Category Archives: Healthcare Reform

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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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

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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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Senate Democrats fight to reverse Supreme Court, state abortion restrictions

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Most of the momentum in fights over birth control and abortion has been in the direction of opponents of late. But you wouldn’t know that by watching the U.S. Senate.

Democrats who control the chamber have scheduled a vote for Wednesday on a bill that would effectively reverse the Supreme Court’s Hobby Lobby ruling regarding contraceptive requirements in the Affordable Care Act.

And on Tuesday the Judiciary Committee heard testimony on a separate, sweeping measure that would invalidate many state abortion restrictions. Continue reading

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Readers’ questions about contraceptive coverage and Medicare enrollment

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Q. How will my health insurance change now that the Supreme Court has ruled that some employers that have religious objections to contraceptives don’t have to provide birth control coverage?

A. Although the recent decision in Burwell v. Hobby Lobby Stores allows a “closely held” company to decline to cover contraception, the health law requirement that most plans provide such coverage without cost to consumers remains in effect and will continue to apply to women in most plans, say experts. Continue reading

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New respect for primary care docs?

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Blue doctorBy Jay Hancock
KHN Staff Writer
This KHN story also ran in wapo.

BALTIMORE — A few years ago it struck the D.C. region’s biggest medical insurer that the doctors who saw its members most often and knew them best got the smallest piece of the healthcare dollar.

By paying primary care doctors to cut specialist and hospital revenue, CareFirst is helping to alter the medical spoils system.

CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients.

Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy.

The company’s move to shift that balance tells a lesser-known story of the Affordable Care Act and efforts to change the health system. Continue reading

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Narrow networks bring down premiums in Chattanooga

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Chattanooga,_Tennessee_Skyline

Photo by Emilio Craddock – Creative Commons license

This KHN story also ran in .

CHATTANOOGA, Tenn. — Angela Allen’s struggle to ease her neck pain has been a huge pain in the neck.

Her regular spine doctor does not accept the new insurance she bought through the federal health marketplace.

Allen, who has two slipped disks in her neck vertebrae, said the closest specialist she found who would see her and take her insurance works 34 miles away in another county.

She belatedly learned that her physical therapist also is out of network and she owes $900. “It’s been a nightmare,” said Allen, a 42-year-old office manager.

Yet these restrictions carry an enviable price tag. At $187 a month, Allen’s policy is cheaper than almost any other midlevel, or silver, plan in the nation. Continue reading

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Some plans skew drug benefits to drive away patients, advocates warn

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The insurers say they’re in compliance with the law.

Four Florida insurers allegedly discriminate against people with HIV/AIDS by structuring their prescription drug benefits so that patients are discouraged from enrolling, according to a recent complaint filed with federal officials. Continue reading

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Did the Supreme Court tip its hand on contraception cases yet to come?

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The Supreme Court’s opinion Monday holding that some for-profit firms do not have to provide women the contraceptive coverage required under the Affordable Care Act if they have religious objections addressed only half of the ongoing legal battle over the birth control mandate.

But those on both sides of the issue think the court’s majority may have telegraphed which way it could rule when one of those other cases reaches the justices. Continue reading

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Washington Healthplanfinder announces special enrollment opportunity for same-sex marriages

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Gay_pride_flag.Washington state’s health insurance exchange, Washington Healthplanfinder, will offer a special enrollment period for Washington residents whose same-sex domestic partnerships were recently converted to marriages.

The conversion is considered a “qualifying life event” that triggers a special enrollment period under the Affordable Care Act.

Residents whose same-sex domestic partnership has been converted to marriage on June 30 should take the following steps by Aug. 28 to apply for a special enrollment:

  • Complete an application on wahealthplanfinder.org
  • If you are eligible for a Qualified Health Plan, you will be prompted to complete a special enrollment questionnaire
  • Answer “yes” to the question about recently getting married

Here are the details:

Continue reading

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Proposal to add skimpier ‘Copper’ plans to exchanges raises concerns

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US_PennyBy Michelle Andrews
KHN

If you offer it, will they come? Insurers and some U.S. senators have proposed offering cheaper, skimpier “copper” plans on the health insurance marketplaces to encourage uninsured stragglers to buy.

But consumer advocates and some policy experts say that focusing on reducing costs on the front end exposes consumers to unacceptably high out-of-pocket costs if they get sick. The trade-off, they say, may not be worth it.

“It’s a false promise of affordability,” says Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms. “If you ever have to use the plan, you won’t be able to afford it.” Continue reading

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