Category Archives: Healthcare Reform

More GOP-led states move towards expanding Medicaid

Share

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

Share

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

Share

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.

Share

Small Firms slow to embrace business exchanges

Share
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

Share

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

Share

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

Share

Understanding high US health care costs – Commonwealth Fund

Share

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.

Share

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

Share

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

Share

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

Share

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

Share

Turning 65? Know your Medicare options – Guest column

Share

Center for Medicare & Medicaid ServicesMedicare tips from Oraida Roman, president of Senior Products for Humana’s Intermountain Region

Approximately 11,000 adults become eligible for Medicare every day, reflecting a dramatically increasing senior population, and that number is only going to grow.

The U.S. Census Bureau predicts there will be nearly 47 million seniors age 65 and up in 2015 and about 72.1 million seniors – nearly 20 percent of the population – by 2030.,

Here in Washington, the 65 and older population is expected to increase from 13.9 percent of the overall population in 2015 to 18.1 percent of the overall population by 2030.

Health concerns are a major issue for seniors, with nine of 10 older adults living with at least one chronic condition, such as diabetes, arthritis, hypertension or lung disease, according to the National Council on Aging.

Making matters worse, these conditions place a significant financial burden on seniors and, sometimes, their caregivers. As a result, there’s a clear need for access to affordable health care that meets the needs of individuals as they age.

As Seattle residents approach their 65th birthday, it is important for them to know their Medicare options, including when they can enroll and the types of health plans available. Continue reading

Share

Special exchange enrollment period for those with signup or billing problems begins today

Share

Coverage is hereA temporary special enrollment period begins today for those consumers who have experienced difficulties with enrollment in health plans on the Washington Healthplanfinder.

Insurance Commissioner Mike Kreidler authorized the special enrollment period this week as another option to those who feel they might need more help.

This voluntary special enrollment period starts Aug. 27 and runs through Nov. 14, 2014.

Only people who attest to having enrollment, billing, or payment issues with an Exchange plan may change plans during this time.

If you’re considering this option, you should be aware of all of the details involved, including the fact that you could lose a current premium subsidy.

Special enrollment may not be the best choice for everyone. But as the commissioner notes, “Hopefully, it will bring relief to some.”

 A list of answers to questions about this temporary special enrollment is available on the exchange’s website

Share

90 health plans OK’d for next year’s Exchange; Rates to rise a record low of 1.9%

Share

ACA health reform logoThe Washington State Office of the Insurance Commissioner (OIC) has approved 10 health insurers to sell 90 individual health plans inside Washington’s Exchange, Washington Healthplanfinder next year.

The overall approved average rate change is just 1.9 percent, significantly lower than the Exchange insurers’ original request of 8.6 percent, the OIC said.

Also, Kaiser Health Plan of the Northwest (Kaiser) and Moda Health Plan, Inc. (Moda) have been approved to sell 23 health plans inside the Washington Healthplanfinder Business, formerly known as SHOP.

Kaiser enrollees will receive an average rate decrease of 3.7 percent and Moda is new to the market and will be available statewide. Kaiser is available only in Clark and Cowlitz counties.

The Washington’s Health Benefit Exchange Board is scheduled to certify the approved insurers and their plans at its Aug. 28 board meeting. Continue reading

Share

Federal officials order Medicaid to cover autism services

Share
Jigsaw puzzle with one piece to add

Photo: Willi Heidelbach

When Yuri Maldonado’s 6-year-old son was diagnosed with autism four years ago, she learned that getting him the therapy he needed from California’s Medicaid plan for low-income children was going to be tough.

Medi-Cal, as California’s plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states which offer no autism coverage.

But Maldonado’s son was approved for 30 hours a week of applied behavioral analysis (ABA), a type of behavior modification therapy that has been shown to be effective with autistic children, and she was worried that wasn’t enough.

So she and her husband, neither of whose jobs offered health insurance, bought an individual private policy for their son, with a $900 monthly price tag, to get him more of the comprehensive therapy.

“I don’t know any family that can really afford that,” says Maldonado. “We made some sacrifices.”

That should be changing soon. In July, the Centers for Medicare & Medicaid Services announced that comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program plans, another federal-state program that provide health coverage to lower-income children. Continue reading

Share

Special enrollment period for those having trouble signing up or with billing on health insurance exchange

Share

MKreidlerPhotoFrom the Office of the Insurance Commissioner

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler announced a limited special enrollment period – effective Aug. 27 – for people who have experienced difficulty enrolling in health coverage through Washington’s Exchange, Washington Healthplanfinder, or who have had billing or payment issues.

The special enrollment period starts Aug. 27 and is scheduled to run through Nov. 14, 2014.

Anyone who has been unable to get or keep coverage in a plan through the Exchange because of an error in their enrollment, bill, or premium payment is eligible.

Only people who attest to having enrollment, billing, or payment issues with an Exchange plan may change plans during this time.

General open enrollment for 2015 individual and family coverage starts Nov. 15, 2014 and ends Feb. 15, 2015. Continue reading

Share

New birth control rules appear to track Supreme Court suggestion

Share

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.

Those who favor women being guaranteed no-cost birth control coverage under their health insurance say the new rules for nonprofit religious organizations issued by the Obama administration simply put into force what the Supreme Court suggested last month.

“We interpret what  [the administration] did to be putting into effect that order,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center. She’s referring to the controversial Supreme Court order in a lower court case involving Wheaton College, a Christian school in Illinois.

The unsigned order agreed to by six of the nine justices said Wheaton College need not fill out and send to its insurance company a form opting out of offering the coverage. Instead, it could merely inform the government of its objections.

The new rules unveiled Friday require those with religious objections to providing some or all FDA-approved contraceptives to do exactly that – notify the government rather than their insurance carriers that they cannot provide the coverage. Continue reading

Share

Obamacare still ‘red meat’ for GOP candidates but focus of attacks shift

Share

JUPITER, Fla. – Beverly Hires, a former nurse running for Congress here in one of the nation’s rare competitive House races, ticks off her problems with the federal health care law: higher premiums, cancelled policies and employers cutting full-time jobs.

“The Affordable Care Act is not making insurance more affordable,” she said in an interview, citing many of the same criticisms as her five GOP opponents in the Aug. 26 primary, who are vying for the chance to oust first-term Democrat Rep. Patrick Murphy.

Hires’ messaging on Obamacare in this South Florida district targeted by the GOP tracks a pattern around the country as Republican candidates follow a focus-group tested script recommended by pollsters.

“The messages that work best are succinct, clear statements about the effects of Obamacare on consumers directly,” by increasing costs, taxes and taking away jobs, said Whit Ayres, president of North Star Opinion Research, a Republican polling group that’s surveyed likely voters to determine the best way to attack Obamacare. Continue reading

Share

Californians favor tougher rules on health insurance rates, survey

Share

California voters are showing strong early support for a ballot initiative that would expand the state’s authority to regulate health insurance rates.

Nearly 7 of every 10 respondents indicated that they would vote in favor of Proposition 45, while 16 percent would vote against it, according to an independent poll released Wednesday by the Field Research Corp. in San Francisco.

Proposition 45 would give California’s insurance commissioner the power to veto health insurance rate increases.

Proposition 45 would give California’s insurance commissioner the power to veto health insurance rate increases. Continue reading

Share