Category Archives: Health Insurance

Medicaid expansion helps cut rate of older, uninsured adults from 12 to 8 percent

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ACA health reform logoBy Michelle Andrews
KHN

The health law’s expansion of Medicaid coverage to adults with incomes over the poverty line was key to reducing the uninsured rate among 50- to 64-year-olds from nearly 12 to 8 percent in 2014, according to a new analysis.

“Clearly most of the gains in coverage were in Medicaid or non-group coverage,” says study co-author Jane Sung, a senior strategic policy adviser at the AARP Public Policy Institute, which conducted the study with the Urban Institute.

Under the health law, adults with incomes up to 138 percent of the federal poverty level ($16,243 for one person in 2015) are eligible for Medicaid if a state decides to expand coverage. Twenty-seven  states  had done so by the end of 2014.

The study found the uninsured rate for people between age 50 and 64 who live in states that haven’t expanded Medicaid was twice as high—11 percent—as for those who live in states that have done so.

More than 2 million people between 50 and 64 gained coverage between December 2013 and December 2014, according to the study. Continue reading

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Most enrolled in exchange plans satisfied with premiums, cost sharing and provider networks, survey finds

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Affordability Remains Significant Concern for Many in Non-Group Plans

ACA health reform logoFollowing the Affordable Care Act’s second open enrollment period, most people enrolled in marketplace plans report being satisfied with a wide range of their plan’s coverage and features, finds a new Kaiser Family Foundation survey of people who buy their own health insurance.

A large majority (74%) of those in marketplace plans rate their coverage as excellent or good, the survey finds.

Most (59%) also say their plan is an excellent or good value for what they pay for it, though the share rating the value as “excellent” declined somewhat from 23 percent last year to 15 percent in the current survey.

Majorities also say they are “very” or “somewhat” satisfied with seven different features of their plans, including:

  • Their choice of primary-care doctors (75%), hospitals (75%) and specialists (64%);
  • What they have to pay out of pocket for doctor visits (73%), prescription drugs (70%) and annual deductible (60%);
  • And their monthly premiums (65%).

To learn more go here.

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Paramedics steer non-emergency patients away from ERs

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By Anna Gorman
KHN

SPARKS, Nev. — Paramedic Ryan Ramsdell pulled up to a single-story house not far from Reno’s towering hotels and casinos in a nondescript Ford Explorer.

No ambulance, no flashing lights. He wasn’t there to rush 68-year-old Earl Mayes to the emergency room. His job was to keep Mayes out of the ER.

Mayes, who has congestive heart failure and chronic lung disease, greeted Ramsdell and told him that his heart was fluttering more than usual. “I had an up-and-down night,” he said.

Paramedic Ryan Ramsdell checks 68-year-old Earl Mayes blood pressure during a home visit on March 26, 2015 in Sparks, Nevada. Ramsdell is part of a community health plan to help reduce avoidable emergency room visits by treating patients at home (Photo by Heidi de Marco/Kaiser Health News).

Paramedic Ryan Ramsdell checks 68-year-old Earl Mayes blood pressure during a home visit on March 26, 2015 in Sparks, Nevada. Ramsdell is part of a community health plan to help reduce avoidable emergency room visits by treating patients at home (Photo by Heidi de Marco/Kaiser Health News).

“Let’s take a look at it,” the paramedic responded, carrying a big red bag with medical supplies. “We’ll put you on the monitor.”

Since Mayes was released from the hospital a few weeks earlier, paramedics had visited him several times to monitor his heart and lungs and make sure he was following his doctor’s orders.

“With these guys coming by and checking me all the time, it makes it so much better,” Mayes said.  “When they leave, you know where you stand.” Continue reading

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What preventive services must be provided for free under the Affordable Care Act?

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Preventive Services Covered Under the Affordable Care A

stethoscope doctor's bag chest x-rayIf you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider.

  • Covered Preventive Services for Adults
  • Covered Preventive Services for Women, Including Pregnant Women
  • Covered Preventive Services for Children

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Learning a new health insurance system the hard way

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By Jenny Gold
KHN

The insurance program was called “Believe Me”  — but Kairis Chiaji had her doubts.

She and her husband Arthur were skeptical that the new health plan they purchased for 2015 would actually work out. That’s because their experience in 2014 had been a disaster, she said.

The Sacramento, Calif., couple had been thrilled to learn last year about the prospect of subsidized coverage under the nation’s health law, she recalled. Each of them had been uninsured for years when they signed up for coverage through the state exchange, Covered California.

“I just thought about how many people who are like me,” explained Kairis, 43, a self-employed natural hairstylist and doula. “If you have a lot of money, you’re covered. If you don’t have any money, you’re covered. When you’re in the middle, working hard every day, that’s when it’s really tough.”

When her children were little she worried about paying for their care if they were injured.

“I just simply told my children, listen, all I’ve got is a ruler and duct tape, so you’re not allowed to break any bones. Literally you can’t get hurt,” she said. Continue reading

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After two years, statewide health care transparency database signed into law – Puget Sound Business Journal

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$100-dollar bill inside a capsuleGov. Jay Inslee signed legislation that will create what’s called an all-payer claims database where health insurers are mandated to provide information about the cost and quality of care.

The database will be open and available to employers, consumers and providers.

Source: After two years, statewide health care transparency database signed into law – Puget Sound Business Journal

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A top-rated nursing home is hard to find in Texas, 10 other states

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Natalie Anne Sealy's headshot.

Natalie Sealy (Photo courtesy of Billie Pender)

LOCKHART, Texas — The call from the nursing home came just before dawn, jolting Martha Sherwood awake.

During the night, fire ants had swarmed over her 85-year-old mother, injecting their stinging venom into Natalie Sealy’s face, arms, hands and chest.

“She was just lying there being eaten alive,” said daughter Billie Pender, who said she and her sister had repeatedly complained about a broken windowsill in their mother’s room at Parkview Nursing and Rehabilitation Center.

In 11 states, 40 percent or more of nursing homes get Medicare’s lowest two lowest rating.

The Sept. 2 attack devastated Sealy, a retired bank teller with dementia. “She went steadily downhill,” dying in late March, said Sherwood, who brought a lawsuit against the home.

Their mother had chosen the for-profit facility two years earlier because it was near her adult children. The family didn’t know that Parkview scored poorly on staffing and other quality measures.

This year, Medicare rates it one star out of a possible five stars — the lowest rating possible — on Nursing Home Compare, which was designed by the federal government to help consumers choose a long-term care facility.

The problem for Sealy’s family and residents of many parts of the country is they have few, if any, higher-rated options if they want their loved ones close by.

In 11 states, 40 percent or more of nursing homes get the two lowest ratings, according to an analysis by the Kaiser Family Foundation.  (Kaiser Health News is an editorially independent program of the foundation.)

states-nursing-homes-ratings-kff-600

Texas has the highest percentage of one-and two-star homes in the country: 51 percent of its nursing homes are rated “below average,” or “much below average,” on Nursing Home Compare, according to the analysis. Louisiana is close behind at 49 percent, with Oklahoma, Georgia and West Virginia tying for third at 46 percent. Continue reading

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Just say no . . .

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Radical Approach To Huge Hospital Bills: Set Your Own Price

Twenty-dollar bill in a pill bottleBy Jay Hancock
KHN

In the late 1990s you could have taken what hospitals charged to administer inpatient chemotherapy and bought a Ford Escort econobox.

Today average chemo charges (not even counting the price of the anti-cancer drugs) are enough to pay for a Lexus GX sport-utility vehicle, government data show.

Hospital prices have risen nearly three times as much as overall inflation since Ronald Reagan was president.

When hospitals send invoices with charges that seem to bear no relationship to their costs, one benefit firm tells its clients to just say no.

Health payers have tried HMOs, accountable care organizations and other innovations to control them, with little effect.

A small benefits consulting firm called ELAP Services is causing commotion by suggesting an alternative: Refuse to pay.

When hospitals send invoices with charges that seem to bear no relationship to their costs, the Pennsylvania firm tells its clients (generally medium-sized employers) to just say no. Continue reading

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‘Free’ contraception means ‘free,’ Obama administration tells insurers

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Birth control patch - Photo by John Heilman, MD under creative commons licesnse

Birth control patch – Photo by John Heilman, MD (CC)

By Phil  Galewitz
KHN

Free means free.

The Obama administration said Monday that health plans must offer for free at least one of every type of prescription birth control — clarifying regulations that left some insurers misinterpreting the Affordable Care Act’s contraceptive mandate.

“Today’s guidance seeks to eliminate any ambiguity,” the Health and Human Services Department said. “Insurers must cover without cost-sharing at least one form of contraception in each of the methods that the Food and Drug Administration has identified … including the ring, the patch and intrauterine devices.”

The ruling comes after reports by the Kaiser Family Foundation and the National Women’s Law Center, an advocacy group, found many insurers were not providing no-cost birth control for all prescription methods. (KHN is an editorially independent project of the Kaiser Family Foundation.) Continue reading

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Home visits by nurses for first-time mothers help reduce costs

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Symphonie Dawson and her son Andrew.

By Michelle Andrews
KHN

Symphonie Dawson was 23 and studying to be a paralegal while working part-time for a temporary staffing agency when she learned that the reason she kept feeling sick was because she was pregnant.

Living with her mom and two siblings near Dallas, Dawson worried about what to expect during pregnancy and what giving birth would be like, not to mention how to juggle having a baby with being in school.

(Photo courtesy of Symphonie Dawson)

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How one hospital brought its C-sections down in a hurry

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In 2012, Hoag Hospital’s cesarean section rate was about 38 percent – five percent higher than the state average.  The Newport Beach hospital has been working to lower the amount of c-sections by stepping up data analysis and patient education (Photo by Heidi de Marco/Kaiser Health News).

In 2012, Hoag Hospital’s cesarean section rate was about 38 percent – five percent higher than the state average.(Photo by Heidi de Marco/Kaiser Health News).

By Anna Gorman
KHN

NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.

A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.

“We were under intense scrutiny,” said Dr. Allyson Brooks, executive medical director of Hoag’s women’s health institute.

The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.

Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of women who had vaginal births after delivering previous children by C-section.

In medicine, this qualifies as a quick turnaround. And the story of how Hoag changed sheds light on what it takes to rapidly improve a hospital’s performance of crucial services, to the benefit of patients, insurers and taxpayers.

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AP-GFK POLL: DOUBTS ON COURT’S FAIRNESS IN HEALTH LAW CASE

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U.S. Supreme CourtMany people in the United States doubt that the Supreme Court can rule fairly in the latest litigation jeopardizing President Barack Obama’s health care law.

The Associated Press-GfK poll finds only 1 person in 10 is highly confident that the justices will rely on objective interpretations of the law rather than their personal opinions.

Nearly half, 48 percent, are not confident of the court’s impartiality.

Source: News from The Associated Press

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Despite law, mental health still gets short shrift

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Illustration of the skull and brainBy Michael Ollove
Stateline

Under federal law, insurance plans that cover mental health must offer benefits that are on par with medical and surgical benefits. Twenty-three states also require some level of parity.

The federal law, approved in 2008, and most of the state ones bar insurers from charging higher copayments and deductibles for mental health services.

  • Insurers must pay for mental health treatment of the same scope and duration as other covered treatments.
  • They can’t require people to get additional authorizations for mental health services.
  • They must offer an equally extensive selection of mental health providers and approved drugs.

Federal and state regulators have an easy time keeping track of copayments and deductibles, and insurers typically follow those rules. Compliance with parity requirements for the actual delivery of medical services is another story.

A Seattle attorney said that some of her clients whose insurance companies denied their mental health or substance use claims appealed to the state of Washington for help, but did not receive any.

The responsibility for enforcing parity laws is divided between the federal government and the states. Under the federal parity law, states are supposed to police commercial insurance plans and Medicaid, although the federal government can step in if it determines states aren’t doing enough. The federal government is responsible for overseeing self-insured plans.

But among states, only California and New York consistently enforce the rules, mental health experts say.

As a result, Americans with mental illness and addictions “don’t have a right to mental health and addiction treatment that the law promises,” said Emily Feinstein of CASAColumbia, a nonprofit organization focused on drug addiction.  Continue reading

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Cataract surgery is fast and safe, but many patients still get costly test before their operation

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EyeBy Michelle Andrews
KHN

Requiring patients to get blood work and other tests before undergoing cataract surgery hasn’t been recommended for more than a dozen years.

There’s good reason for that: The eye surgery generally takes less time than watching a rerun of “Marcus Welby, MD” — just 18 minutes, on average.

“It’s so low risk it’s almost like saying you’re going to get your nails done.”

It’s also incredibly safe, with a less than 1 percent risk of major cardiac problems or death.

Yet more than half of Medicare patients received at least one pre-operative test in the month before undergoing surgery to remove cataracts in 2011, a recent study found. Continue reading

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