Category Archives: Health Insurance

Doctors order fewer preventive services for Medicaid patients – study finds

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Blue doctorMichelle Andrews
KHN

Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, a recent study found.

The study by researchers at the Urban Institute examined how office-based primary care practices provided five recommended preventive services over a five-year period.

The services were clinical breast exams, pelvic exams, mammograms, Pap tests and depression screening.

The study used data from the National Ambulatory Medical Care Survey, a federal health database of services provided by physicians in office-based settings.

It looked at 12,444 visits to primary care practitioners by privately insured women and 1,519 visits by women who were covered by Medicaid between 2006 and 2010.

That difference reflects the fact that the share of women who are privately insured is seven times larger than those on Medicaid, the researchers said. Pregnancy-related visits and visits to clinics were excluded from the analysis.

Overall, 26 percent of the visits by women with Medicaid included at least one of the five services, compared with 31 percent of the visits by privately insured women. Continue reading

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After court victory, Obama asks GOP to work with him to improve health care

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Obama July 10_2By Mary Agnes Carey
KHN

President Barack Obama called on Republicans Wednesday to find a bipartisan way to fix problems in the nation’s health care system rather than continue to fight over the health law.

“Part of what I’m hoping is with the Supreme Court case now behind us what we can do is … focus on how we can make it even better because it’s not as if we’ve solved all the problems in our health care system,” Obama said in remarks at an elementary school in Nashville, Tenn. “America still spends more on health care than any other advanced nation and our outcomes aren’t particularly better.”

Kaiser Family Foundation poll released Wednesday found 43 percent supporting the law and 40 percent in opposition, much as it has been for the past several months.

In a 6-3 ruling, the high court last week rejected a challenge that would have ended federal premium subsidies in at least 34 states for individuals and families buying insurance through the federal government’s online marketplace.

Such a result would have made coverage unaffordable for millions and created price spirals for those who kept their policies, many experts predicted.

While the president’s law survived its second Supreme Court test in three years, the decision by no means has ended the legal and political assaults from opponents.

Several GOP presidential hopefuls and House Speaker John Boehner, R-Ohio, among others, have continued to call for the law’s repeal. Continue reading

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Your colonoscopy is covered — but surprise! The prep kit may not

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Question Q&ABy Michelle Andrews
KHN

With summer vacations coming up, one reader this week asked about travel insurance, while others had questions about coverage of preventive services, including costs related to colonoscopies.

Q. We know now that anesthesia for a screening colonoscopy is covered with no cost sharing  as a preventive service under the health law. As a plan administrator, I am also struggling to find guidance on how to handle bowel prep kits for colonoscopies. Can you help? Continue reading

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Health care wait times vary greatly across the US

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Sign for an emergency room.Whether you get in to see a doctor on the same day you call for an appointment or have to wait months depends in large part on where you live, according to a new report by the Institute of Medicine.

“Everyone would like to hear the words, ‘How can we help you today?’ when reaching out for health care assistance,” said Gary Kaplan, chair of the study committee that wrote the report, and chairman and chief executive officer of Virginia Mason Health System in Washington state Care with this commitment is feasible and found in practice today, but it is not common. Our report lays out a road map to improve that.” Continue reading

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Same-sex marriage ruling expect to boost coverage among gay couples

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U.S. Supreme CourtBy Jay Hancock
KHN

The right to marry in any state won’t be the only gain for gay couples from last week’s Supreme Court ruling.

The decision will probably boost health insurance among gay couples as same-sex spouses get access to employer plans, say analysts and benefits consultants.

How much is unclear, but “it’s going to increase coverage” in a community that has often had trouble getting access to medical services, said Jennifer Kates, a vice president at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

The logic is simple. Fewer than half of employers that offer health benefits make the insurance available to same-sex partners who aren’t married. Virtually all of them offer coverage to spouses.

By marrying partners with employer health plans, people in same-sex relationships are likely to get coverage in states that banned gay marriage until now.

By marrying partners with employer health plans, people in same-sex relationships are likely to get coverage in states that banned gay marriage until now, as well as in those that welcomed it. Thanks to rapidly shifting legal ground, 37 states recognized gay marriage before last week’s ruling, up from nine in 2012.

New York legalized gay marriage in 2011. The next year, there was a big increase in same-sex couples covered by employer-sponsored health insurance, according to a study published Friday by the Journal of the American Medical Association.

Continue reading

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States struggle with ‘hidden’ rural homelessness

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Stella Dempsey lives in a tent in Fredericksburg, Virginia. She says she’s been homeless for years because of physical and mental health issues. States struggle to help people like Dempsey. (Rollie Hudson)

Stella Dempsey lives in a tent in Fredericksburg, Virginia. She says she’s been homeless for years because of physical and mental health issues. States struggle to help people like Dempsey. (Rollie Hudson)

By Teresa Wiltz
Stateline

FREDERICKSBURG, Virginia—At the Micah Ecumenical Ministries, in the center of this quaint colonial town, Stella Dempsey sits in the waiting room, looking dejected. Ministry staffers offered her a bed at a shelter, but she says she can’t bear to go back. Still, she’s feeling desperate.

She is homeless and jobless and sleeps in a tent in the woods. She’s got cirrhosis of the liver, high blood pressure, diabetes and a bad back. Two months ago, she said, she almost died. Now, she’s run out of all her medications, from her bipolar meds to her insulin. She is not eligible for Medicaid under Virginia law.

“I have nothing until they give me disability,” the former waitress said, her eyes welling. “I’m hoping for help. I need food stamps, a clinic for my meds. … People look down on people who are homeless. They think we’re nasty and no good. But some of us can’t help it. If I could help it, trust me, I would.”

At first blush, Dempsey, 43, doesn’t fit the stereotype of the chronically homeless. She’s neatly dressed in flowered capris, her hazel eyes rimmed with eyeliner. But in Fredericksburg, as in other small towns, suburbs and rural corners of the country, the homeless are often hidden, out of sight and mind, hard to reach and hard to help, say people who work with the homeless. Continue reading

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Half of health law plans offer narrow networks – study

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narrow-networks-570By Michelle Andrews
KHN

If the physician networks for plans sold on the health law’s online insurance exchanges were T-shirts, more than 40 percent would be size X-small or small.

That’s the takeaway from a new study that analyzed nearly 400 physician networks in silver-level plans sold around the country  in 2014.

  • The study labeled 11 percent of plans “extra small” because they covered fewer than 10 percent of physicians in a plan’s region.
  • Another 30 percent were “small,” meaning they covered between 10 and 25 percent of physicians
  • . Just 11 percent of plans were classified as “extra large” because they covered at least 60 percent of physicians in the area.

As consumers shop for coverage on the exchanges, knowing the trade-off between premium price and network size could be important to some, says Kathy Hempstead, director of the coverage team at the Robert Wood Johnson Foundation, which funded the study. Continue reading

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High Court Upholds Health Law Subsidies

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Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

By Jay Hancock
KHN

The Affordable Care Act survived its second Supreme Court test in three years, raising odds for its survival but by no means ending the legal and political assaults on it five years after it became law.

The 6-3 ruling stopped a challenge that would have erased subsidies in at least 34 states for individuals and families buying insurance through the federal government’s online marketplace.

Such a result would have made coverage unaffordable for millions and created price spirals for those who kept their policies, many experts predicted.

Chief Justice John Roberts wrote the opinion for the court, joined by frequent swing vote Anthony Kennedy and the liberal justices Ruth Bader Ginsburg, Stephen Breyer, Sonya Sotomayor and Elana Kagen.

“The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner,” said Roberts. Continue reading

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Not expanding Medicaid can cost local taxpayers

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200px-Flag-map_of_TexasBy Michael Ollove
Stateline

DALLAS — Dallas County property owners paid more than $467million in taxes last year to Parkland Health and Hospital System, the county’s only public hospital, to provide medical care to the poor and uninsured.

Their tax burden likely would have been lower if the state of Texas had elected to expand Medicaid, the federal-state health insurance program for low-income people.

In most states that have chosen not to expand Medicaid, residents pay local taxes to help support hospitals that care for uninsured people.

If more low-income patients at Parkland had been covered by Medicaid, then federal and state taxpayers would have picked up more of the costs.

Elsewhere in Texas and in most of the 20 other states that have chosen not to expand Medicaid, residents pay local taxes to help support hospitals that care for uninsured people.

On top of that, they pay a portion of the federal taxes that help subsidize Medicaid in the 29 states and District of Columbia that did expand the program to cover more people — places where residents can expect to see lower local taxes as more people become insured. Continue reading

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When do workplace wellness programs become coercive?

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ImprimirBy Julie Appleby
KHN

Christine White pays $300 a year more for her health care because she refused to join her former employer’s wellness program, which would have required that she fill out a health questionnaire and join activities like Weight Watchers.

“If I didn’t have the money … I’d have to” participate, says White, 63, a retired groundskeeper from a Portland, Ore., community college.

Like many Americans, White gets her health coverage through an employer that uses financial rewards and penalties to get workers to sign up for wellness programs.

Participation used to be a simple matter — taking optional classes in nutrition or how to stop smoking.

But today, a small but growing number of employers tie those financial rewards to losing weight, exercising or dropping cholesterol or blood-sugar levels — often requiring workers to provide personal health information to private contractors who administer the programs.

The incentives, meanwhile, can add up to hundreds, or even thousands, of dollars a year.

Employers say wellness programs boost workers’ health and productivity while helping companies curb rising health care costs. President Barack Obama’s signature health law allows employers to increase those financial incentives.

But asking workers to undergo medical exams or share personal health information is sharply limited by another law, the 1990 Americans With Disabilities Act (ADA), which prohibits such questioning — except under limited circumstances, such as by voluntary wellness programs.

So what is a voluntary wellness program and when do employer incentives cross the line to become coercive? Continue reading

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Medicare slow to adopt telemedicine due to cost concerns

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telemedicine-5701By Phil Galewitz
KHN

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.

For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor.

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it.

So she turned on her computer and logged on to www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.

“This was so easy,” Miles said.

For Medicare patients, it’s also incredibly rare. Continue reading

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A new focus on family caregivers

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A younger man holds an elderly man's handBy Susan Milligan
Stateline

Iraq war veteran Doug Mercer had been home in McAlester, Oklahoma, for just four days when he was in a motorcycle accident that left him broken and brain-damaged.

His wife Michelle became his caregiver after he left the hospital, but nobody there explained how to transport him safely.  A few weeks later, Michelle struggled as she tried to get Doug from the car to his wheelchair, breaking his leg.

“They’re sending you home, and you’re thinking, ‘What?’ Nobody instructs you, and says, ‘This is what’s coming home with you and how to use it,’” she said.

The Mercers’ story was a driving force behind an Oklahoma law that took effect in November that requires hospitals to train a designated family caregiver to tend to the medical needs of a released patient.

As many as 42 million Americans take care of a family member at any given time.

Since then, 12 more states (Arkansas, Colorado, Connecticut, Indiana, Mississippi, New Hampshire, New Jersey, New Mexico, Nevada, Oregon, Virginia and West Virginia) have approved similar laws. In Illinois and New York, legislation is awaiting the governor’s signature.

As many as 42 million Americans take care of a family member at any given time. Traditionally, family caregivers provide assistance with bathing, dressing and eating. They shop for groceries and manage finances.

But as the number of elderly Americans with chronic conditions has grown, family caregivers have taken on medical tasks once provided only in hospitals, nursing homes or by home care professionals.

In an AARP survey released in 2012, nearly half of family caregivers said they administered multiple medications, cared for wounds, prepared food for special diets, used monitors or operated specialized medical equipment. Continue reading

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