Category Archives: Insurance

Top hospitals likely are available on a marketplace plan, study


hospital-ratings-570By Michelle Andrews

Despite much hand-wringing over the size and quality of provider networks on the health insurance marketplaces, many top-notch hospitals are available in-network in marketplace plans this year, a new study found.

However, more than half of those hospitals participated in fewer plans than last year, limiting their in-network availability to just one marketplace plan in a growing number of cases.

The analysis by the Robert Wood Johnson Foundation examined the marketplace plan participation in 2015 and 2016 of 156 hospitals that were highly ranked on U.S. News and World Report’s most recent list of Best Regional Hospitals based on clinical care and other measures.

More than 95 percent of highly rated regional hospitals were available in at least one marketplace plan.

Overall, the study found that more than 95 percent of highly rated regional hospitals were available in at least one marketplace plan in both years.

Following reports of marketplace plans with narrow provider networks and declines in the number of preferred provider organization plans with out-of-network coverage, “some people were starting to say that marketplace coverage is second-tier coverage,” said Katherine Hempstead, who leads the foundation’s work on health insurance coverage and authored the study.

The analysis showed that marketplace plans are “not so dissimilar from employer-sponsored insurance,” she said. “The cost-sharing might be more aggressive [in marketplace plans], but they’re not that dissimilar.” Continue reading


Not sure if we can help you with an insurance problem? Ask us anyway


MKreidlerPhotoBy Mike Kreidler
Washington State Insurance Commissioner

Recently, a Washington consumer posted a story on Facebook about her brother, who was on the waiting list for a heart transplant but was being put on hold because of “paperwork” issues with the insurance company. She asked her Facebook friends to file a complaint with the Insurance Commissioner, resulting in more than 40 complaints to our office.

One of our consumer advocates looked into the complaint and determined that the insurance provider was Apple Health, our state’s Medicaid program that is overseen by the Washington state Health Care Authority. In other words, we have no authority over the plan. But that didn’t deter our consumer advocate from trying to help. Continue reading


Farm contractors balk at Obamacare requirements

USDA photo by Lance Cheung.

USDA photo by Lance Cheung.

By April Dembosky, KQED

Obamacare is putting the agricultural industry in a tizzy.

Many contractors who provide farm labor and must now offer workers health insurance are complaining loudly about the cost in their already low-margin business.

Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore. About half of the farm labor workforce in the U.S. is undocumented.

“There’s definitely going to be some repercussions to it,” said Jesse Sandoval, a farm labor contractor based in Stockton, California. “I think there’s going to be some things that cannot be ignored.”

“Under the Affordable Care Act, employees can be asked to contribute 9.5 percent of their income toward health premiums. But for farm workers who pick oranges or peaches for $10 an hour, that’s still too much.”

Sandoval came to an educational conference for farm labor contractors — essentially staffing agencies for field workers — held at the San Joaquin County Agricultural Center in Stockton in the fall.

Men with broad shoulders, wearing denim jackets and cowboy hats, sat in the audience, listening to lectures on a litany of laws and rules regulating their industry, including Obamacare’s employer mandate.

Last year, employers with 100 or more full-time employees had to offer health insurance to their workers or pay a stiff penalty. This year, employers with 50 to 99 full-time employees must comply.

Sandoval has about 100 workers on his payroll. When farmers need a crew to pick cherries, pumpkins or asparagus, they call him to send the workers. He has to offer them insurance this year, and he’s smarting over the price tag. At $300 a month per employee, he’s looking at a $30,000 monthly bill.

Sandoval said he can’t absorb the hit. “The numbers aren’t there,” he said. “My margin is 10 percent, and I have to increase expenses 10 percent? Well, that doesn’t work.” Continue reading


Will get a California makeover?


California exchangeBy Pauline Bartolone

When 28-year-old Charis Hill discovered that the medication to treat her degenerative arthritis condition had risen to $2,000 a month, she chose to be in pain instead.

“I felt like an invalid,” said Hill, who lives in Sacramento and at the time had only catastrophic health coverage. She said the month without medication made it hard to get out of bed.

Paying for drugs isn’t a problem for Hill now: She has a more robust Covered California health plan, and she gets assistance from a drug company program.

And as of the first of this year, she won’t have to worry about sticker shock if she switches medications. All Covered California plans have a cap on how much patients pay for drugs: $250 a month in silver, gold and platinum plans, and $500 a month in bronze plans.

“I could try a better treatment,” said Hill, a patient advocate, who says she is exploring that because her symptoms are becoming more severe. “The $250 is something I know that I can always fall back on.”

The copay cap on drugs is just one way Covered California chose to shape the health insurance marketplace this year.

Experts say the California exchange uses more of its powers as an “active purchaser” than the vast majority of other states.

That means it can decide which insurers can join the exchange, what plans and benefits are available and at what price.

The federal government — in pending proposed rules for 2017 — has signaled it too wants to have more of a hand in crafting plans. Though there are no plans to go as far as a monthly drug copay cap, would be forging ahead on a path California already paved, swapping variety for simplicity in plan design. Continue reading


Administration will continue to push Obamacare expansion, HHS chief says


HHS Sec. Burwell says ‘beat goes on’ as agency seeks to expand health law’s influence

By Mary Agnes Carey

Official portrait of the Secretary of Health & Human Services Sylvia Mathews BurwellDepartment of Health and Human Services Secretary Sylvia M. Burwell on Friday hailed the health law’s 2016 enrollment gains and said the department was already beginning to gear up for the next enrollment period.

In addition to the health law, Burwell’s agency is juggling many other priorities these days, including coordinating her agency’s response to the emerging threat of the Zika virus, President Barack Obama’s “Moonshot on Cancer” initiative and the growing epidemic of opioid abuse.

“The beat goes on,” she said during a briefing with reporters at HHS headquarters. Continue reading


Insurers should be current on emerging treatments for consumers


MKreidlerPhotoBy Mike Kreidler
Washington State Insurance Commissioner

A growing concern for consumers and health insurers is the cost of prescription drugs and specifically, treatment for debilitating and life-threatening diseases.

Hepatitis C is a good example. New drugs are now used to cure this life-threatening liver ailment with proven success. But the pills are costly, ranging from $55,000 to almost $95,000 per patient for a standard 12-week treatment period.

Two nationwide organizations, the American Association for the Study of Liver Diseases and the Infectious Disease Society of America, now recommend that most patients receive treatment even if they are in the early stage of the disease versus waiting until it has progressed.

Last November, the federal government encouraged states to ensure that health coverage policies are “informed” by the treatment guidelines noted above. Unfortunately we do not have the authority to mandate that insurance companies abide by the guidelines. However, we do expect insurers to be current on all appropriate guidelines that best serve consumers. That is true for all types of treatments.

We recently asked health insurers in Washington if they were aware of the new guidelines and if they were making any changes to how they were treating patients with this disease. The responses were varied, but there were common themes:   Continue reading


Obamacare enrollment tops expectations


By Phil Galewitz

2016 Obamacare Enrollment Tops Expectations At 12.7 Million

ACA health reform logoAbout 12.7 million Americans enrolled in private health insurance through the federal and state marketplaces for 2016, the Obama administration said Thursday.

Sign-ups in the third enrollment period for the Affordable Care Act’s online marketplaces — and the last that will be completed while President Barack Obama is in office — easily topped last year’s amount and also beat the administration’s modest forecast.

The 2016 enrollment period began Nov. 15 and ended Jan. 31. Except for limited exceptions such as job losses, Americans will have to wait until mid-November to enroll again.

About 4 million enrollees on this year enrolled in the coverage for the first time.

The annual Obamacare enrollment numbers routinely draw debate. Supporters boast that millions of people have gained coverage.  Detractors stress millions remain uninsured because they can’t afford coverage and that not enough healthy young adults are enrolling. The latter issue threatens the business case for insurers, causing them to lose money and raise prices or drop out of the exchanges.

Of the 12.7 million consumers enrolling in marketplace coverage, more than 9.6 million came through the federal exchange that handles 37 states. The rest, 3.1 million, selected a plan through the 13 state-based marketplaces.

About 4 million enrollees on this year enrolled in the coverage for the first time, according to the Department of Health and Human Services.

At the end of last year’s enrollment period, 11.7 million people had chosen plans,  but that figure dropped to 9.3 million by September because not everyone paid premiums and some found coverage elsewhere, such as through employers.

In October, the White House estimated that 10.1 million Americans would have health care coverage through the exchange at the end of 2016, a figure that counts people who paid and were covered at the end of the entire year.


A voter’s guide to the health law


GOP LogoBy Julie Rovner

Nearly six years after its enactment, the Affordable Care Act remains a hot-button issue in the presidential race — in both parties.

“Our health care is a horror show,” said GOP candidate Donald Trump at the Republican debate in South Carolina Dec 15.

Texas Sen. Ted Cruz, winner of the Iowa caucuses, said at the debate in Des Moines Jan. 28 that the health law has been “a disaster. It is the biggest job-killer in our country.”

Democratic LogoDemocrats largely support the law, but even they can’t agree on how to fix its problems. Hillary Clinton said at the Jan. 25 town hall on CNN that she wants to “build on the ACA. Get costs down, but improve it, get to 100 percent coverage.”

Clinton’s rival for the nomination, Vermont Sen. Bernie Sanders, acknowledged that “the Affordable Care Act has done a lot of good things,” but added that “the United States today is the only major country on earth that doesn’t guarantee health care to all people as a right.” Sanders is pushing a government-run “Medicare for All” plan instead.

In some cases candidates are bending the truth. But in general, both praise and criticisms of the law are accurate. That’s because the health law is so big and sweeping that it has had effects both positive and negative.

Here is a brief guide to some things the health law has — and has not — accomplished since it was signed by President Barack Obama in 2010. Continue reading


Licking wounds, insurers move to limit health-law enrollment


Twenty-dollar bill in medicine bottleBy Jay Hancock

Stung by losses under the federal health law, major insurers are seeking to sharply limit how policies are sold to individuals in ways that consumer advocates say seem to discriminate against the sickest and could hold down future enrollment.

In recent days Anthem, Aetna and Cigna, all among the top five health insurers, told brokers they will stop paying them sales commissions to sign up most customers who qualify for new coverage outside the normal enrollment period, according to the companies and broker documents.

“The only explanation I can see for them doing this is risk avoidance — and that is discriminatory marketing “

The health law allows people who lose other coverage, families with new children and others in certain circumstances to buy insurance after enrollment season ends. In most states the deadline for 2016 coverage was Jan. 31.

Last year, these “special enrollment” clients were much more expensive than expected because lax enforcement allowed many who didn’t qualify to sign up, insurers said. Nearly a million special-enrollment customers selected plans in the first half of 2015, half of them after losing previous coverage. Continue reading


Uninsured rate in Washington state drops by half to 7.3 percent


From the Office of the Insurance Commissioner

Screen Shot 2016-02-03 at 9.16.09 PM

The number of people without health insurance in Washington state has dropped from 14.5 percent in 2012 to an estimated 7.3 percent or 522,000 people in 2015, according to a new report issued today by Insurance Commissioner Mike Kreidler.

Nearly every county in Washington saw a drop in the uninsured.

The report highlights the positive impact of the federal Affordable Care Act in Washington with county-by-county data on the uninsured and the law’s effect on many segments of the population.

“Today, there are nearly 470,000 fewer uninsured people in our state,” said Kreidler.  “Nearly every county in Washington saw a drop in the uninsured rate, illustrating how the Affordable Care Act has delivered on its promise to improve access to health coverage in our state.”

Among the report’s key findings, from 2012 to 2014:

  • Adams, Yakima, and Grays Harbor counties experienced the largest decline in uninsured.
  • Kitsap County had the lowest uninsured rate at 5.6 percent.
  • Kittitas County had the highest uninsured rate at 14.5 percent.

Continue reading


Inslee appoints Acting Secretary for DSHS, launches national search for new secretary


LashwayBioOlympia, Feb. 3 — Gov. Jay Inslee Tuesday announced he is appointing Patricia Lashway, Assistant Secretary for the Department of Social and Health Services’ Services and Enterprise Support Administration, to serve as Acting Secretary of the 17,500-employee agency.

The Department provides assistance to 2.5 million of Washington residents providing behavioral health and developmental disability services, aging and long-term care and child and family support, juvenile rehabilitation, and food and cash assistance.

Outgoing Secretary Kevin W. Quigley, who has served as DSHS Secretary since Inslee took office in 2013, announced his resignation January 5 and will depart the agency on Feb. 22. Lashway’s appointment will begin Feb. 23.

In her current position, Lashway is responsible for day-to-day management of the Department. Prior to that, she was the DSHS Senior Director of Policy and External Relations where she oversaw strategic development, legislative and policy initiatives.

Her career with DSHS began in 1988 at what was then the Aging and Disability Services Administration, where she served for almost nine years as the Director of Residential Care Services.

Her team was responsible for developing a nationally recognized statewide complaint resolution and investigation unit that provided the foundation to serve all long-term care consumers in the state and their families.

Prior to state service Lashway worked in the legal field and has spent her career, including overseas duty as a Peace Corps volunteer.

“This is a critical time for the Department, especially with the challenges surrounding mental health services, and I’m confident our team, with the support of the governor and legislature, will ensure we provide the critical services to those who need them,” said Lashway. “I look forward to this assignment and appreciate the confidence by both the governor and my colleagues.”

Lashway received a bachelor’s degree from the University of Oregon, a juris doctorate from Seattle University and is a member of the Washington State Bar Association.

A national executive search will begin next week for a new DSHS Secretary.


Surprise! Here’s another bill for that ‘paramedic response’


Katie Gurzi, 85, at her apartment in Long Beach, Calif. on Thursday, January 21, 2016. Gurzi received a bill from the City of La Habra for the $260 after an emergency ambulance ride. “I was quite sure I’d be covered,” she said. “What I didn’t know is [the city] charges above and beyond.” (Heidi de Marco/KHN)

Katie Gurzi, 85, at her apartment in Long Beach, Calif. on Thursday, January 21, 2016. Gurzi received a bill from the City of La Habra for the $260 after an emergency ambulance ride. “I was quite sure I’d be covered,” she said. “What I didn’t know is [the city] charges above and beyond.” (Heidi de Marco/KHN)

By Anna Gorman

After Katie Gurzi woke in the middle of the night with excruciating chest pains, paramedics rushed her to the hospital.

Gurzi was rebuffed nearly every step of the way, as she contacted more than a dozen people from city bill collectors to her congressman. Some didn’t return her calls. Others refused to help. A few were just plain rude.

That part went smoothly: Gurzi, 85, was pleased with the care she received. And doctors determined she wasn’t having a heart attack, just a spasm in her esophagus.

But then, in January of 2015, the city of La Habra, California sent her a $260 bill for “paramedic response” — after her insurers had already been billed for the November ambulance ride. That made Gurzi mad.

It wasn’t just that she believed the city was trying to reach into her purse for money it couldn’t get from health insurers. It was that she was rebuffed nearly every step of the way, as she contacted more than a dozen people from city bill collectors to her congressman. Some didn’t return her calls. Others refused to help. A few were just plain rude. Continue reading


Washington health insurance exchange enrollment jumps 25%


Washington Healthplanfinder Sees More Than 200,000 Residents Sign Up For Qualified Health Plans by the Close of Open Enrollment

Residents currently without coverage may still qualify for a 2016 health plan

Washington MapThe Washington Health Benefit Exchange today announced that more than 200,000 Washingtonians selected a health insurance plan through the Washington Washington Healthplanfinder by the close of open enrollment on Jan. 31.

The number of plans selected is nearly 25 percent higher than those selected in open enrollment last year.

The number of plans selected is nearly 25 percent higher than those selected in open enrollment last year, with approximately 39,000 more customers signed up for coverage this year than in 2015.

Washington Healthplanfinder saw 300 sign-ups per hour leading up to Sunday’s midnight close of open enrollment. The Customer Support Network assisted more than 3,500 callers over the weekend, and nearly 11,000 unique users accessed

If a customer was unable to select a health plan by the Jan. 31 open enrollment deadline on Washington Healthplanfinder because of an operational issue, they may be eligible for additional time to select a plan.

This determination will be made by Exchange staff after reviewing the specific application in question. Customers in this situation have until this Sunday, Feb. 7 at 8 p.m. to provide an explanation of the issue they encountered by calling the Customer Support Center at 1-855-923-4633. Continue reading


California voters to have their say on drug prices


Twenty-dollar bill in a pill bottleBy Anna Gorman

California voters will weigh in this November on a high-stakes ballot propositionintended to help control the cost of prescription drugs – the latest attempt to limit soaring prices that have prompted public criticism nationwide.

The proposition would require the state to drive a harder bargain with drug companies so it doesn’t pay more for medications than the U.S. Department of Veterans Affairs.

The initiative would affect about 5 million people whose health care is covered by the state, proponents said. They include retired state workers, inmates and some low-income residents in the Medi-Cal insurance program.


According to AARP, the retail price for 98 specialty drugs widely used to treat chronic conditions rose dramatically between 2005 and 2013. As indicated in the graph, the annual retail price of therapy per drug increased from $18,240 in 2005 to $53,384 in 2013.

Across the nation, prices have spawned state legislative proposals as well as federal hearings and task forces. Dozens of bills have been proposed to address the high cost of specialty drugs, according to the National Conference of State Legislatures.

Political leaders in Virginia and New Jersey have introduced legislation that would require manufacturers to report production costs of some high-priced drugs. A bill in New Mexico would create a task force on pharmaceutical pricing, while a proposed law in Washington state would cap consumers’ out-of-pocket spending on prescription medications.

Even presidential candidates have offered proposals to make expensive prescription drugs more accessible.

Among the catalysts for public outrage are the sky-high price of treatments for diseases such as hepatitis C and the unapologetic markups for specialty drugs by former pharmaceutical executive Martin Shkreli.

“It’s a universal issue,” said Geoffrey Joyce, a professor and director at the USC Schaeffer Center for Health Policy & Economics. “How do we control these prices and at the same time not dampen incentives to innovate?” Continue reading