Category Archives: Health Insurance

Insurers should be current on emerging treatments for consumers

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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

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Obamacare enrollment tops expectations

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By Phil Galewitz
KHN

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 healthcare.gov 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 healthcare.gov exchange that handles 37 states. The rest, 3.1 million, selected a plan through the 13 state-based marketplaces.

About 4 million enrollees on healthcare.gov 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.

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A voter’s guide to the health law

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GOP LogoBy Julie Rovner
KNH

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

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Licking wounds, insurers move to limit health-law enrollment

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Twenty-dollar bill in medicine bottleBy Jay Hancock
KHN

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

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Uninsured rate in Washington state drops by half to 7.3 percent

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From the Office of the Insurance Commissioner

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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

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

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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.

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After Texas stopped funding Planned Parenthood, low-income women had more babies – LA Times

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200px-Flag-map_of_TexasThe state of Texas’ sustained campaign against Planned Parenthood and other family planning clinics affiliated with abortion providers appears to have led to an increase in births among low-income women who lost access to affordable and effective birth control, a new study says.

The analysis, published Wednesday in the New England Journal of Medicine, documents a significant increase in births among women who had previously received birth control at clinics that no longer get state funding.

Source: After Texas stopped funding Planned Parenthood, low-income women had more babies – LA Times

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

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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
KHN

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

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Washington health insurance exchange enrollment jumps 25%

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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 wahealthplanfinder.org.

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

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California voters to have their say on drug prices

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Twenty-dollar bill in a pill bottleBy Anna Gorman
KHN

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.

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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

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Despite kvetching, most consumers satisfied with health plans, poll

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By Jordan Rau
KHN

Bashing insurance companies may be a popular pastime, but a poll released Thursday found most people were satisfied with their choices of doctors and even thought the cost of their health coverage was reasonable.

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The Kaiser Family Foundation poll revealed that 71 percent of insured adults younger than 65 considered the health care services they receive to be either “excellent” or “good” values. (KHN is an editorially independent program of the foundation.)

A majority — 61 percent — said their insurance plan was either excellent or good, given its cost.

A majority — 61 percent — said their insurance plan was either excellent or good, given its cost.

While many insurance plans are limiting the networks of doctors and hospitals to restrain prices, the survey found that a majority of people didn’t mind.

Fifty-four percent of insured adults younger than 65 said they were “very satisfied” with their selection of doctors. Another 34 percent said they were “somewhat satisfied.”

Only 12 percent said they had to change doctors because they were not covered by their insurance plan.

People lacking insurance — frequently because they found it too expensive — were less pleased with the value of their health care services. Forty-eight percent considered those services to be “only a fair” or “poor” value: nearly double the percentage of those with coverage who thought their care wasn’t worth the money.

The poll found health care was not a top priority for voters in the upcoming presidential election. Only 6 percent of registered voters considered the cost of health care and insurance to be the most important factor in their presidential choice, fewer than those who were focused on the economy and jobs, terrorism or gun control.

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Twenty-eight percent did say health care costs would be “extremely important” in determining who they would vote for. About the same number expressed similar concern about gun control, the situation in Iraq and Syria, and dissatisfaction with government.

 

Just 4 percent ranked the 2010 health care law as their highest concern — fewer than those who were focused on the economy and jobs, terrorism, dissatisfaction with government or gun control. Republican candidates have been promising to repeal the law if elected president. Continue reading

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Final call for 2016 coverage

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Washington Healthplanfinder Delivers Final Call for 2016 Coverage

Residents have until Sunday, Jan. 31 to sign up for health insurance, avoid higher tax penalties

clockThe Washington Health Benefit Exchange today issued a reminder to those individuals and families still needing to sign up for 2016 health coverage that they have until 11:59 p.m. this Sunday, Jan. 31, to confirm the selection of a health insurance plan through Washington Healthplanfinder.

As important, residents who fail to select a 2016 health plan face possible tax penalties from the IRS and could be required to wait until next year to sign up for health coverage, officials said.

Residents who fail to select a 2016 health plan face possible tax penalties from the IRS

The Exchange advises customers to take immediate action to review their health plan options and sign up for a Qualified Health Plan that best meets their needs and budget.

“With only a few days remaining until the Jan. 31 deadline, we are urging all those who have not selected a 2016 health plan to take the necessary steps to get covered,” said Pam MacEwan, CEO of the Washington Health Benefit Exchange. “Our customer support network is available now to help residents locate affordable health insurance options that meet their individual needs.”

Washingtonians who have not yet signed up for coverage may access assistance offered through the Exchange including: Continue reading

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Consumers cut costs by combining limited coverage plans, despite risk of penalties

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By Michelle Andrews
KHN

Last fall, Shalonda Brown decided she’d had it with paying nearly $1,000 a month for a family health, dental and vision plan through her job at an independent lab in Dallas. Casting about for an alternative, she checked out individual family plans on healthcare.gov. No dice: Their income was too high to qualify for subsidies and comparable coverage wouldn’t be any cheaper.

So Brown instead cobbled together three different policies that each provide limited coverage for her, her husband and 2-year-old daughter:

  •  a short-term plan with a $10,000 deductible that provides up to $1 million in coverage for just under a year;
  •  a critical illness plan that pays a $20,000 lump sum if one of them is diagnosed with invasive cancer, heart attack or stroke; and a dental plan that provides $1,000 in coverage.

The total monthly tab: $390.

Faced with sky-high premiums and high deductibles for traditional plans, it’s not surprising that some people are looking at other options, experts say.

“I feel like it’s just giving me everything I need as of right now,” said Brown, 31. “Me and my family, knock on wood, there’s nothing urgent or major to deal with now.”

Under the health law, most people are required to have insurance that meets minimum standards or pay a fine. Limited benefit policies such as short-term, critical illness, accident, dental and vision plans don’t qualify.

In 2016, the penalty is $695 per adult and $347.50 per child, or 2.5 percent of household income, whichever is greater.

Brown knows she’ll face a penalty if her family doesn’t have comprehensive coverage this year, but she’s willing to pay the fine. “When I look at what I’m saving having a short-term plan versus regular insurance, it’ll balance out,” she said.

Faced with sky-high premiums and high deductibles for traditional plans, it’s not surprising that some people are looking at other options, experts say. Continue reading

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Is Medicaid expansion near a tipping point?

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By Christine Vestal
Stateline

Louisiana this month became the first state in the Deep South to make the politically charged decision to expand Medicaid health insurance to low-income adults under the Affordable Care Act.

At least one other state — South Dakota — is expected to extend Medicaid coverage this year. But in the lead up to the November presidential election, supporters of the ACA aren’t holding out much hope that more states will join in extending Medicaid coverage to more people — although the governors of Alabama, Virginia and Wyoming say they want to, as do key legislators in Maine and Nebraska.

“The ideological opposition to the president will have to start fading when he’s out of office. At that point, the facts and the evidence will start to matter more.”

Meanwhile, newly elected Republican Gov. Matt Bevin in Kentucky and Republican lawmakers in Arkansas are threatening to roll back or modify their states’ existing expansion programs.

After a new president is elected, the situation could change and more states could join in expanding coverage, predicted Joan Alker, executive director of Georgetown University’s Center for Children and Families, which advocates for greater health care coverage for the poor.

Ever since the Supreme Court’s 2012 decision making Medicaid expansion a state option, the issue has been more political than practical.

Many Republican governors and lawmakers have rejected the deal, fearing they would lose their jobs if they were seen cooperating with President Barack Obama on a law most conservatives abhor.

With Obama out of office, that could change. “The ideological opposition to the president will have to start fading when he’s out of office,” Alker said. “At that point, the facts and the evidence will start to matter more.”   Continue reading

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