Category Archives: Health Insurance

Patients Not Hurt When Their Hospitals Close, Study Finds

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By Jordan Rau
KHN

A hospital closure can send tremors through a city or town, leaving residents fearful about how they will be cared for in emergencies and serious illnesses. A study released Monday offers some comfort, finding that when hospitals shut down, death rates and other markers of quality generally do not worsen.

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Researchers at the Harvard School of Public Health examined 195 hospital closures between 2003 and 2011, looking at health experiences in the year before and the year after the hospital went out of business.

Their paper, published in the journal Health Affairs, found that changes in death rates of people on Medicare — both those who had been in the hospital and among the broader populace — were no different than those for people in similar places where no hospital had closed.

While the researchers noted that some people might be inconvenienced by having to travel further for care, they found no significant changes in how often Medicare beneficiaries were admitted to hospitals, how long they stayed or how much their care cost.

The closed hospitals tended to be financially troubled, with revenues averaging 13 percent less than the cost of running the institutions.

“It’s possible that we didn’t see any change in outcomes because patients instead went to nearby hospitals that had better finances and may have had more resources to provide care,” said Dr. Karen Joynt, the lead researcher on the study.

She cautioned that the study looked at the average experience of a hospital closure and should not be interpreted to mean that every hospital loss is harmless. “I would be shocked if you couldn’t find an example where access is really threatened,” she said. Continue reading

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Paying Medicaid enrollees to get check ups, quit smoking and low weight: Will It pay off?

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wellness-incentive-570By Phil Galewitz
KHN

When Bruce Hodgins went to the doctor for a checkup in Sioux City, Iowa, he was asked to complete a lengthy survey to gauge his health risks.

In return for filling it out, he saved a $10 monthly premium for his Medicaid coverage.

In Las Cruces, N.M., Isabel Juarez had her eyes tested, her teeth cleaned and recorded how many steps she walked with a pedometer.

In exchange, she received a $100 gift card from Medicaid to help her buy health care products including mouthwash, vitamins, soap and toothpaste.

Taking a cue from workplace wellness programs, Iowa and New Mexico are among more than a dozen states offering incentives to Medicaid beneficiaries to get them to make healthier decisions — and potentially save money for the state-federal health insurance program for the poor.

The stakes are huge because Medicaid enrollees are more likely to engage in unhealthy practices, such as smoking, and are less likely to get preventive care, studies show. Continue reading

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Running out of money is more than just a worry for many seniors, study finds

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clockBy Michelle Andrews
KHN

For many older people and their families, particularly those dealing with conditions such as Alzheimer’s or cancer that often require long-term, pricey medical care, running out of money is a nagging concern.

Families are right to be worried, according to a new study that analyzed data from nearly 1,200 people who died between 2010 and 2012 and who participated in the University of Michigan’s ongoing national Health and Retirement Study.

Among people who were age 85 or older when they died,  one in five had no assets left apart from their homes, and 12 percent had no assets left at all, only income from sources such as Social Security or pensions.

Among people who were age 85 or older when they died,  one in five had no assets left apart from their homes, and 12 percent had no assets left at all, only income from sources such as Social Security or pensions.

The analysis by the Employee Benefit Research Institute found that those who died younger were even worse off.

Among people who died between age 50 and 64, 30 percent were without assets and 37 percent had only their homes. Continue reading

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The Doctor Will Video Chat With You Now: Insurer Covers Virtual Visits – NPR

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you can live stream movies, why not live stream medical care?

Insurance company UnitedHealthcare will start covering visits to the doctor’s office — via video chat. Patients and physicians talk live online — on smartphones, tablets or home computer — to get to a clinical diagnosis.

This move to cybermedicine could save insurers a ton of money — or have unintended consequences.

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An Obamacare payment reform success story

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 One Health System, Two Procedures

By Jay Hancock/KHN

200px-Flag-map_of_TexasTo understand how the health law is supposed to fix the mediocre, overpriced, absurd medical system, you could read wonky research papers on bundled payments and accountable care organizations.

Or you could look at what’s going on at Baptist Health System in San Antonio.

Under the potent lure of profit, doctors, nurses and managers at Baptist’s five hospitals have joined forces to cut costs for hip and knee replacements, getting patients on their feet sooner and saving taxpayers money.

“What we’ve seen is just incredible from a cost savings standpoint.”

“Everybody was aligned on this,” said Michael Zucker, Baptist’s chief development officer. “What we’ve seen is just incredible from a cost savings standpoint.”

Baptist made money doing what used to be industry heresy: reducing patients’ use of the medical system.

The hospital group made a deal with Medicare, the huge government program for seniors, as part of an ambitious array of experiments authorized by the Affordable Care Act.

Medicare let Baptist take responsibility for the whole process of replacing knees and hips, from admission to surgery to rehab and anything else that happened within a month. (Traditionally the system, essentially tied with Methodist Health System as the region’s biggest, managed only what happens within its doors.)

Then Medicare lowered the average amount of what it pays for all that care by 3 percent, giving Baptist a lump sum for each patient getting the procedures. If the system and its orthopedic surgeons reduced costs below that price, they could keep the difference and divvy it up so long as quality didn’t suffer. If costs went up, Baptist was on the hook.

This is a purified form of the health law’s recipe to save health care: Get hospitals, doctors and other providers to work together. Cap their costs. Offer incentives to save and penalties for breaking the budget. Repeat.

preliminary study of the tests at Baptist and elsewhere, overseen by the health law’s Center for Medicare & Medicaid Innovation, found substantial savings along with shorter patient stays in the hospital and lower use of expensive nursing facilities afterward. Continue reading

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More evidence health plans stint on mandated birth control coverage

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Woman's HeadBy Julie Rovner
KHN

Women’s health advocates were thrilled when the Affordable Care Act became law in 2010, because it required insurance companies to cover a broad array of women’s health services at no additional out-of-pocket cost beyond premiums.

Five years later, however, that requirement is not being enforced, according to two new studies. Health insurance plans around the country are failing to provide many of those legally-mandated services including birth control and cancer screenings.

The studies by the National Women’s Law Center looked at health plan coverage documents and consumer complaints in 15 states. One of the studies focused on contraception, while the other looked at a range of women’s health issues, including maternity care, breast-feeding support and other services.

“We found some very clear violations of the law,” said Karen Davenport, the group’s director of health policy. Among the companies named as not complying with the law’s requirements in at least some states are Aetna, Cigna, Physicians Plus and Anthem Blue Cross Blue Shield. Continue reading

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Women’s Group Says Insurers Aren’t Meeting Health-Law Requirements – WSJ

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Woman's HeadThe National Women’s Law Center, a feminist group that strongly backs the health law, said in a report that it had found widespread violations across more than a dozen states where it investigated new plans sold on the exchanges.

The center, which is based in Washington, D.C., also said it had received complaints on a hotline from women in every state about how the rules were working, including in coverage provided by an employer.

Source: Women’s Group Says Insurers Aren’t Meeting Health-Law Requirements – WSJ

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Only 1 day left to get 2015 coverage

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HCGOV Medium Seal Update

Only 1 day left to get 2015 coverage

The Special Enrollment Period ends this Thursday, April 30.

If you owed the fee for not having coverage in 2014, take advantage of this chance to get covered for 2015. To beat the deadline, you must enroll by April 30.

Get covered, avoid the fee. The fee for people who don’t have health coverageincreases in 2015 to $325 per person or 2% of your household income – whichever is greater. If you don’t sign up for health coverage, you won’t be covered this year and will risk having to pay the fee again next year. Take a few minutes today to learn about the options that are available and enroll in a plan that meets your needs.

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Financial help is available: With tax credits through the Marketplace, 8 out of 10 people can find coverage for $100 or less a month.

We hope you take advantage of this extended opportunity to get quality coverage this year.

The HealthCare.gov Team

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How getting married affects health insurance tax credits

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uninsured-570By Michelle Andrews
KHN

This week I answered questions from people about health insurance cost and coverage rules, including how getting married or working here as a foreign national may affect them.

Q. Last year, I had single coverage through the marketplace from January through May. Then I got married and canceled my policy because I had coverage through my husband’s job for the rest of the year. When I filed my 2014 taxes, we had to repay half of the premium tax credits for the months when I had a marketplace plan. Why? Those first five months I was single and relying on my own income. Why should my husband’s income be counted?

A. The Internal Revenue Service has a special rule to handle situations like yours when people get married during the tax year. Though not a perfect solution, without it, chances are you would have had to repay even more of your tax credit.

First, some background: The premium tax credits that people can qualify for if their income is under 400 percent of the federal poverty level (about $46,000 for one person) make coverage purchased on the health insurance marketplace more affordable.

Like you, many people opt to receive the credit in advance and have it sent directly to their insurer, which reduces their monthly bill.

The amount of the tax credit is based on your annual household income, which you estimated when you signed up for coverage. At tax time, your estimated income is reconciled against your actual income and, if the estimate was too low, you have you repay the excess, up to a cap.

That’s the situation you found yourself in. However, when people marry during the tax year, the IRS offers an alternative way of calculating household income that for many reduces the excess premium tax credit they have to repay. Continue reading

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Time is running out!

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Special Enrollment Period: Time is running out

The Special Enrollment Period ends next week.

The Health Insurance Marketplace is providing individuals and families who paid the fee for not having health coverage when they filed their 2014 taxes with one last chance to get covered for 2015.

Get covered, avoid the fee. The fee for people who don’t have health coverage increases in 2015 to $325 per person or 2% of your household income – whichever is greater. The good news is you have until April 30 to learn about the options and financial assistance that is available and to enroll in a plan that meets your needs.

hcgov get coverage with arrow

Join the millions who are saving: 8 out of 10 people can find coverage for $100 or less a month with tax credits through the Marketplace.

We hope you take advantage of this extended opportunity to get quality coverage this year.

The HealthCare.gov Team

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Few using quality and price information to make health decisions

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Shopping cart redBy Jordan Rau
KHN

Despite the government’s push to make health information more available, few people use concrete information about doctors or hospitals to obtain better care at lower prices, according to a poll released Tuesday.

Prices for the health care industry have historically been concealed and convoluted, unlike those for most other businesses. The 2010 health law aimed to make such information more transparent.

Only one in five people say they had seen specific cost or quality information about a hospital, insurer or doctor.

People shopping for insurance can now compare the prices of competing plans through online marketplaces, including premiums, deductibles and their share of any medical expenses.

The federal government also publishes more than 100 quality ratings about hospitals, as do some large private insurers.

Private groups such as Consumer Reports and U.S. News & World Report also rate providers, and Internet forums such as Yelp are now littered with easily accessible opinions.

The poll from the Kaiser Family Foundation found that about two of three people say it is still difficult to know how much specific doctors or hospitals charge for medical treatments or procedures. (KHN is an independent program of the foundation.)

Only about one in five people said they had seen specific cost or quality information about a hospital, insurer or doctor.

The poll found that this information rarely makes a difference. About 6 percent of people ever used quality information in making a decision regarding an insurer, hospital or doctor. And fewer than 9 percent used information about prices, most commonly in relation to health plans. Only 3 percent said they used price information about physicians, the poll found. Continue reading

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Medicare & Medicaid at 50 – Video

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With Medicare and Medicaid turning 50 this year, the Kaiser Family Foundation produced an updated video that provides a brief history of both programs, including an examination of the health care, social and political landscapes that gave rise to them, the significant ways each program has evolved over five decades and the important roles they play in the U.S. health care system today.

The video includes archival footage, as well as commentary and perspective from policymakers, government officials and experts.

To learn more about Medicare go to the Kaiser Family Foundation Medicare webpage.

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Bloomberg Politics Poll: Majority of Americans Say Obamacare Should Get Time to Work

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-1x-1Fifty-one percent of U.S. adults say that while the Affordable Care Act may still require small changes, “we should see how it works,” according to a new Bloomberg Politics poll.

Twelve percent said President Barack Obama’s signature legislative accomplishment should be left alone, 35 percent said it should be repealed, and two percent said they weren’t sure.

via Bloomberg Politics Poll: Majority of Americans Say Obamacare Should Get Time to Work – Bloomberg Politics.

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Administration proposal for workplace wellness programs earns business praise, consumer concerns

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431px-Lewis_Hine_Power_house_mechanic_working_on_steam_pumpBy Michelle AndrewS
KHN

Business groups praised a proposed new rule from the Equal Employment Opportunity Commission clarifying how employers can construct wellness programs, but consumers advocates said the new policy could harm workers.

The EEOC published the long-awaited rule Thursday.

“This is a big step forward, primarily because the EEOC has defined what it means for a wellness program to be voluntary,” says Steve Wojcik, vice president for public policy at the National Business Group on Health, which represents large employers.

The Americans With Disabilities Act prohibits employers from discriminating against workers based on their health. But they can ask workers for details about their health and conduct medical exams as part of a voluntary wellness program.

Before this proposal was unveiled, employers and consumer advocates alike had been uncertain how the commission defined voluntary. Continue reading

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Some states pay doctors more to treat Medicaid patients

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Blue doctorBy Michael Ollove
Stateline

Fifteen states are betting they can convince more doctors to accept the growing number of patients covered by Medicaid with a simple incentive: more money.

The Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services—but only temporarily. The federal spigot ran dry on Jan. 1.

Fearing that lowering the rates would exacerbate the shortage of primary care doctors willing to accept patients on Medicaid, the 15 states are dipping into their own coffers to continue to pay the doctors more.

It seems to be working. Continue reading

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