Category Archives: Healthcare Reform

Some seeking insurance told they didn’t qualify, others balked at cost, poll finds

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By Jordan Rau
KHN

Nearly half of Americans lacking health insurance during the first year of the health law’s marketplaces appeared to be eligible for government assistance, but two-thirds of them said they found the health plans too expensive or were told they didn’t qualify, according to a survey released Thursday.

“Lack of awareness of new coverage options and financial assistance appear to be a major barrier.”

Far fewer cited reasons often mentioned in political circles: a philosophical opposition to the 2010 health law or sign-up difficulties cause by the early technical problems experienced by the government’s healthcare.gov enrollment website, according to the Kaiser Family Foundation survey of 10,502 non-elderly adults. (KHN is an editorially independent program of the foundation.)

“Lack of awareness of new coverage options and financial assistance appear to be a major barrier,” the report said.Screen Shot 2015-01-29 at 8.41.07 AM

About 30 million Americans lack health insurance. Some of them are not eligible for financial assistance, either because they are not in the country legally or because their incomes are too high. Others live in a state that has not opted for a health law provision to expand Medicaid, the state-federal health program for the poor, to cover people earning up to 138 percent of the federal poverty level, which is $32,913 for a family of four.

Those people in the so-called “coverage gap” —about 4 million — don’t qualify for their states’ existing Medicaid program and don’t earn enough to qualify for the other financial assistance created in the 2010 health law. (As of this week, 22 states have not expanded their programs.)

The survey found that nearly six out of 10 uninsured people who appeared eligible for coverage through the health law did not attempt to get it last year. Cost was the main reason cited by more than half the people who seemed eligible for coverage but who remained uninsured. Continue reading

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If Supreme Court rules against insurance subsidies, most want them restored

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U.S. Supreme CourtBy Julie Rovner
KHN

A new poll finds that most people think Congress or states should act to restore health insurance subsidies if the Supreme Court decides later this year they are not permitted in states where the federal government is running the marketplace.

The court in March is set to hear King v. Burwell, a lawsuit arguing that the wording of the Affordable Care Act means that financial assistance with premiums is available only in the 13 states that created and are running their own online insurance exchanges.

If the court were to invalidate subsidies in the federally run states, 64 % said Congress should restore them, and 59% said states should create their own exchanges.

If the court sides with those challenging the law, millions of people in the 37 states that use the federal Healthcare.gov site would lose the help they have been getting. A decision in the case is expected in late June.

Less than half the respondents in the monthly tracking poll by the Kaiser Family Foundation said they had heard about the case. (Kaiser Health News is an editorially independent project of the foundation.)

But if the court were to invalidate subsidies in the federally run states, 64 percent said Congress should restore them, and 59 percent said states should create their own exchanges. Continue reading

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More states lean toward Medicaid expansion

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Indiana state flagBy Christine Vestal
Stateline

The federal government yesterday approved Indiana’s plan to expand Medicaid under the Affordable Care Act, increasing the number of expansion states to 28, plus the District of Columbia.

With enrollment starting Feb. 1, Indiana’s plan could add an estimated 350,000 low-income adults to the nearly 5 million expected to enroll in the 27 states that expanded Medicaid last year.

In accepting Indiana’s plan, the Obama administration demonstrated its determination to increase the number of expansion states, even if it means waiving traditional Medicaid rules.

For example, under Indiana’s plan, people with incomes above the federal poverty level ($11,670 for an individual) must contribute to a health savings account or be locked out of coverage for six months.

The penalty for not paying into a health savings account, which has never before been approved by the U.S. Department of Health and Human Services, reflects an important GOP health care tenet: People who receive Medicaid benefits should take personal responsibility for their care. Republican Gov. Mike Pence called his plan “the first-ever consumer-driven health care plan for a low-income population.”

FamiliesUSA

FamiliesUSA

Judith Solomon, health policy director at the Center on Budget and Policy Priorities, which advocates for low-income people, noted that Indiana’s plan is derived from a successful demonstration project that has been in effect since 2007, so its green light doesn’t necessarily apply to other states.

Under the Medicaid expansion that is part of the Affordable Care Act (ACA), the federal government pays the full price for covering newly eligible adults with incomes up to 138 percent of the federal poverty level ($16,105) through 2016 and then gradually lowers its share to 90 percent in 2020 and beyond. Continue reading

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Many African-Americans fall into a health ‘coverage gap’

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By Teresa Wiltz
Stateline

Thanks to the Affordable Care Act, the percentage of people of color who do not have health insurance is projected to fall dramatically by 2016, greatly narrowing the historic disparities in coverage between whites and nonwhites.

Many low-income African-Americans are caught in a “coverage gap”: They make too much to qualify for Medicaid, but not enough to qualify for subsidized insurance an exchanges.

But one minority group is likely to benefit less than others: African-Americans.

Fifty-five percent of all African-Americans reside in the 23 states that have not expanded Medicaid eligibility under the ACA. By comparison, 42 percent of whites, 38 percent of Latinos and 23 percent of Asians live in nonexpansion states, according to the Urban Institute.

In those nonexpansion states, a disproportionate number of blacks don’t qualify for the narrower Medicaid program in place now. Medicaid typically covers pregnant women, young children, and disabled and elderly adults.

Relatively few able-bodied adults with children qualify in those states, and only at incomes well below the federal poverty level. (Childless adults do not qualify.)

FamiliesUSA

FamiliesUSA

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Obamacare cost to be 20% less than forecast, budget office says – LA Times

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Twenty-dollar bill in a pill bottlePresident Obama’s healthcare law will cost about 20% less over the next decade than originally projected, the Congressional Budget Office reported Monday, in part because lower-than-expected healthcare inflation has led to smaller premiums.

So far, the number of uninsured Americans has dropped by about 12 million. By the end of 2016, 24 million fewer Americans will lack insurance, the nonpartisan budget office forecast.

Excluding immigrants in the country illegally, who are not eligible for coverage under the law, only about 8% of Americans under age 65 will lack insurance by the time Obama leaves office, the budget office’s latest report on the law estimates.

via Obamacare cost to be 20% less than forecast, budget office says – LA Times.

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Adminstration to quicken pace towards quality-based Medicare payments

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cms-logo-200pxBy Jordan Rau
KHN

HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments

The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

The announcement by Health and Human Services Secretary Sylvia Burwell is intended to spur efforts to supplant Medicare’s traditional fee-for-service medicine, in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares.

Within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

Since the passage of the federal health law in 2010, the administration has been designing new programs and underwriting experiments to come up with alternate payment models.

Last year, 20 percent of traditional Medicare spending, about $72 billion, went to models such as accountable care organizations, or ACOs, where doctors and others band together to care for patients with the promise of getting a piece of any savings they bring to Medicare, administration officials said.

There are now 424 ACOs, and 105 hospitals and other health care groups that accept bundled payments, where Medicare gives them a fixed sum for each patient, which is supposed to cover not only their initial treatment for a specific ailment but also all the follow-up care.

Other Medicare-funded pilot projects give doctors extra money to coordinate patient care among specialists and seek to get Medicare to work more in harmony with Medicaid, the state-federal health insurer for low-income people.

Burwell’s targets are for 30 percent, or about $113 billion, of Medicare’s traditional spending to go to these kind of endeavors by the end of President Barack Obama’s term in 2016, and 50 percent — about $215 billion — to be spent by the end of 2018. Continue reading

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Uninsured? Beware of the health law’s tax penalty

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The penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent.

By April Dembosky, KQED and Jeff Cohen, WNPR

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is.

“This year taxes and health care intersect in a brand new way. ‘

IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form.

Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

cohen hr block 570

An H&R Block office in Hartford, Conn., is decorated with cardboard cutouts from a national ad campaign on the health law’s tax implications. (Photo by Jeff Cohen/WNPR)

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be much more complex for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges.

To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.” Continue reading

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Texas prisons try telemedicine to curb spending | Dallas Morning News

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200px-Flag-map_of_TexasThe high-tech medical consultation, known as telemedicine, uses technology to connect prisoners, who are often housed in remote areas, with medical experts throughout the state.

It’s just one way that the Texas Department of Criminal Justice is trying to control spending on prison health care. But while telemedicine has shown some success in curbing spending, it hasn’t been enough to stem rising costs due to an aging prison population.

via Texas prisons try telemedicine to curb spending | Dallas Morning News.

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States continue war over Obamacare | Center for Public Integrity

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Center for public integrity logoIn Washington, there’s been little consensus on modifying the health reform law—short of repeated votes in the House to kill or cripple it.

That might change as Republicans take control of the House and Senate, though what fixes, if any, Congress might prescribe—and whether any can get a signature from the President— aren’t clear.

But in state capitals around the country, from Albany and Columbia to Austin and Sacramento, lawmakers have been mulling over hundreds of proposals that reflect a myriad of starkly different views on Obamacare as settled law.

via States continue war over Obamacare | Center for Public Integrity.

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Renewing customers urged to take immediate action to continue 2015 coverage

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Washington Healthplanfinder Urges Renewing Customers to Take Immediate Action to Continue 2015 Health Coverage

Thousands of Customers Have Not Yet Taken Action; Next Deadline to Enroll is Jan. 23

 The Washington Health Benefit Exchange is urging 2014 customers who have not yet renewed their coverage for 2015 to return as soon as possible to continue their health plan this year.

“There is still time to come back and get enrolled, but time is running out.”

Customers who were unable to renew by the Dec. 23 deadline or were unaware of additional action needed on their account may be eligible for a special 60-day enrollment opportunity. These customers should fill out an online form to initiate eligibility for retroactive coverage that begins on Jan. 1.

Up to 4,000 customers have completed an application for 2015 coverage but did not submit payment by the Dec. 23 deadline for coverage that began on Jan. 1. 

These applications will be reviewed by Exchange staff to ensure that eligible individuals are able to receive retroactive coverage.

“There is still time to come back and get enrolled, but time is running out,” said Richard Onizuka, CEO for the Washington Health Benefit Exchange. “Customers should contact us as soon as possible if they need assistance with their application.” Continue reading

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High court considers if providers can sue states for higher Medicaid pay

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Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

By Phil Galewitz
KHN

The U.S. Supreme Court heard arguments Tuesday in a case that could block hospitals, doctors — or anyone else — from suing states over inadequate payment rates for providers who participate in the Medicaid program for low-income Americans.

Many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

Federal law requires Medicaid, which covers 70 million people, to provide the same access to care as that given to people with private insurance. But many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

In Armstrong vs. Exceptional Child Center, several providers for developmentally disabled Medicaid patients sued the state of Idaho after officials failed to increase Medicaid payments as required under a formula approved by the federal government.

An appellate court upheld a judgment in favor of the providers last year, noting that Idaho had conceded that it held rates flat since 2006 for “purely budgetary reasons.”

The issue before the high court is whether the U.S. Constitution gives providers the right to sue the state to increase their pay. And the court appeared split on that issue based on their remarks Tuesday. Continue reading

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Sen. Hatch vows to dismantle health law but predicts bipartisan success on other issues

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Screen Shot 2015-01-20 at 2.54.48 PMBy Mary Agnes Carey
KHN

While Republicans cannot expect a full repeal of the health law while President Barack Obama remains in office, the GOP intends to “strike away at it, piece by piece,” Senate Finance Committee Chairman Orrin Hatch, R-Utah, said Tuesday.

But in a speech at the U.S. Chamber of Commerce, Hatch also said he expected that Republican and Democratic lawmakers would work together on several other key pieces of health legislation.

Hatch said there may be more bipartisanship in some “must pass items,” including continued funding for the Children’s Health Insurance Program and overhauling the way Medicare pays physicians, known as the “sustainable growth rate.”

On CHIP, Hatch said the Finance Committee has “heard from a number of governors from red states and blue stakes alike that they want to see this program extended. It has been a marvelous program. It has worked very, very well. I’m optimistic that we can work on a bipartisan, bicameral basis to extend CHIP in a responsible way.” Continue reading

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Obama expected to defend health law in State of the Union address

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President Obama will deliver his State of the Union address tonight at 9 p.m. ET.

To watch online go to: WhiteHouse.gov/SOTU.

The site will include interactive features that make clear what the President’s proposals mean for you, and shareable charts and stats that help supplement and expand on the points you’ll hear Obama make. If you’re watching on your TV, you can still follow along on your phone or tablet.

Watch Tonight

 

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Once, same-sex couples couldn’t wed; Now, some employers say they must

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EqualBy Julie Appleby
KHN

Until recently, same-sex couples could not legally marry. Now, some are finding they must wed if they want to keep their partner’s job-based health insurance and other benefits.

With same-sex marriage now legal in 35 states and the District of Columbia, some employers that formerly covered domestic partners say they will require marriage licenses for workers who want those perks.

“We’re bringing our benefits in line, making them consistent with what we do for everyone else.”

“We’re bringing our benefits in line, making them consistent with what we do for everyone else,” said Ray McConville, a spokesman for Verizon, which notified non-union employees in July that domestic partners in states where same-sex marriage is legal must wed if they want to qualify for such benefits.

Employers making the changes say that since couples now have the legal right to marry, they no longer need to provide an alternative. Such rule changes could also apply to opposite-sex partners covered under domestic partner arrangements.

“The biggest question is: Will companies get rid of benefit programs for unmarried partners?” said Todd Solomon, a partner at McDermott Will & Emery in Chicago. Continue reading

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