Category Archives: Health-care Policy

Lack of understanding about insurance could lead to poor choices

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insurance jargonBy Michelle Andrews
KHN

People know less than they think they know. That’s the finding of a recent study that evaluated people’s confidence about choosing and using health insurance compared with their actual knowledge and skills.

As people shop for health coverage this fall, the gap between perception and reality could lead them to choose plans that don’t meet their needs, the researchers suggest.

Many people don’t understand commonly used terms such as “out-of-pocket costs,” “HMO” and “PPO.”

“There’s a concern that people who don’t have much experience with health insurance don’t protect themselves financially, and then something happens,” says Kathryn Paez, a principal researcher at the American Institutes for Research who co-authored the study. “So they’re learning through hard knocks.” Continue reading

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How Obamacare went south in Mississippi

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Flag_of_Mississippi.svg

In the country’s unhealthiest state, the failure of Obamacare is a group effort.

By Sarah Varney
KHN / October 29, 2014

The lunch rush at Tom’s on Main in Yazoo City, Mississippi, had come to a close, and the waitresses, having cleared away plates of shrimp and cheese grits, seasoned turnip greens and pitchers of sweet tea, were retreating to the counter to cash out and count their tips.

It didn’t take long: The $6.95 lunchtime specials didn’t land them much, and the job certainly didn’t come with benefits like health insurance. For waitress Wylene Gary, 54, being uninsured was unnerving, but she didn’t try to buy coverage on her own until the Affordable Care Act forced her to. She didn’t want to be a lawbreaker.

Months earlier, she had gone online to the federal government’s new website, signed up and paid her first monthly premium of $129. But when her new insurance card arrived in the mail, she was flabbergasted.

“It said, $6,000 deductible and 40 percent co-pay,” Gary told me at the check-out counter, her timid drawl giving way to strident dismay. Confused, she called to speak to a representative for the insurer Magnolia Health. “’You tellin’ me if I get a hospital bill for $100,000, I gotta pay $40,000?’ And she said, ‘Yes, ma’am.’”

Never mind that the Magnolia worker was wrong — her out-of-pocket costs were legally capped at $6,350. Gary figured with a hospital bill that high, she would have to file for bankruptcy anyway. So really, she thought, what was the point?

“This ain’t worth a tooth,” she said.

She canceled her coverage.

The first year of the Affordable Care Act in Mississippi was, by almost every measure, an unmitigated disaster. In a state stricken by diabetes, heart disease, obesity and the highest infant mortality rate in the nation, President Barack Obama’s landmark health care law has barely registered, leaving the country’s poorest and perhaps most segregated state trapped in a severe and intractable health care crisis. Continue reading

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Washington launches small business health exchange

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Ron Wanger, owner of Royal Ridges Retreat in Yacolt, talks about signing up for health insurance through Washington Healthplanfinder Business.

From Washington Healthplandfinder:

The Washington Health Benefit Exchange today announced the statewide launch of Washington Healthplanfinder Business, a customer-friendly, online marketplace that allows employers in Washington with up to 50 employees to compare health plans, decide their contribution level and manage payment – all in one place. 

The marketplace was available through Kaiser Health Plan of the Northwest in Clark and Cowlitz counties in 2014, but will now be available statewide for the first time through Moda Health Inc. Small employers can choose from a total of 23 different health plans.

“We are thrilled to launch our statewide offering for small businesses in Washington this year,” said Richard Onizuka, CEO for the Washington Health Benefit Exchange. “With the addition of Moda Health, we’re confident that employers will be able to find a Qualified Health Plan that’s right for their employees and their budget.”

Washington Healthplanfinder Business benefits small employers by:

  • Simplifying choices: Washington Healthplanfinder Business provides side-by-side comparisons of state-certified health plans, including their benefits, premiums and quality. All plans cover essential health benefits such as visits to the doctor and emergency room, prescriptions, and preventative care. In addition, plans are offered in three “metal tiers” based on the costs covered.
  • Expanding employee options: Business can offer employees a variety of health plans, and their employees can choose the plan that fit their needs and their budget.  Washington Healthplanfinder Business is the only place where employers can provide a “metal level” choice in health plans.
  • Preserving employer control: Washington Healthplanfinder Business gives employers a secure location to determine their own level of contribution toward their employees’ coverage and make a single monthly payment rather than payments to multiple plans. Consolidated billing will also be available so employers can avoid the hassle of contracting with multiple insurers.
  • Lowering Costs: Businesses can save money by spreading insurers’ administrative costs across more employers. In addition, Washington Healthplanfinder Businessprovides exclusive access to a 50 percent tax credit for health premiums for eligible employers.

Continue reading

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Washington state approves first association health plan

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ACA health reform logoFrom the Office of the Insurance Commissioner

The Office of the Insurance Commissioner has approved UnitedHealthcare of Washington, Inc.’s 2014 association health plan for Associated General Contractors of Washington.

This is the first approval for the more than 60 association health plans currently under review for compliance with new federal regulations.

Association health plans are sold by insurers to a large professional or trade group. In the past, small employers within an association had the benefit of buying large group insurance for their employees.

Until recent federal regulation, association health plans were exempt from having to meet key consumer protections and from the rating and underwriting standards of the individual or small-employer market.  Continue reading

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Hepatitis C patients may not qualify for pricey drugs unless illness is advanced

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Twenty-dollar bill in a pill bottleBy Michelle Andrews
KHN / October 28, 2014

In the past year, new hepatitis C drugs that promise higher cure rates and fewer side effects have given hope to millions who are living with the disease.

But many patients whose livers aren’t yet significantly damaged by the viral infection face a vexing reality: They’re not sick enough to qualify for the drugs that could prevent them from getting sicker.

An estimated 3 million people have hepatitis C. Faced with a cost per patient of roughly $95,000 or more for a 12-week course of treatment, many public and private insurers are restricting access to those who already have serious liver damage.

Many baby boomers who have hepatitis C contracted it years ago from blood transfusions at a time when blood was not screened for the virus.

Other strategies that limit access include restricting who can prescribe the drugs or requiring early proof the drug is working before continuing with treatment.

In addition, many state Medicaid programs require that patients be drug and alcohol free for a period of months before they can get the hepatitis C drugs. Continue reading

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Beyond the ‘Private Option’ for Medicaid Expansion

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Screen Shot 2014-10-24 at 9.53.58 AMBy Christine Vestal
Stateline

Less than a year after low-income Arkansans started receiving health coverage under the Affordable Care Act’s controversial Medicaid expansion, the state is declaring its so-called “private option” experiment a success.

Hospitals saw fewer uninsured patients, state coffers were spared millions in health care costs and private insurers reported record-low premium hikes.

Most important, Arkansas’ uninsured rate fell from 23 percent to 12 percent, the sharpest drop in the country.

Arkansas calls its ‘private option’ Medicaid plan a success, and early estimates indicate next year’s insurance rates in the state will be an average of 2 percent lower than this year.

But lawmakers in Arkansas, where Gov. Mike Beebe is a Democrat and the legislature is controlled by Republicans, have already asked the federal government for adjustments to their groundbreaking plan, under which Arkansans used Medicaid dollars to purchase private health insurance on the insurance exchange created under the ACA.

Meanwhile, other states are customizing their own alternative approaches to expanding Medicaid to cover adults with incomes up to 138 percent of the federal poverty level ($16,105 for an individual). Continue reading

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Health news headlines – October 24th

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Silhouettes of U.S. Soldiers at night in Iraq

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What would happen if you ended the Obamacare subsidies? The individual mandate?

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Question MarkWhat would happen if you ended the tax credits that subsidize premiums for health insurance purchased on the exchanges created by the Affordable Care Act?

Or ended the requirement that everyone buy insurance or pay a fine — the much maligned individual mandate?

The RAND Corporation, a non-partisan research organization, looked at how various tweaks to Obamacare would likely play out.

Some of their key findings:

Eliminating the Affordable Care Act’s (ACA’s) tax credits would cause large declines in enrollment and substantial increases in premiums.

Without the ACA’s premium support, premiums rise by nearly 45 percent, and enrollment falls by nearly 70 percent.

Without the ACA’s individual mandate, the number of people enrolled in the individual market falls by more than 20 percent, and premiums rise by about 7 percent.

To learn more read their study: Assessing Alternative Modifications to the Affordable Care Act

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Kreidler calls for insurers to review mental health denials back to 2006

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MKreidlerPhotoFrom the Office of the Insurance Commissioner

Insurance Commissioner Mike Kreidler is directing all health insurers in Washington state to identify any policyholders who had mental health services denied because of a blanket or categorical exclusion since Jan. 1, 2006 and notify them of their right to have their claim re-evaluated.

The Washington State Supreme Court recently ruled that Washington’s Mental Health Parity Act prevents insurers from using blanket exclusions for mental health services that may be medically necessary.

Kreidler sent a letter to the insurers today (PDF, 371KB), outlining his expectations for how to implement the court’s decision and what steps he expects them to take on behalf of consumers.

“The court ruled decisively on behalf of Washington consumers, and I intend to see that insurers doing business in our state follow through on this decision,” Kreidler said.  “I expect the insurers to do a thorough review of all policyholders who may have current and past claims that may be impacted by this decision and to start the process immediately.” Continue reading

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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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