Category Archives: Insurance

Happy 50th birthday, Medicare. your patients Are getting healthier

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Photo: Courtesy of Ed g2s under Creative Commons license

The past 15 years have seen a marked drop in deaths and hospitalizations among Medicare patients — people 65 and older. Teasing out why is tricky, but it seems a good trend for the 50-year-old program.

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Five challenges facing Medicaid at 50

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By Phil Galewitz
KHN

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President Lyndon B. Johnson signed the bill creating Medicare and Medicaid at the library of former President Harry Truman, who was in attendance, on July 30, 1965. (Photo courtesy of Truman Library)

A “sleeper” provision when Congress created Medicare in 1965 to cover health care for seniors, Medicaid now provides coverage to nearly 1 in 4 Americans, at an annual cost of more than $500 billion.

Today, it is the workhorse of the U.S. health system, covering nearly half of all births, one-third of children and two-thirds of people in nursing homes.

Enrollment has soared to more than 70 million people since 2014 when the Affordable Care Act began providing billions to states that chose to expand eligibility to low-income adults under age 65. Previously, the program mainly covered children, pregnant women and the disabled.

Unlike Medicare, which is mostly funded by the federal government (with beneficiaries paying some costs), Medicaid is a state-federal hybrid. States share in the cost, and within broad federal parameters, have flexibility to set benefits and eligibility rules.

Though it provides a vital safety net, Medicaid faces five big challenges to providing good care and control costs into the future: Continue reading

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Most Americans approve court’s decision on Obamacare subsidies

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7.01.15_-_Polling_-_ACA_opinionA new poll finds that 62% of Americans approve of the Supreme Court’s decision to continue allowing Obamacare health insurance subsidies in all states, while 32% disapprove. The public’s overall approval remains evenly divided with 43% saying they approve of the health reform law and 40% that they disapprove. The poll was conducted by the non-partisan Kaiser Family Foundation.

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Whether you like your insurance depends a lot on how much you pay out-of-pocket

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Consumers’ Satisfaction With Coverage Linked To Out-Of-Pocket Expenses

By Michelle Andrews
KHN

Twenty-dollar bill in a pill bottleHow much money people have to fork over when they go to the doctor can make a big difference in how satisfied they are with their health plan, a recent study suggests.

“It looks like it’s boiling down to costs,” says Paul Fronstin, director of the Employee Benefit Research Institute’s  health research and education program and the author of the report. Continue reading

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Ruling: Washington can require pharmacies to dispense Plan B | www.kirotv.com

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planb-175Washington state can force pharmacies to dispense Plan B or other emergency contraceptives, a federal appeals court said Thursday in a long-running lawsuit brought by pharmacists who said they have religious objections to providing the drugs.

The unanimous decision Thursday by the three-judge panel of the 9th U.S. Circuit Court of Appeals overturned a 2012 ruling by U.S. District Court Judge Ronald B. Leighton, who had found that the state’s rules violated the religious freedom of pharmacy owners.

Source: Ruling: Washington can require pharmacies to dispense Plan B | www.kirotv.com

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King County Council puts comprehensive children’s health program to the voters | The Seattle Times

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Map of SeattleKing County could be one of the nation’s first metropolitan areas to adopt a wide-reaching plan to curb public health problems through services for pregnant women, infants and children, if voters approve a new property tax this fall.

Source: King County Council puts comprehensive children’s health program to the voters | The Seattle Times

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HHS pushes states to negotiate lower Obamacare rates

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ACA health reform logoBy Julie Rovner
KHN

Some analysts who have looked at health insurers’ proposed premiums for next year predict major increases for policies sold on state and federal health exchanges.

Others say it’s too soon to tell. One thing is clear: There’s a battle brewing behind the scenes to keep plans affordable for consumers.

Now the Obama administration is weighing in, asking state insurance regulators to take a closer look at rate requests before granting them.

Under the Affordable Care Act, state agencies largely retain the right to regulate premiums in their states. So far only a handful have finalized premiums for the coming year, for which enrollment begins in November. Continue reading

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No escaping medical copayments — even in prison

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$100-dollar bill inside a capsuleBy Michael Ollove
Stateline

Even going to prison doesn’t spare patients from having to pay medical copays.

In response to the rapidly rising cost of providing health care, states are increasingly authorizing the collection of fees from prisoners for medical services they receive while in state prisons or local jails.

At least 38 states now do it, according to the Brennan Center for Justice at New York University School of Law and Stateline reporting.

The fees are typically small, $20 or less. And states must waive them when a prisoner is unable to pay but still needs care, in keeping with a U.S. Supreme Court ruling that prisoners have a constitutional right to “adequate” health care.

The rationale for charging copays is the same for prisoners as it is for people not behind bars: to discourage seeking medical care when it is not really needed. Continue reading

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More health plan choices at work. What’s the catch?

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Steve Heller has worked for Minnesota’s John Henry Foster company for 15 years. He says he likes the greater choice of health plans he now has because of the private exchange. (Photo by Mark Zdechlik/MPR)

By Mark Zdechlik, Minnesota Public Radio

Until recently, John Henry Foster, an equipment distribution firm based in Eagan, Minn., offered its employees only a couple of health plans to choose from. That’s common in companies across America.

“They just presented what we got,” says Steve Heller, a forklift operator who has worked at John Henry Foster for 15 years.

But these days the company’s employees have dozens of choices. And something else is new: Each worker now receives money from the company (from $350 to $1,000 a month, depending on whether Heller and his co-workers are buying insurance for a single person, a couple or a family) to buy a health plan.

Employees are then directed to an online exchange — a private, secure website that offers the selection of plans for side-by-side comparison. Workers can choose high-deductible plans with relatively low monthly premiums or they can pay more each month to have more of their care and medications covered.

Just as before, the company determines the insurance companies listed, and the scope of the treatments and procedures covered by each plan.

Three years after the switch, Heller says he’s happy with his insurance and the exchange. The company’s managers are happy with it, too. Continue reading

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You may still qualify to sign up for health insurance

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Life change? You may be able to qualify for 2015 coverage.

You may qualify for a Special Enrollment Period

Thinking about moving, getting married, having a baby, or changing jobs?

When you make big decisions in life, you may be eligible to buy or change Health Insurance Marketplace coverage outside the yearly Open Enrollment Period.

If you’ve had a qualifying major life event, you have 60 days from the life event to enroll in coverage. You can apply or change plans online or by phone.

See if you qualify for a Special Enrollment Period. 

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Surprise! That urgent care center may send you a big bill (just like the ER)

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Sign for an emergency room.By Julie Appleby
KHN

Sallyann Johnson considers herself a pretty savvy health care consumer. When she fell and injured her hands and wrists, she didn’t head for an expensive emergency room, choosing an urgent care clinic near her Milwaukee home instead.

Before seeking treatment, she asked the key question: Did the center accept her insurance? Yes, Johnson was assured, both on the phone and then again when she arrived at the clinic.

After X-rays and a visit with a physician assistant, Johnson learned her wrists were sprained, but weeks later, it was her wallet that sustained the most damage.

“I received a bill from a doctor for $356,” said Johnson, 62. “I felt I asked all the right questions. I even re-asked the questions.”

Long seen as a lower-cost alternative to hospital emergency rooms for minor illnesses or injuries, urgent care centers are increasingly popular with consumers – and their insurers.

But like doctors and hospital ERs, urgent care can also present payment headaches if they are not part of a patient’s insurance network. And consumers may need to ask specifically about network participation to find out. Continue reading

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Health Care Access Improves With Expansion of ‘Obamacare': CDC: MedlinePlus

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ACA health reform logoWhile more Americans have health insurance following the expansion of the Affordable Care Act, Hispanic adults have realized some of the biggest gains in access to medical care, a new government report shows.

Approximately 34 percent of Hispanic adults were uninsured in 2014, compared with 41 percent in 2013, according to the U.S. Centers for Disease Control and Prevention report, which was released Wednesday.

Source: Health Care Access Improves With Expansion of ‘Obamacare': CDC: MedlinePlus

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Report: ACA plans have a third fewer providers than employer-based plans – The Washington Post

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Blue doctorConsumers who bought insurance on the health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage, according to an analysis released Wednesday.

The study by consulting firm Avalere Health provides a statistical basis for anecdotal reports from consumers and others about the more limited doctor and hospital choices in plans offered on marketplaces created by the Affordable Care Act. In these “narrow networks,” health plans negotiate contracts with a select number of providers who agree to be reimbursed at lower rates.

That means the insurers can set their premiums lower, at least theoretically. But, depending on the plan’s design, consumers typically pay more, and sometimes much more, if they use a doctor or hospital outside the network.

Source: Report: ACA plans have a third fewer providers than employer-based plans – The Washington Post

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Uninsured rate falls to historic low – Gallup survey finds

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The uninsured rate among U.S. adults aged 18 and older was 11.4% in the second quarter of 2015, down from 11.9% in the first quarter.

The uninsured rate has dropped nearly six percentage points since the fourth quarter of 2013, just before the requirement for Americans to carry health insurance took effect.

The latest quarterly uninsured rate is the lowest Gallup and Healthways have recorded since daily tracking of this metric began in 2008.

Full story here.

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Medicaid Expansion: a Question of Math and Politics

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President Barack Obama has vowed to redouble his administration’s efforts to persuade all states to expand Medicaid. But if history is any indication, achieving that goal will take some time.

By Christine Vestal
Stateline

Flag-map_of_Florida.svgTAMPA, Florida — With its ruling in King v. Burwell last month, the U.S. Supreme Court likely settled the question of whether President Barack Obama’s signature Affordable Care Act will survive.

Whether and when the health law will be fully implemented in all 50 states is a different question.

“With the King decision behind us, the drumbeats for Medicaid expansion are increasing,” said Matt Salo, executive director of the National Association of Medicaid Directors. “There is movement in every state. They’ll get there. Maybe not today and maybe not this year, but they’ll get there soon.”

200px-Flag-map_of_TexasThat’s the hope of health care industry groups and legions of consumer advocates. Major business organizations and local and county governments are also onboard. Following the high court’s decision, President Obama vowed to do all he can to persuade states to opt in before he leaves office in 18 months.

But in the mostly Southern and Midwestern states that have rejected expansion, opposition shows little sign of abating.  Continue reading

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