Category Archives: Healthcare Reform

Health care wait times vary greatly across the US

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Sign for an emergency room.Whether you get in to see a doctor on the same day you call for an appointment or have to wait months depends in large part on where you live, according to a new report by the Institute of Medicine.

“Everyone would like to hear the words, ‘How can we help you today?’ when reaching out for health care assistance,” said Gary Kaplan, chair of the study committee that wrote the report, and chairman and chief executive officer of Virginia Mason Health System in Washington state Care with this commitment is feasible and found in practice today, but it is not common. Our report lays out a road map to improve that.” Continue reading

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Same-sex marriage ruling expect to boost coverage among gay couples

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U.S. Supreme CourtBy Jay Hancock
KHN

The right to marry in any state won’t be the only gain for gay couples from last week’s Supreme Court ruling.

The decision will probably boost health insurance among gay couples as same-sex spouses get access to employer plans, say analysts and benefits consultants.

How much is unclear, but “it’s going to increase coverage” in a community that has often had trouble getting access to medical services, said Jennifer Kates, a vice president at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

The logic is simple. Fewer than half of employers that offer health benefits make the insurance available to same-sex partners who aren’t married. Virtually all of them offer coverage to spouses.

By marrying partners with employer health plans, people in same-sex relationships are likely to get coverage in states that banned gay marriage until now.

By marrying partners with employer health plans, people in same-sex relationships are likely to get coverage in states that banned gay marriage until now, as well as in those that welcomed it. Thanks to rapidly shifting legal ground, 37 states recognized gay marriage before last week’s ruling, up from nine in 2012.

New York legalized gay marriage in 2011. The next year, there was a big increase in same-sex couples covered by employer-sponsored health insurance, according to a study published Friday by the Journal of the American Medical Association.

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States struggle with ‘hidden’ rural homelessness

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Stella Dempsey lives in a tent in Fredericksburg, Virginia. She says she’s been homeless for years because of physical and mental health issues. States struggle to help people like Dempsey. (Rollie Hudson)

Stella Dempsey lives in a tent in Fredericksburg, Virginia. She says she’s been homeless for years because of physical and mental health issues. States struggle to help people like Dempsey. (Rollie Hudson)

By Teresa Wiltz
Stateline

FREDERICKSBURG, Virginia—At the Micah Ecumenical Ministries, in the center of this quaint colonial town, Stella Dempsey sits in the waiting room, looking dejected. Ministry staffers offered her a bed at a shelter, but she says she can’t bear to go back. Still, she’s feeling desperate.

She is homeless and jobless and sleeps in a tent in the woods. She’s got cirrhosis of the liver, high blood pressure, diabetes and a bad back. Two months ago, she said, she almost died. Now, she’s run out of all her medications, from her bipolar meds to her insulin. She is not eligible for Medicaid under Virginia law.

“I have nothing until they give me disability,” the former waitress said, her eyes welling. “I’m hoping for help. I need food stamps, a clinic for my meds. … People look down on people who are homeless. They think we’re nasty and no good. But some of us can’t help it. If I could help it, trust me, I would.”

At first blush, Dempsey, 43, doesn’t fit the stereotype of the chronically homeless. She’s neatly dressed in flowered capris, her hazel eyes rimmed with eyeliner. But in Fredericksburg, as in other small towns, suburbs and rural corners of the country, the homeless are often hidden, out of sight and mind, hard to reach and hard to help, say people who work with the homeless. Continue reading

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Half of health law plans offer narrow networks – study

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narrow-networks-570By Michelle Andrews
KHN

If the physician networks for plans sold on the health law’s online insurance exchanges were T-shirts, more than 40 percent would be size X-small or small.

That’s the takeaway from a new study that analyzed nearly 400 physician networks in silver-level plans sold around the country  in 2014.

  • The study labeled 11 percent of plans “extra small” because they covered fewer than 10 percent of physicians in a plan’s region.
  • Another 30 percent were “small,” meaning they covered between 10 and 25 percent of physicians
  • . Just 11 percent of plans were classified as “extra large” because they covered at least 60 percent of physicians in the area.

As consumers shop for coverage on the exchanges, knowing the trade-off between premium price and network size could be important to some, says Kathy Hempstead, director of the coverage team at the Robert Wood Johnson Foundation, which funded the study. Continue reading

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High Court Upholds Health Law Subsidies

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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 Jay Hancock
KHN

The Affordable Care Act survived its second Supreme Court test in three years, raising odds for its survival but by no means ending the legal and political assaults on it five years after it became law.

The 6-3 ruling stopped a challenge that would have erased subsidies in at least 34 states for individuals and families buying insurance through the federal government’s online marketplace.

Such a result would have made coverage unaffordable for millions and created price spirals for those who kept their policies, many experts predicted.

Chief Justice John Roberts wrote the opinion for the court, joined by frequent swing vote Anthony Kennedy and the liberal justices Ruth Bader Ginsburg, Stephen Breyer, Sonya Sotomayor and Elana Kagen.

“The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner,” said Roberts. Continue reading

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Not expanding Medicaid can cost local taxpayers

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200px-Flag-map_of_TexasBy Michael Ollove
Stateline

DALLAS — Dallas County property owners paid more than $467million in taxes last year to Parkland Health and Hospital System, the county’s only public hospital, to provide medical care to the poor and uninsured.

Their tax burden likely would have been lower if the state of Texas had elected to expand Medicaid, the federal-state health insurance program for low-income people.

In most states that have chosen not to expand Medicaid, residents pay local taxes to help support hospitals that care for uninsured people.

If more low-income patients at Parkland had been covered by Medicaid, then federal and state taxpayers would have picked up more of the costs.

Elsewhere in Texas and in most of the 20 other states that have chosen not to expand Medicaid, residents pay local taxes to help support hospitals that care for uninsured people.

On top of that, they pay a portion of the federal taxes that help subsidize Medicaid in the 29 states and District of Columbia that did expand the program to cover more people — places where residents can expect to see lower local taxes as more people become insured. Continue reading

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When do workplace wellness programs become coercive?

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ImprimirBy Julie Appleby
KHN

Christine White pays $300 a year more for her health care because she refused to join her former employer’s wellness program, which would have required that she fill out a health questionnaire and join activities like Weight Watchers.

“If I didn’t have the money … I’d have to” participate, says White, 63, a retired groundskeeper from a Portland, Ore., community college.

Like many Americans, White gets her health coverage through an employer that uses financial rewards and penalties to get workers to sign up for wellness programs.

Participation used to be a simple matter — taking optional classes in nutrition or how to stop smoking.

But today, a small but growing number of employers tie those financial rewards to losing weight, exercising or dropping cholesterol or blood-sugar levels — often requiring workers to provide personal health information to private contractors who administer the programs.

The incentives, meanwhile, can add up to hundreds, or even thousands, of dollars a year.

Employers say wellness programs boost workers’ health and productivity while helping companies curb rising health care costs. President Barack Obama’s signature health law allows employers to increase those financial incentives.

But asking workers to undergo medical exams or share personal health information is sharply limited by another law, the 1990 Americans With Disabilities Act (ADA), which prohibits such questioning — except under limited circumstances, such as by voluntary wellness programs.

So what is a voluntary wellness program and when do employer incentives cross the line to become coercive? Continue reading

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Medicare slow to adopt telemedicine due to cost concerns

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telemedicine-5701By Phil Galewitz
KHN

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.

For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor.

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it.

So she turned on her computer and logged on to www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.

“This was so easy,” Miles said.

For Medicare patients, it’s also incredibly rare. Continue reading

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19 million would become uninsured if health law repealed – CBO

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By Phil Galewitz
KHN

Repealing the federal health law would add an additional 19 million to the ranks of the uninsured in 2016 and increase the federal deficit over the next decade, the Congressional Budget Office said Friday.

cbo repeal 600

The report is the first time CBO has analyzed the costs of the health law using a format favored by congressional Republicans that factors in the effects on the overall economy. It is also the agency’s first analysis on the law under Keith Hall, the new CBO director appointed by Republicans earlier this year.

CBO projected that a repeal would increase the federal deficit by $353 billion over 10 years because of higher direct federal spending on health programs such as Medicare and lower revenues. But when including the broader effects of a repeal on the economy, including slightly higher employment, it estimated that the federal deficit would increase by $137 billion instead.

Both estimates are higher than in 2012, the last time that the CBO scored the cost of a repeal. Continue reading

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Don’t assume your employer’s plan covers care you need

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Sign for an emergency room.By Jay Hancock
KHN

Marlene Allen thought she had decent medical coverage after she fell in December and broke her wrist. She had come in from walking the dogs. It was wet. The fracture needed surgery and screws and a plate.

Weeks later, she learned her employer health plan would cover nothing. Not the initial doctor visit, not the outpatient surgery, not the anesthesiology. She had $19,000 in bills.

Allen’s employer plan covered only vaccines, blood-pressure tests and other preventive care.

“Make sure you find out what kind of plan it is” when employers offer coverage, advises Allen, who lives in northern Minnesota. “I thought health insurance was health insurance.”

A complex health law and bad information helped cause the trouble.

When her employer offered the health plan late last summer she thought she had to sign up.

That was wrong.

Once she was on the employer plan, she thought she had to drop better, comprehensive coverage she had bought through MNsure, the state’s online insurance marketplace.

That was wrong.

After she learned that her work plan covered hardly anything and tried to get back on a marketplace policy, MNsure told her she’s not eligible for subsidies to buy it. Wrong again.

“Horrible situation,” said Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms. It “does make you wonder about the training these call-center folks are getting.” Continue reading

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Connecting released inmates to health care

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9638276289_550f033bb8_nBy Michael Ollove
Stateline

Joe Calderon faced uncomfortably high odds of dying after his release from a California prison in 2010.

According to one study, his chances of dying within two weeks — especially from a drug overdose, heart disease, homicide or suicide — were nearly 13 times greater than for a person who had never been incarcerated.

Despite suffering from hypertension during his 17 years and three days of incarceration, Calderon was lucky. He stumbled onto a city of San Francisco program that paid for health services for ex-offenders, and he was directed to Transitions Clinic, which provides comprehensive primary care for former prisoners with chronic illnesses. The clinic saw to all his health needs in the months after his release.

An increasing number of states are striving to connect released prisoners like Calderon to health care programs on the outside. Frequently, that means enrolling them in Medicaid and scheduling appointments for medical services before they are released.

Some state programs — in Massachusetts and Connecticut, for example — provide help to all outgoing prisoners. Programs in some other states are more targeted. Those in Rhode Island and New York, for instance, focus on ex-offenders with HIV or AIDS.

Elsewhere, probation and parole are being used to encourage ex-offenders to adhere to certain treatments. Utah, for example, passed a measure this year that cuts probation time for former prisoners if they get treatment for mental illness or substance abuse.

The goal of these programs isn’t just to address the health needs of a notoriously unhealthy population, but to improve the likelihood they will succeed in society.

“We want to support them as much as possible to make sure they are productive and do not return to prison,” said Dr. Shira Shavit, executive director of Transitions. Continue reading

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What’s at stake when the Supreme Court rules on health plan subsidies

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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 Julie Rovner and Mary Agnes Carey
KHN

Later this month, the Supreme Court is expected to rule on King v. Burwell, a case challenging the validity of federal tax subsidies helping millions of Americans buy health insurance if they don’t get it through an employer.

If the court rules against the Obama administration, those subsidies could be cut off for people in the approximately three dozen states using healthcare.gov, the federal exchange website.

Here are answers to some frequently asked questions about the case.

Q: What is this case about?

A: The case challenges the federal government’s ability to provide subsidies to individuals who buy health insurance on the federal marketplace, sometimes called an exchange.

Those subsidies are provided to lower- and middle-income customers since the health law mandates that most people have insurance.

At issue is a line in the law stipulating that subsidies are available to those who sign up for coverage “through an exchange established by the state.” In the heated politics following the health law’s passage, a majority of states opted not to set up their own exchanges and instead rely on the federal government.

In regulations issued in 2012, the Internal Revenue Service said the subsidies would be available to those enrolling through both the state and the federal health insurance exchanges.

Those challenging the law insist that Congress intended to limit the subsidies to state exchanges, but the Obama administration says the legislative history and other references in the law show that all exchanges are covered. Many lawmakers and staff members involved in the debate agree.

Q: What happens if the court rules against the Obama administration? Continue reading

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