Category Archives: Health-care Policy

Group Health state’s market leader in health insurance

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Group Health IconAccording to the Office of the Insurance Commissioner, the top three health insurance companies in Washington state by market share are: 

  • Group Health Cooperative Group, with 20 percent of the market and $3.2 million in written premiums.
  • Cambia Health Solutions, Inc., which includes Regence Blue Shield, with 16 percent of the market and $2.6 million in written premiums.
  • Premera Blue Cross Group, with 15 percent of the market and $2.4 million in written premiums.

For more information go here.

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What’s been the local impact of the Affordable Care Act?

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California congressman Rep. Henry Waxman, a Democrat, has released a report detailing the impact of the Affordable Care Act broken down by congressional district.

Below are details from the report on the health law’s impact in the 7th district, represented by Congressman Jim McDermott, a strong supporter of the law, and the 8th district, represented by Congressman David Reichert, who has voted repeatedly to repeal the law.

For information about other districts go here.

In District  7 – Jim McDermottScreen Shot 2014-08-01 at 8.47.35 AM

As a result of the law:

  • There are 27,000 district residents who were previously uninsured now have health coverage because of the Affordable Care Act.
  • Overall, the number of uninsured district residents has declined by 35%.
  • Approximately 13,300 individuals purchased coverage through the new health insurance marketplace.
  • 31,700 enrolled in Medicaid
  • 7,600 young adults were able to retain coverage through their parents’ plans.
  • For more than 79% of the individuals enrolled in the health insurance marketplace, financial assistance was available that substantially reduced the cost of coverage – in many cases to less than $100 per month.
  • 295,000 individuals in the district – including 42,000 children and 132,000 women – now have health insurance that covers preventive services without any co-pays, coinsurance, or deductible.
  • 5,700 seniors in the district received Medicare Part D prescription drug discounts worth $8.9 million.
  • 94,000 seniors in the district are now eligible for Medicare preventive services without paying any co-pays, coinsurance, or deductible
  • 279,000 individuals in the district are protected by ACA provisions that prevent insurance companies from spending more than 20% of their premiums on profits and administrative overhead.
  • Because of these protections, over 5,700 individuals in the district received approximately $250,000 in insurance company rebates
  • Up to 26,000 children in the district with preexisting health conditions can no longer be denied coverage by health insurers.
  • 279,000 individuals in the district now have insurance that cannot place annual or lifetime limits on their coverage.

District 8 – Dave ReichertScreen Shot 2014-08-01 at 8.48.16 AM

  • 28,000 district residents who were previously uninsured now have health coverage.
  • Overall, the number of uninsured district residents has declined by 35%.
  • Approximately 13,900 individuals purchased coverage through the new health insurance marketplace
  • 33,000 enrolled in Medicaid
  • 5,400 young adults were able to retain coverage through their parents’ plans.
  • For more than 79% of the individuals enrolled in the health insurance marketplace, financial assistance was available that substantially reduced the cost of coverage – in many cases to less than $100 per month.
  • 286,000 individuals in the district – including 63,000 children and 114,000 women – now have health insurance that covers preventive services without any co-pays, coinsurance, or deductible.
  • 6,900 seniors in the district received Medicare Part D prescription drug discounts worth $9.9 million.
  • 100,000 seniors in the district are now eligible for Medicare preventive services without paying any co-pays, coinsurance, or deductible.
  • 252,000 individuals in the district are protected by ACA provisions that prevent insurance companies from spending more than 20% of their premiums on profits and administrative overhead.
  • Because of these protections, over 6,900 individuals in the district received approximately $240,000 in insurance company rebates.
  • Up to 42,000 children in the district with preexisting health conditions can no longer be denied coverage by health insurers.
  • 252,000 individuals in the district now have insurance that cannot place annual or lifetime limits on their coverage.

 

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California exchange rates up modest 4.2 Percent

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Flag_of_CaliforniaBy Pauline Bartolone, Capital Public Radio
AUGUST 1ST, 2014

Covered California says health care premiums will go up modestly for most people buying coverage on the state exchange next year by an average of 4.2 percent.

“We enrolled a lot of people, they’re healthy, and that’s kept rates down,” Covered California Executive Director Peter Lee said at a press conference on Thursday in Sacramento to announce the rates.

“We enrolled a lot of people, they’re healthy, and that’s kept rates down.”

About 1.4 million people purchased insurance on the marketplace in California for 2014, the first year Affordable Care Act insurance was available.

California is one of the states that created its own exchange, and it is an “active purchaser” under the law, which means it can negotiate with insurers directly on rates. Continue reading

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Unfavorable views of health law spike in July: poll

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ACA health reform logoBy Jordan Rau
KHN / AUGUST 1ST, 2014

The health law’s unpopularity among the public rose sharply in July with a surge of disapproval from people who had been agnostic about it in recent months, a poll released Friday shows. The law is as unpopular as it has been since it was enacted four years ago.

The poll from the Kaiser Family Foundation found that 53 percent of the public had an unfavorable view of the law in Julythe highest level since the law was passed in 2010.

Fewer than four in 10 people were aware that people getting insurance through the law had a choice among private plans.

It was up from 45 percent in June. (KHN is an editorially independent program of the foundation.)

The law’s unpopularity hit similar levels several times since passing, most recently in January when 50 percent of people disliked it.

Support for the law in July remained about the same as in June, with 37 percent supporting it. Continue reading

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Report sparks fight over future of doctor training programs

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doctors-300By Julie Rovner
KHN 

A high-level report recommending sweeping changes in how the government distributes $15 billion annually to subsidize the training of doctors has brought out the sharp scalpels of those who would be most immediately affected.

The reaction also raises questions about the sensitive politics involved in redistributing a large pot of money that now goes disproportionately to teaching hospitals in the Northeast U.S. All of the changes recommended would have to be made by Congress. Continue reading

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Ballet stretches her body’s limits, insurance brings peace of mind

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By Heidi de Marco
KHN Staff Writer

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Allynne Noelle has had two metatarsal stress fractures, a torn foot ligament, and two broken ribs. Yet, the 32-year-old ballerina considers herself pretty lucky.

Allynne Noelle 3 300Noelle says not to be fooled by the graceful movements on stage − ballet is a full-contact sport.

“As beautiful as the art form of ballet is, it’s extremely demanding on the body,” said Noelle, a principal dancer with the Los Angeles ballet. “It works every single muscle and fiber.”

The annual injury rates at ballet companies run between 67 and 95 percent.

The annual injury rates at ballet companies run between 67 and 95 percent, according to a study by the American Journal of Sports Medicine.  But ballerinas and their male counterparts often dance through the pain.

“You’re kind of raised with the idea that you’re stronger than any pain you feel,” said Noelle, who once danced with a 103-degree fever that led to her hospitalization with pneumonia. Continue reading

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Survey finds 1 In 5 uninsured don’t want coverage

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Dye with Yes, No and Maybe of the three visible sidesBy Phil Galewitz
KHN / JULY 29TH

Though millions of people gained health coverage this year as a result of the Affordable Care Act, millions more remain unaware of their options or have no interest in getting insured, a new survey has found.

Among those who were uninsured last year and remain uninsured, only 59 percent were familiar with the new Obamacare marketplaces and 38 percent were aware of federal subsidies to lower their insurance costs, according to the survey conducted in June by the nonpartisan Urban Institute.

20 percent say they don’t want health insurance or would rather pay the fine.

About 60 percent of respondents list cost as the main reason for not having insurance. But 20 percent say they don’t want health insurance or would rather pay the fine for not having coverage. Continue reading

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Panel recommends sweeping changes to doctor training system

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An expert panel recommended Tuesday completely overhauling the way government pays for the training of doctors, saying the current $15 billion system is failing to produce the medical workforce the nation needs.

“We recognize we are recommending substantial change,” said health economist and former Medicare Administrator Gail Wilensky, co-chairwoman of the nonpartisanInstitute of Medicine panel that produced the report. “We think it’s key to justifying the continued use of public funds.” Continue reading

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Medicare experiment could signal sea change for hospice

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Diane Meier 176By Michelle Andrews
KHN / JUL 29, 2014

Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses.

Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City.

We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited version of that conversation.

Q. There’s a lot of confusion about how hospice care differs from palliative care. Maybe we should start by clearing up what those terms mean. Continue reading

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Good News for Boomers: Medicare’s Hospital Trust Fund flush until 2030

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Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday.

That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act. Continue reading

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Limits of new health plans rankle some enrollees

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Jigsaw puzzle with one piece to add

Photo: Willi Heidelbach

This KHN story also ran in .

Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.

“They said, ‘We take the old plan, but not the new one,’” says Perez, an attorney in Palo Alto, California.

In Washington state, administrative rules announced this spring require insurers to provide enough primary care doctors so enrollees can get an appointment within 10 days and 30 miles of their home or workplace.

In Plymouth, Indiana, Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.

Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Continue reading

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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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