Category Archives: Healthcare Reform

Patients often win if they appeal a denied health claim

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


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


Focus one exchange enrollment overlooks millions who bought private insurance

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 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


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

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


State exchange directors offer enrollment snapshots

 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


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

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


Medicare records provide tantalizing details of payments to doctors

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


Primary care Shortage? Not for the insured, study finds

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


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

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 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


Obama administration retreats on private Medicare rate cuts

Twenty-dollar bill in a pill bottleBy Jay Hancock

April 8, 2014 – Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members.  Continue reading


You have insurance, now what?

Blank checklist on clipboard, with large red ticks, and room for text.By Britt Olson
Coverage is Here
Public Health – Seattle & King County

Maybe you have never had health insurance. Or perhaps it has been so long since you were last covered that you don’t recall how to use your policy or what to expect when you do.

Enrolling in an insurance plan is just the starting point for your journey through the health system.

To smooth your trip through the medical complex, and to maximize the benefits of your new insurance policy, here are some tips:  Continue reading


Decoding the high-stakes debate over Medicare Advantage cuts

United States Capitol BuildingBy Jay Hancock
KHN Staff Writer

APR 07, 2014

This KHN story was produced in collaboration with 

In high-visibility ad campaigns, insurers maintain that reduced payment rates, which are expected to be announced Monday, will do real harm. What should beneficiaries expect?  Continue reading


Co-op health plans see early success

coOp_health_logo_RGBBy Eric Whitney

POLSON, Mont. – The names of the big health insurance companies are familiar – Blue Cross, Aetna, United Healthcare.

But what about CoOportunity Health, or Health Republic Insurance of New York?

These are among 23 new health insurance companies that started under the Affordable Care Act.

They’re all nonprofit, member-owned cooperatives, and the aim is to create more competition and drive prices down.  Continue reading


3 million gained coverage through Medicaid from October to February

ACA health reform logoBy Phil Galewitz

The number of low-income people enrolled in Medicaid rose by 3 million to 62.3 million from October through February as more Americans joined the state-federal insurance program through state and federal online insurance marketplaces, according to a report released Friday by the Department of Health and Human Services.

States that expanded Medicaid eligibility under the health law saw an average 8 percent increase in enrollment, with enrollment leaping almost 35 percent in Oregon and almost 34 percent in West Virginia.  Continue reading


Top academic hospital begins to tackle readmissions problem

Refresh ThumbBy Rachel Gotbaum

Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates of readmissions among Medicare patients in the country.

That meant federal fines of more than $1 million—and a lot of soul searching for the staff, says Dr. Julius Yang, the head of quality for the hospital.

“Patients coming to our hospital, getting what we believed was high quality care, were coming back at an alarmingly high rate,” says Yang.  Continue reading