Category Archives: Insurance

How much will your x-ray cost? You can find out in New Hampshire

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This KHN story also ran in the .

When Anthem Blue Cross Blue Shield became embroiled in a contract dispute with Exeter Hospital in N.H. in 2010, its negotiators came to the table armed with a new weapon: public data showing the hospital was one of the most expensive in the state for some services.

Local media covering the dispute also spotlighted the hospital’s higher costs, using public data from a state website.

When the dust settled, the insurer had extracted $10 million in concessions from Exeter. The hospital “had to step back and change their behavior,” said health policy researcher Ha Tu, who studied the state’s efforts to make health care prices transparent.

New Hampshire is among 14 states that require insurers to report the rates they pay different health care providers —and one of just a handful that makes those prices available to consumers.

The theory is that if consumers know what different providers charge for medical services, they will become better shoppers and collectively save billions.

In most places, though, it’s difficult, if not impossible to find out how much you will be charged for medical care. And with more people enrolled in high-deductible insurance plans, there is a growing demand for accurate price information. Continue reading

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For autistic adults, coverage options are scarce

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Graphic showing an umbrella sheltering medicinesBy Michelle Andrews
KHN / September 19th

It’s getting easier for parents of young children with autism to get insurers to cover a pricey treatment called applied behavioral analysis.

Once kids turn 21, however, it’s a different ballgame entirely. Continue reading

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One-quarter of ACOs save enough to earn bonuses

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Twenty-dollar bill in a pill bottleBy Jordan Rau
KHN

About a quarter of the 243 groups of hospitals and doctors that banded together as accountable care organizations under the Affordable Care Act saved Medicare enough money to earn bonuses, the Centers for Medicare & Medicaid Services announced Tuesday.

Those 64 ACOs earned a combined $445 million in bonuses, the agency said. Medicare saved $372 million after accounting for the ACOs that did not show success, including four that overspent significantly and now owe the government money.

The bonuses, losses and Medicare savings are teensy sums in the context of a program that spends half a trillion dollars a year on care for the elderly and disabled.

But the Obama administration views the results so far as evidence that reorganizing the financial incentives for doctors and hospitals — a key element of the health law – can translate to substantial savings if the program expands nationwide. Continue reading

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Responding to cuts, new county committee to examine gaps in family planning health care access – Puget Sound Business Journal

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king county state mapIn response to budget cuts, the public health department for King County and Seattle is forming an oversight committee to keep tabs on, and hopefully replenish, county-run family planning health services that might slip through the cracks and leave clients with nowhere else to turn.

via Responding to cuts, new county committee to examine gaps in family planning health care access – Puget Sound Business Journal.

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Insurers limiting drug benefits shifts costs to the sick

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$100-dollar bill inside a capsuleBy Charles Ornstein
ProPublica

This story was co-published with The New York Times’ The Upshot.

Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions.

But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.

By charging higher prices for generic drugs that treat certain illness, health insurers may be violating the spirit of the Affordable Care Act, which bans discrimination against those with pre-existing conditions.

Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as “non-preferred” and charging higher co-payments.

But according to an editorial to be published Thursday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs. Continue reading

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Plan will keep White Center’s Greenbridge Public Health Center open

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greenbridgeA partnership between City of Seattle and Planned Parenthood will allow the White Center Public Health Center at Greenbridge to remain open, King County Executive Dow Constantine said Monday.

The White Center clinic, which serves West Seattle, Burien, SeaTac, Tukwila, and Des Moines, was under threat of closing due to cut backs in state and federal funding.

Under the new partnership, Planned Parenthood of the Great Northwest will provide family planning services at the facility, while Public Health continues to provide Women, Infant and Children (WIC) and Maternity Support services for the next two years.

Seattle Mayor Ed Murray has committed $400,000 in 2015 to help keep Greenbridge open and preserve a variety of public health services.

Key details of the partnership include: Continue reading

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States sidestep health law’s measures to curb mandates

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By Michelle Andrews
KHN / September 16, 2014

For decades, states have set rules for health coverage through mandates, laws that require insurers to cover specific types of medical care or services.

The health law contains provisions aimed at curbing this piecemeal approach to coverage. States, however, continue to pass new mandates, but with a twist: Now they’re adding language to sidestep the health law, making it tougher than ever for consumers to know whether they’re covered or not.

Confused? Policy experts fear consumers will be too.

State coverage mandates vary widely. They may require coverage of broad categories of benefits, such as emergency services or maternity care, or of very specific benefits such as autism services, infertility treatment or cleft palate care.

Some mandates require that certain types of providers’ services be covered, such as chiropractors.

They may apply to all individual and group plans regulated by the state, or they may be more limited.

Photo by Michal Zacharzewski

Continue reading

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CDC survey confirms drop in uninsured

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An umbrella sheltering medicines - credit MicrosoftBy Jordan Rau
KHN /SEPTEMBER 16TH, 2014

The federal government’s first survey of the nation’s insured rate since the health care law’s new marketplaces began found a decrease in the number of adults without coverage, particularly among young adults.

The National Health Interview Survey of people during the first three months of this year found that the number of adults under 65 without health insurance dropped to 18.4 percent from 20.4 percent in 2013.

Among all ages, the survey found that the uninsured rate dropped to 13.1 percent from 14.4 percent in 2013; 41 million people still lacked insurance. Continue reading

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Health law shows little effect in lowering children’s uninsured rate, study

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The uninsured rate for kids under age 18 hasn’t budged under the health law, according to a new study, even though they’re subject to the law’s requirement to have insurance just as their parents and older siblings are.

Many of those children are likely eligible for coverage under Medicaid or the Children’s Health Insurance Program.

The Urban Institute’s health reform monitoring survey analyzed data on approximately 2,500 children, comparing the uninsured rate in June 2014 with the previous year, before the health insurance marketplaces opened and the individual mandate took effect.

It found that rates remained statistically unchanged at just over 7 percent for both time periods.

Part of the explanation is that even before the health law passed, the uninsured rate for children was already quite low, says Genevieve Kenney, a senior fellow at the Urban Institute and the lead author of the study. Continue reading

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Can I buy coverage after accident injuries? And who pays the ‘Cadillac Plan’ tax?

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This week, I am answering questions from readers about whether people can wait until they get sick to buy health insurance and who’s allowed to buy plans on the state marketplaces, as well as a query about the tax on so-called Cadillac plans.

Q. Let’s say an uninsured person is in a car accident, has emergency surgery and is hospitalized, and after awaking from surgery asks to purchase insurance right away. Under the health law, would his medical costs be covered since he can’t be denied insurance because of a pre-existing medical condition? An article I saw said the hospital would even enroll people and pay their premiums. Is that correct?

A.

It’s unlikely . . .

It’s unlikely that this hypothetical person would be able to sign up for coverage after being injured, says Judith Solomon, a vice president for health policy at the Center on Budget and Policy Priorities. Continue reading

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Family premiums rise modestly for 3rd ear, survey finds

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Family premiums rose 3 percent in 2014, one of the lowest increases tracked since the Kaiser Family Foundation and the Health Research & Educational Trust began surveying employers in 1999. (Kaiser Health News is an editorially independent program of the foundation.)

Family premiums rose 3 percent in 2014, one of the lowest increases since 1999.

Nonetheless, the cost of the average family plan rose to $16,834 annually, according to the survey of more than 2,000 employers nationwide.

While both critics and supporters of the Affordable Care Act are likely to find fodder for their positions, the report portrays 2014 as a relatively stable year for employer coverage, with little change in the type of plans offered or their costs.

The percentage of firms offering health benefits (55 percent) and the percentage of workers covered at those firms (62 percent) were statistically unchanged from 2013, despite predictions of the law’s critics that many firms would drop coverage. Continue reading

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Consumers to hear soon if plans are canceled

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Consumers may soon find a surprise in their mailbox: a notice that their health plan is being canceled.

Last year, many consumers who thought their health plans would be canceled because they didn’t meet the standards of the health law got a reprieve.

.Following stinging criticism for appearing to renege on a promise that people who liked their existing plans could keep them, President Barack Obama backed off plans to require all individual and small group plans that had not been in place before the health law to meet new standards starting in 2014.

The administration initially announced a transitional policy that, with state approval, would allow insurers to renew plans that didn’t comply with coverage or cost standards starting in December 2013 and continue doing so until October 2014.

Then in March, the administration said it would extend the transitional policy for two more years, meaning that some people will be able to hang onto their non-compliant plans through 2017. Continue reading

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Early results: Average 2015 exchange premiums decline slightly

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Photo by Sanja Gjenero

Photo by Sanja Gjenero

By Jay Hancock
KHN

In preliminary but encouraging news for consumers and taxpayers, insurance filings show that average premiums will decline slightly next year in 16 major cities for a benchmark Obamacare plan.

Prices for a benchmark “silver” or mid-priced plan sold through the health law’s online marketplaces aren’t all moving in the same direction, however, a report from the Kaiser Family Foundationn (KFF) shows. (Kaiser Health News is an editorially independent program of the foundation.)

In Nashville, the premium will rise 8.7 percent, the largest increase in the study, while in Denver it will fall 15.6 percent, the largest decrease.

But overall the results, based on available filings, don’t show the double-digit percentage increases that some have anticipated for the second year of marketplace operation.

On average, rates will drop 0.8 percent in the areas studied. Continue reading

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DC Appeals Court to rehear case that could cripple health law

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A judge's wooden gavelBy Julie Rovner
KHN
SEPTEMBER 4TH, 2014

The controversial federal court decision that threatened the future of the Affordable Care Act is no more.

The full District of Columbia Court of Appeals Thursday agreed to rehear Halbig v. Burwell, a case charging that the federal government lacks the authority to provide consumers tax credits in health insurance exchanges not run by states.

A majority of judges on the full appeals court are Democratic appointees, including four appointed by President Barack Obama.

.The order agreeing to hear the case technically cancels the three-judge ruling from July that found for the plaintiffs.

That ruling, if upheld, could jeopardize the entire structure of the Affordable Care Act by making insurance unaffordable for millions of consumers in the 36 states where the federal government operates the exchange. Continue reading

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Health care spending forecast to increase modestly in next decade

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National health spending will increase modestly over the next decade, propelled in part by the gradual rebound of the U.S. economy and the growing ranks of Americans who became insured under the health law, government actuaries projected Wednesday.

But those growth rates are not as high as what the country saw for the two decades before the Great Recession crippled the U.S. economy at the end of 2007, according to the report from the Centers for Medicare & Medicaid Services Office of the Actuary and published in the journal Health Affairs.

The actuaries estimate that health spending grew just 3.6 percent in 2013, the fifth year of historically low rates of spending growth. But it will accelerate to 5.6 percent in 2014.

They also forecast that the average growth rate for 2015-2023 would be 6 percent. That is up just slightly from last year.

The findings also suggest that health care will outpace growth in the gross domestic product over the next decade.

Health care’s share of GDP, which has remained fairly stable since 2009, will rise from 17 percent in 2012 to more than 19 percent in 2023. Continue reading

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