Category Archives: Healthcare Reform

Health law shows little effect in lowering children’s uninsured rate, study

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The uninsured rate for kids under age 18 hasn’t budged under the health law, according to a new study, even though they’re subject to the law’s requirement to have insurance just as their parents and older siblings are.

Many of those children are likely eligible for coverage under Medicaid or the Children’s Health Insurance Program.

The Urban Institute’s health reform monitoring survey analyzed data on approximately 2,500 children, comparing the uninsured rate in June 2014 with the previous year, before the health insurance marketplaces opened and the individual mandate took effect.

It found that rates remained statistically unchanged at just over 7 percent for both time periods.

Part of the explanation is that even before the health law passed, the uninsured rate for children was already quite low, says Genevieve Kenney, a senior fellow at the Urban Institute and the lead author of the study. Continue reading

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Can I buy coverage after accident injuries? And who pays the ‘Cadillac Plan’ tax?

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This week, I am answering questions from readers about whether people can wait until they get sick to buy health insurance and who’s allowed to buy plans on the state marketplaces, as well as a query about the tax on so-called Cadillac plans.

Q. Let’s say an uninsured person is in a car accident, has emergency surgery and is hospitalized, and after awaking from surgery asks to purchase insurance right away. Under the health law, would his medical costs be covered since he can’t be denied insurance because of a pre-existing medical condition? An article I saw said the hospital would even enroll people and pay their premiums. Is that correct?

A.

It’s unlikely . . .

It’s unlikely that this hypothetical person would be able to sign up for coverage after being injured, says Judith Solomon, a vice president for health policy at the Center on Budget and Policy Priorities. Continue reading

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Family premiums rise modestly for 3rd ear, survey finds

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Family premiums rose 3 percent in 2014, one of the lowest increases tracked since the Kaiser Family Foundation and the Health Research & Educational Trust began surveying employers in 1999. (Kaiser Health News is an editorially independent program of the foundation.)

Family premiums rose 3 percent in 2014, one of the lowest increases since 1999.

Nonetheless, the cost of the average family plan rose to $16,834 annually, according to the survey of more than 2,000 employers nationwide.

While both critics and supporters of the Affordable Care Act are likely to find fodder for their positions, the report portrays 2014 as a relatively stable year for employer coverage, with little change in the type of plans offered or their costs.

The percentage of firms offering health benefits (55 percent) and the percentage of workers covered at those firms (62 percent) were statistically unchanged from 2013, despite predictions of the law’s critics that many firms would drop coverage. Continue reading

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Consumers to hear soon if plans are canceled

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Consumers may soon find a surprise in their mailbox: a notice that their health plan is being canceled.

Last year, many consumers who thought their health plans would be canceled because they didn’t meet the standards of the health law got a reprieve.

.Following stinging criticism for appearing to renege on a promise that people who liked their existing plans could keep them, President Barack Obama backed off plans to require all individual and small group plans that had not been in place before the health law to meet new standards starting in 2014.

The administration initially announced a transitional policy that, with state approval, would allow insurers to renew plans that didn’t comply with coverage or cost standards starting in December 2013 and continue doing so until October 2014.

Then in March, the administration said it would extend the transitional policy for two more years, meaning that some people will be able to hang onto their non-compliant plans through 2017. Continue reading

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Early results: Average 2015 exchange premiums decline slightly

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Photo by Sanja Gjenero

Photo by Sanja Gjenero

By Jay Hancock
KHN

In preliminary but encouraging news for consumers and taxpayers, insurance filings show that average premiums will decline slightly next year in 16 major cities for a benchmark Obamacare plan.

Prices for a benchmark “silver” or mid-priced plan sold through the health law’s online marketplaces aren’t all moving in the same direction, however, a report from the Kaiser Family Foundationn (KFF) shows. (Kaiser Health News is an editorially independent program of the foundation.)

In Nashville, the premium will rise 8.7 percent, the largest increase in the study, while in Denver it will fall 15.6 percent, the largest decrease.

But overall the results, based on available filings, don’t show the double-digit percentage increases that some have anticipated for the second year of marketplace operation.

On average, rates will drop 0.8 percent in the areas studied. Continue reading

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DC Appeals Court to rehear case that could cripple health law

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A judge's wooden gavelBy Julie Rovner
KHN
SEPTEMBER 4TH, 2014

The controversial federal court decision that threatened the future of the Affordable Care Act is no more.

The full District of Columbia Court of Appeals Thursday agreed to rehear Halbig v. Burwell, a case charging that the federal government lacks the authority to provide consumers tax credits in health insurance exchanges not run by states.

A majority of judges on the full appeals court are Democratic appointees, including four appointed by President Barack Obama.

.The order agreeing to hear the case technically cancels the three-judge ruling from July that found for the plaintiffs.

That ruling, if upheld, could jeopardize the entire structure of the Affordable Care Act by making insurance unaffordable for millions of consumers in the 36 states where the federal government operates the exchange. Continue reading

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Health care spending forecast to increase modestly in next decade

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National health spending will increase modestly over the next decade, propelled in part by the gradual rebound of the U.S. economy and the growing ranks of Americans who became insured under the health law, government actuaries projected Wednesday.

But those growth rates are not as high as what the country saw for the two decades before the Great Recession crippled the U.S. economy at the end of 2007, according to the report from the Centers for Medicare & Medicaid Services Office of the Actuary and published in the journal Health Affairs.

The actuaries estimate that health spending grew just 3.6 percent in 2013, the fifth year of historically low rates of spending growth. But it will accelerate to 5.6 percent in 2014.

They also forecast that the average growth rate for 2015-2023 would be 6 percent. That is up just slightly from last year.

The findings also suggest that health care will outpace growth in the gross domestic product over the next decade.

Health care’s share of GDP, which has remained fairly stable since 2009, will rise from 17 percent in 2012 to more than 19 percent in 2023. Continue reading

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Enrolling people In Obamacare who have no ‘concept of insurance’

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Nagat Sahouba, a medical assistant for the Arab Community Center for Economic and Social Services, takes down a client's information for an appointment in the center's clinic in Dearborn, Mich. on Aug. 7, 2014 (Photo by Marissa Evans/KHN).

Nagat Sahouba, a medical assistant for the Arab Community Center for Economic and Social Services, takes down a client’s information for an appointment in the center’s clinic in Dearborn, Mich. (Photo by Marissa Evans/KHN).

By Marissa Evans
KHN Staff Writer

DEARBORN, Mich.–Signing people up for health insurance is the easy part of Rawha Abouarabi’s job ministering to immigrants and Arab Americans in this manufacturing hub along the Rouge River.

But many of those she’s enrolled are surprised and indignant when they go to the doctor and are asked to a pay a bill— perhaps a copayment.

They insist they’ve already paid their monthly insurance premium.

“They call us and say, ‘it’s a scam’,” says Abouarabi, an insurance navigator for the Arab Community Center for Economic & Social Services (ACCESS), a nonprofit agency that specializes in helping the largest Arab-American population in any U.S. city.

“This whole concept of insurance doesn’t exist in the Eastern world.”

That’s just one example of the confusion immigrants face as they try to navigate the U.S. health care system. Even after signing up for insurance through the Affordable Care Act, advocates find that explaining to clients that they will still have to pay out of their own pockets each time they go to the doctor or get lab tests requires more than translating words like “premium” and “deductible” for non-English speakers.

“This whole concept of insurance doesn’t exist in the Eastern world,” said Madiha Tariq, public health manager for ACCESS. “People are always confused about the health care system when they come to this country.” Continue reading

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More GOP-led states move towards expanding Medicaid

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ACA health reform logoBy Phil GalewitZ
KHN

Who’s next?

With the long-awaited deal to expand Medicaid finally struck last week between Pennsylvania and the Obama administration, 27 states and the District of Columbia have adopted a key coverage plank of the Affordable Care Act.

And the momentum continues to grow in Republican-led states as Tennessee and several others look to expand coverage to low-income residents in 2015.

Indiana has an expansion plan pending with the Centers for Medicare & Medicaid Services. Tennessee Gov. Bill Haslam, a Republican, said he plans to submit a plan later this year, although state Republican leaders warn it will be difficult to win legislative approval.

Obamacare proponents say the more states that expand Medicaid, the more pressure will be on reluctant state officials to come on board.

.Wyoming Gov. Matt Mead, also a Republican, said he will present an expansion plan to his legislature early next year. Continue reading

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Serving High-Need, High-Cost Patients – Commonwealth Fund video

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People with complex, long-term health care needs, and those living in poverty, often struggle the most to get their needs met. In this video, The Commonwealth Fund’s Melinda Abrams and Mark Zezza, along with Jennifer DeCubellis of Hennepin County Health in Minneapolis, talk about new models of care that can help health care providers improve the health and health care of their high-need patients, while also lowering costs. They also explain how focusing on these patients has the potential to improve care for all Americans.

To learn more visit The Commonwealth Fund’s website.

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Small Firms slow to embrace business exchanges

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Photo by Sanja Gjenero

Photo by Sanja Gjenero

By Christine Vestal
Stateline

Unhappy with the choices her insurance broker was offering, Denver publishing company owner Rebecca Askew went to Colorado’s small business health insurance exchange last fall.

She found exactly what she’d been hoping for: affordable insurance options tailored to the diverse needs of her 12 employees.

But Askew is in a tiny minority. Only 2 percent of all eligible businesses have checked out so-called SHOP (Small Business Health Options Program) exchanges in the 15 states where they have been available since last October under the Affordable Care Act. Even fewer purchased policies.

So far, 15 states, including Washington state, and the District Columbia have set up SHOPs.

In November, three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own.

SHOP exchanges were supposed to open nationwide on Oct. 1, the same day as exchanges offering health insurance for individuals.

But the Obama administration postponed the SHOP launch, citing the need to fix serious technical problems with the exchanges for individuals, which it said were a higher priority. Continue reading

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If you got your health care subsidies mistakenly, you may owe Uncle Sam

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Consumers getting government subsidies for health insurance who are later found ineligible for those payments will owe the government, but not necessarily the full amount, according to the Treasury Department.

The clarified rule could affect some of the 300,000 people facing a Sept. 5 deadline to submit additional documents to confirm their citizenship or immigration status, and also apply broadly to anyone ultimately deemed ineligible for subsidies.

If found ineligible, residents could owe thousands of dollars.

First reported by the newsletterInside Health Policy on Thursday, the clarification worries immigration advocates, who say many residents are facing website difficulties and other barriers to meeting the deadline to submit additional details.

Those who don’t know about the deadline, or can’t meet it because of glitches, could be deemed ineligible for subsidies and lose their coverage. Continue reading

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Understanding high US health care costs – Commonwealth Fund

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One of every six dollars spent in the U.S. goes to health care, but the country is not seeing a commensurate return on its investment.

In this video, David Squires and Cathy Schoen of The Commonwealth Fund consider ways the U.S. health system could manage costs while making room for other priorities such as infrastructure and education.

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Beware higher charges if you go to an out-of-network ER

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Sign for an emergency room.By Michelle Andrews
KHN

When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you.

That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care.

Beware, you could be left on the hook for substantially higher charges than you might expect.

The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network.  (Plans that are grandfathered under the law don’t have to abide by these provisions.)

That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect. Continue reading

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State exchange doubles the number health plan options to be offered this fall

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From the Washington Healthplanfinder

Washington MapThe Washington Health Benefit Exchange Board today certified 10 health insurance carriers at to offer 82 Qualified Health Plans (QHPs) for individuals and families through the state’s health insurance exchange, the Washington Healthplanfinder.

Last year, eight health insurers were approved to sell 46 plans through Washington Healthplanfinder.i

The small business market, Washington Healthplanfinder Business, will be available statewide for the first time this year with 23 different health plans.

Additionally, five insurance carriers will offer six pediatric Qualified Dental Plans (QDPs).

The open enrollment period, which runs from Nov. 15, 2014 to Feb. 15, 2015, will provider coverage starting Jan. 1, 2015.

“We’re thrilled to see the number of available health plan options has doubled in one short year,” said Richard Onizuka, Chief Executive Officer for Washington Healthplanfinder.

“Not only will these additional coverage options increase consumer choice, they will also foster competition among our participating health insurance companies,” Onizuka said. Continue reading

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