Category Archives: Healthcare Reform

Qs: Who is responsible for an adult child’s coverage? Must insurers notify smokers of ways to lower premiums?

Share

Question markBy Michelle Andrews

Q. Do we have to carry our 24-year-old daughter on our health insurance policy? She is employed and has two degrees. We informed her that we would be dropping her at the end of the year because it’s costing us a fortune, and she told us today that we are required by law to cover her. We do not claim her on our taxes. Continue reading

Share

Washington enrolls more than 285,000 in Medicaid. Now how to provide the care?

Share

Washington Map
Lisa Stiffler, The Seattle Times
APR 18, 201

This story was produced in partnership with 

Washington state has blown past its targets for signing up new Medicaid participants under the Affordable Care Act (ACA).

The program’s ranks have grown roughly 25 percent in the past six months, helping fulfill one of the act’s key goals to provide health care to nearly all Americans.

By the end of March, more than 285,000 adults who are newly eligible to participate in Medicaid had signed up for coverage.

That’s twice the number officials had hoped to reach by then, and a target they hadn’t expected to hit for three more years.

But with enrollment success comes the challenge of serving more people in a $10 billion program that’s already stretched thin in places. Continue reading

Share

Obama sharply criticizes Republicans as he announces 8 million have enrolled

Share

Enrollment in private health insurance on federal and state marketplaces has surged in recent weeks and now totals 8 million, a feisty President Barack Obama said Thursday.

“This thing is working,” Obama said at a White House news conference in which he lambasted Republican critics of the health law, especially those in states that did not expand Medicaid eligibility, as the law allows.

“I’m sorry. I’m going to say one last thing about this — just because this — this does frustrate me, states that have chosen not to expand Medicaid for no other reason than political spite,” Obama said. “You got 5 million people who could be having health insurance right now, at no cost to these states — zero cost to these states – [yet] other than ideological reasons, they have chosen not to provide health insurance for their citizens.” Continue reading

Share

Obama announces 8 million have enrolled in Marketplace plans

Share

In a White House news conference Thursday, President Barack Obama announced that 8 million people have enrolled in health plans through the health insurance exchanges created by the Affordable Care Act and that 35 percent of people who enrolled on the federally run healthcare.gov marketplace are under age 35.

A transcript follows. Continue reading

Share

Nearly 350,000 in Washington have enrolled in private plans since Oct. 1

Share

ACA health reform logoSince October 1, when the open enrollment began under the Affordable Care Act, 324,900 people in Washington state have signed up for private insurance, according to updated enrollment information reported by health insurers to the Office of the Insurance Commissioner this week.

This number includes 178,981 enrolled outside the Exchange and 146,000 enrolled inside the Exchange, Washington Healthplanfinder, as of March 31. The total is expected to increase as late enrollments through the Exchange are processed and reconciled.  Continue reading

Share

Health law’s free contraceptive coverage saved US women $483 million in 2013

Share

Twenty-dollar bill in a pill bottleThe Affordable Care Act provision that requires insurers to cover contraceptives with zero co-pay saved US women $483 million last year — $269 on average, according to a new report from the IMS Institute for Healthcare Informatics.

Overall, 24 million more prescriptions for oral contraceptives were filled in 2013, the first full year the health law’s contraceptive provision was in force, compared to 2012.

“The share of women with no out-of-pocket cost for these forms of birth control increased to 56% from 14% one year ago,” the report says.

To learn more read: 

IMS Institute for Healthcare Informatics. Medicine use and the shifting costs of healthcare: A review of the use of medicines in the United States in 2013. April 2014. LINK:

Share

FAQ on ACOs: Accountable Care Organizations, explained

Share

Accountable care organizations are practically a footnote in the health law, but advocates say they’ll be critical to holding down the cost of care while improving quality

By Jenny Gold
KHN Staff Writer
APR 16, 2014

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

A doctor walking through a mazeThe law takes a carrot-and-stick approach by encouraging the formation of Accountable Care Organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy. About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up.

An estimated 14 percent of the U.S. population is now being served by an ACO. You may even be in one and not know it.

While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town.  

ACOs have become one of the most talked about new ideas in Obamacare. Here are answers to some of the more common questions about how they work:  Continue reading

Share

Patients often win if they appeal a denied health claim

Share

The health law set national rules for appealing a denied claim, and advocates say consumers should take advantage of them

rejected

Image: sundesigns

By Pauline Bartolone, Capital Public Radio

APR 14, 2014

This KHN story was produced in collaboration with NPR

SACRAMENTO, Calif. — Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.

To help make sure a patient’s claims aren’t improperly denied, the Affordable Care Act creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer.

For Tony Simek, a software engineer in El Mirage, Ariz., appealing was the only way he was able to get additional treatment for sleep apnea.  Continue reading

Share

Focus one exchange enrollment overlooks millions who bought private insurance

Share

ACA health reform logoBy Annie Feidt, APRN

Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is exceedingly complicated.

The Obama administration is tracking the number of plans purchased on the federal website healthcare.gov and on the state marketplaces, and this month reported that It had exceeded expectations by signing up 7.5 million people. In addition, federal officials have said that 3 million people have enrolled in Medicaid since October.

But often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers — and that number could be substantial. Continue reading

Share

Q: Do I face a penalty if my kids’ CHIP coverage starts in April?

Share

Cute Baby Boy Isolated on WhiteBy Michelle Andrews

Q. I understand that I won’t have to pay a penalty for not having insurance because I signed up for coverage before the end of open enrollment.

But what about my kids? Their CHIP coverage didn’t start until April.  Continue reading

Share

State exchange directors offer enrollment snapshots

Share

 Washington MapRichard K. Onizuka from the Washington Health Benefit Exchange reports that 136,497 of Washington state’s 146,000 new enrollees have already paid their premiums. Almost twice as many people, 268,000, gained Medicaid coverage, he added, and 8,000 people signed up on March 31.

 

By Lisa Gillespie
APRIL 11TH, 2014,

The Obama administration is touting the success of the health law’s open enrollment, which signed up  at least 7.5 million Americans for health coverage through the online insurance marketplaces.

But the experience varied according to states and Families USA brought together five state exchange directors Thursday to talk about what they’ve seen so far. These states – Kentucky, New York, Washington, California and Connecticut — all had functioning exchanges and pursued that health law’s Medicaid expansion.  Continue reading

Share

Sebelius Resigns; Obama To Name OMB Chief Burwell To Head HHS

Share
Sec. Kathleen Sebelius

Secretary Kathleen Sebelius

By Mary Agnes Carey
KHN Staff Writer
April 10, 2014

After a five-year tenure that included the flawed rollout of the health care law and stormy relations with Capitol Hill Republicans, Department of Health and Human Services Secretary Kathleen Sebelius is resigning, a White House official said late Thursday.

President Barack Obama plans to nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to replace Sebelius, the official said.  Continue reading

Share

Medicare records provide tantalizing details of payments to doctors

Share

doctor money examine 300By Jordan Rau
KHN Staff Writer
April 9, 2014

Medicare’s release Wednesday of millions of records of payments made to the nation’s doctors comes as the government is looking to find more cost-efficient ways to pay physicians, particularly specialists.

The federal government published data tracing the $77 billion that Medicare paid to physicians, drug testing companies and other medical practitioners throughout 2012, and what services they were being reimbursed for.

The data cover 888,000 different practitioners. More than 6,000 procedures are included, and the full database is so large that it requires statistical software to analyze it.

While the database provides tantalizing details, showing for instance the huge amount ophthalmologists are paid to treat a common eye disorder, experts cautioned that the data can be easily misunderstood and could lead to some doctors’ incomes being unfairly pilloried.  Continue reading

Share

Primary care Shortage? Not for the insured, study finds

Share

stethoscope doctor's bag chest x-rayBy Elana Gordon, WHYY
April 9, 2014

Researchers posing as nonelderly adult patients made nearly 13,000 calls to primary care practices across Pennsylvania, New Jersey and eight other states between fall 2012 and spring of last year.

What they found may provide some comfort amid growing concerns of doctor shortages, especially as more people gain coverage through the Affordable Care Act, potentially straining the health system.  Continue reading

Share

Tried to sign up but couldn’t finish by the deadline?

Share

Washington Healthplanfinder outlines steps you need to take to qualify for special enrollment

From Washington Healthplanfinder:

Coverage is hereWith the deadline to enroll in a Qualified Health Plan through wahealthplanfinder.org now passed, Washington Healthplanfinder is reaching out to residents who couldn’t complete their application by March 31 with important guidance to qualify for a special enrollment.

Washingtonians who were prevented from submitting their application by the deadline should complete these steps as soon as possible to qualify for coverage that begins May 1, 2014. Continue reading

Share