysts who follow the company closely seemed surprised. Continue reading

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Half of abortion clinics in Texas close due to new state law

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200px-Flag-map_of_TexasBy Carrie Feibel, KUHF
KHN / JULY 18TH

This story is part of a partnership that includes Houston Public MediaNPR and Kaiser Health News. 

In just over the past year, the number of abortion clinics in Texas fell from 41 to 20, and watchdogs say that as few as six may be left by September.

Many of those closed because of the requirement that doctors at those clinics obtain hospital admitting privileges within a certain radius of the clinic, and many doctors couldn’t comply. That requirement began November 1. This week marks the one-year anniversary of the law that started it all.

Bitter fighting over the law last summer propelled state senator Wendy Davis into the national spotlight, and she is now running for Texas governor on the Democratic ticket.

“We’re seeing delays,” said Heather Busby, executive director of  NARAL Pro-Choice Texas. “We’re seeing people being pushed further into pregnancy, having to leave the state, having to drive and sleep in their cars in parking lots because of these barriers to access.” Continue reading

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Health system not doing enough to protect patients, experts

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Physician and Nurse Pushing Gurneyby Marshall Allen
ProPublica

WASHINGTON, D.C. — The health care community is not doing enough to track and prevent widespread harm to patients, and preventable deaths and injuries in hospitals and other settings will continue unless Congress takes action, medical experts said today on Capitol Hill.

“Our collective action in patient safety pales in comparison to the magnitude of the problem,” said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. “We need to say that harm is preventable and not tolerable.” Continue reading

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If I have a job-based plan, can I still buy on an exchange?

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 Q. It is my understanding that people who are employed and have insurance through their jobs that offer individual coverage for less than 9.5 percent of their income are not eligible to enroll through the state exchange. Am I confused?

A. Yes, you are, but yours is a common misperception. Almost anyone can buy a health plan on the health insurance marketplaces. As long as you live in the United States, you’re a U.S. citizen or someone who’s lawfully present here, and you’re not in jail, you can probably buy a marketplace plan. Continue reading

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Getting specialty care a challenge with some ACA plans

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“Narrow networks” keep the price of some Obamacare insurance plans low, but they also keep certain hospitals and physicians out of reach for sick patients

Sawhney 300

Dr. Charu Sawhney of Hope Clinic in southwest Houston listens to the lungs of Mang Caan, a refugee from Burma. (Photo by Carrie Feibel/Houston Public Media)

Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace.

Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits.

 ‘Oh by the way, when you sign up, make sure you sign up for the right plan.’

But they’re also causing headaches in the day-to-day work of doctors and clinics. “The biggest problem we’ve run into is figuring out what specialists take a lot of these plans,” said Dr. Charu Sawhney of Houston. Continue reading

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A small business owner shops for health insurance

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By Heidi de Marco
KHN Staff Writer

This KHN story was produced in collaboration with .

Sandra Lopez 2 300

Sandra Lopez  (Photo by Heidi de Marco/KHN).

NEWPORT BEACH, Calif. — Alongside one of this city’s canals, blocks from the beach, Sandra Lopez is finally living her idea of the American dream.

In 1996, six years after crossing the border from Mexico without papers, she began working at Las Fajitas, a popular Mexican restaurant as a cashier and cook. With the help of her boss, she received a work visa in 2001.

Eleven years after that, she bought the business – a bustling establishment where Lopez knows most customers by name. Mexican lanterns hang from the ceiling, and cheers from a soccer match on TV fill the room.

Lopez said the income from her small business fluctuates monthly. “People think that because you own a business, you have lots of money…that life is easy,” she said. “But it’s hard work and I have so many bills to pay.”

Lopez, her husband, and an adult child in the household live on about $46,000 a year.

For years, she felt she couldn’t afford health insurance for herself, let alone her half dozen employees: “How can I offer them something I don’t even have?” Continue reading

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