Category Archives: Health Insurance

Adminstration to quicken pace towards quality-based Medicare payments

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cms-logo-200pxBy Jordan Rau
KHN

HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments

The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

The announcement by Health and Human Services Secretary Sylvia Burwell is intended to spur efforts to supplant Medicare’s traditional fee-for-service medicine, in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares.

Within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

Since the passage of the federal health law in 2010, the administration has been designing new programs and underwriting experiments to come up with alternate payment models.

Last year, 20 percent of traditional Medicare spending, about $72 billion, went to models such as accountable care organizations, or ACOs, where doctors and others band together to care for patients with the promise of getting a piece of any savings they bring to Medicare, administration officials said.

There are now 424 ACOs, and 105 hospitals and other health care groups that accept bundled payments, where Medicare gives them a fixed sum for each patient, which is supposed to cover not only their initial treatment for a specific ailment but also all the follow-up care.

Other Medicare-funded pilot projects give doctors extra money to coordinate patient care among specialists and seek to get Medicare to work more in harmony with Medicaid, the state-federal health insurer for low-income people.

Burwell’s targets are for 30 percent, or about $113 billion, of Medicare’s traditional spending to go to these kind of endeavors by the end of President Barack Obama’s term in 2016, and 50 percent — about $215 billion — to be spent by the end of 2018. Continue reading

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Uninsured? Beware of the health law’s tax penalty

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The penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent.

By April Dembosky, KQED and Jeff Cohen, WNPR

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is.

“This year taxes and health care intersect in a brand new way. ‘

IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form.

Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

cohen hr block 570

An H&R Block office in Hartford, Conn., is decorated with cardboard cutouts from a national ad campaign on the health law’s tax implications. (Photo by Jeff Cohen/WNPR)

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be much more complex for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges.

To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.” Continue reading

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Texas prisons try telemedicine to curb spending | Dallas Morning News

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200px-Flag-map_of_TexasThe high-tech medical consultation, known as telemedicine, uses technology to connect prisoners, who are often housed in remote areas, with medical experts throughout the state.

It’s just one way that the Texas Department of Criminal Justice is trying to control spending on prison health care. But while telemedicine has shown some success in curbing spending, it hasn’t been enough to stem rising costs due to an aging prison population.

via Texas prisons try telemedicine to curb spending | Dallas Morning News.

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States continue war over Obamacare | Center for Public Integrity

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Center for public integrity logoIn Washington, there’s been little consensus on modifying the health reform law—short of repeated votes in the House to kill or cripple it.

That might change as Republicans take control of the House and Senate, though what fixes, if any, Congress might prescribe—and whether any can get a signature from the President— aren’t clear.

But in state capitals around the country, from Albany and Columbia to Austin and Sacramento, lawmakers have been mulling over hundreds of proposals that reflect a myriad of starkly different views on Obamacare as settled law.

via States continue war over Obamacare | Center for Public Integrity.

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Renewing customers urged to take immediate action to continue 2015 coverage

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Washington Healthplanfinder Urges Renewing Customers to Take Immediate Action to Continue 2015 Health Coverage

Thousands of Customers Have Not Yet Taken Action; Next Deadline to Enroll is Jan. 23

 The Washington Health Benefit Exchange is urging 2014 customers who have not yet renewed their coverage for 2015 to return as soon as possible to continue their health plan this year.

“There is still time to come back and get enrolled, but time is running out.”

Customers who were unable to renew by the Dec. 23 deadline or were unaware of additional action needed on their account may be eligible for a special 60-day enrollment opportunity. These customers should fill out an online form to initiate eligibility for retroactive coverage that begins on Jan. 1.

Up to 4,000 customers have completed an application for 2015 coverage but did not submit payment by the Dec. 23 deadline for coverage that began on Jan. 1. 

These applications will be reviewed by Exchange staff to ensure that eligible individuals are able to receive retroactive coverage.

“There is still time to come back and get enrolled, but time is running out,” said Richard Onizuka, CEO for the Washington Health Benefit Exchange. “Customers should contact us as soon as possible if they need assistance with their application.” Continue reading

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High court considers if providers can sue states for higher Medicaid pay

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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 Phil Galewitz
KHN

The U.S. Supreme Court heard arguments Tuesday in a case that could block hospitals, doctors — or anyone else — from suing states over inadequate payment rates for providers who participate in the Medicaid program for low-income Americans.

Many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

Federal law requires Medicaid, which covers 70 million people, to provide the same access to care as that given to people with private insurance. But many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

In Armstrong vs. Exceptional Child Center, several providers for developmentally disabled Medicaid patients sued the state of Idaho after officials failed to increase Medicaid payments as required under a formula approved by the federal government.

An appellate court upheld a judgment in favor of the providers last year, noting that Idaho had conceded that it held rates flat since 2006 for “purely budgetary reasons.”

The issue before the high court is whether the U.S. Constitution gives providers the right to sue the state to increase their pay. And the court appeared split on that issue based on their remarks Tuesday. Continue reading

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Sen. Hatch vows to dismantle health law but predicts bipartisan success on other issues

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Screen Shot 2015-01-20 at 2.54.48 PMBy Mary Agnes Carey
KHN

While Republicans cannot expect a full repeal of the health law while President Barack Obama remains in office, the GOP intends to “strike away at it, piece by piece,” Senate Finance Committee Chairman Orrin Hatch, R-Utah, said Tuesday.

But in a speech at the U.S. Chamber of Commerce, Hatch also said he expected that Republican and Democratic lawmakers would work together on several other key pieces of health legislation.

Hatch said there may be more bipartisanship in some “must pass items,” including continued funding for the Children’s Health Insurance Program and overhauling the way Medicare pays physicians, known as the “sustainable growth rate.”

On CHIP, Hatch said the Finance Committee has “heard from a number of governors from red states and blue stakes alike that they want to see this program extended. It has been a marvelous program. It has worked very, very well. I’m optimistic that we can work on a bipartisan, bicameral basis to extend CHIP in a responsible way.” Continue reading

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Obama expected to defend health law in State of the Union address

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President Obama will deliver his State of the Union address tonight at 9 p.m. ET.

To watch online go to: WhiteHouse.gov/SOTU.

The site will include interactive features that make clear what the President’s proposals mean for you, and shareable charts and stats that help supplement and expand on the points you’ll hear Obama make. If you’re watching on your TV, you can still follow along on your phone or tablet.

Watch Tonight

 

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Once, same-sex couples couldn’t wed; Now, some employers say they must

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EqualBy Julie Appleby
KHN

Until recently, same-sex couples could not legally marry. Now, some are finding they must wed if they want to keep their partner’s job-based health insurance and other benefits.

With same-sex marriage now legal in 35 states and the District of Columbia, some employers that formerly covered domestic partners say they will require marriage licenses for workers who want those perks.

“We’re bringing our benefits in line, making them consistent with what we do for everyone else.”

“We’re bringing our benefits in line, making them consistent with what we do for everyone else,” said Ray McConville, a spokesman for Verizon, which notified non-union employees in July that domestic partners in states where same-sex marriage is legal must wed if they want to qualify for such benefits.

Employers making the changes say that since couples now have the legal right to marry, they no longer need to provide an alternative. Such rule changes could also apply to opposite-sex partners covered under domestic partner arrangements.

“The biggest question is: Will companies get rid of benefit programs for unmarried partners?” said Todd Solomon, a partner at McDermott Will & Emery in Chicago. Continue reading

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Health and Human Services chief calls for Congress to work with her on health issues

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Official portrait of the Secretary of Health & Human Services Sylvia Mathews BurwellBy Mary Agnes Carey
KHN

Department of Health and Human Services Secretary Sylvia M. Burwell Thursday called on Congress to look beyond the Affordable Care Act to find compromise on health care.

In remarks at the New America Foundation, Burwell cited several areas – including opioid abuse, Ebola, medical research and innovation – where Republicans and Democrats have sponsored legislation to work together to solve problems in the nation’s health care system.

As she has before, Burwell defended the health overhaul and urged Congress to “move beyond the back and forth of the Affordable Care Act and focus on the substance of access, affordability and quality.”\

She makes no apologies for the law, which Republicans have voted numerous times to repeal in full or in part. That effort is expected to be part of the discussions this week at Republican lawmakers’ retreats.

But those disagreements should not stop Congress from also focusing on “other critical areas in health care where our common interests give us ample opportunities for common good – improving the quality of the care we receive while spending our dollars more wisely, reducing substance use disorders and overdose deaths, strengthening global health security, reaffirming American leadership in research, innovation and science, and building an innovation economy,” Burwell said. Continue reading

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Hospital prices grow at slowest rate in a decade – Modern Healthcare

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Hospital Entrance SignThe price for acute-care hospital care increased last year at its slowest pace in the 10 years for which comparable data is available, Producer Price Index figures show.

The Producer Price Index for acute-care hospitals increased 0.7% in the 12 months that ended in December. That’s well below the annual average of 2.7% recorded by the U.S. Bureau of Labor Statistics since 2004.

via Hospital prices grow at slowest rate in a decade – Modern Healthcare.

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Premiums highest in Alaska, lowest in the Sunbelt

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By Jordan Rau
KHN

In health insurance prices, as in the weather, Alaska and the Sun Belt are extremes. This year Alaska is the most expensive health insurance market for people who do not get coverage through their employers, while Phoenix, Albuquerque, N.M., and Tucson, Ariz., are among the very cheapest.

1000px-Alaska_area_compared_to_conterminous_US

Map courtesy of Eric Gaba – via Wikimedia Commons under Creative Commons license

In this second year of the insurance marketplaces created by the federal health law, the most expensive premiums are in rural spots around the nation: Wyoming, rural Nevada, patches of inland California and the southernmost county in Mississippi, according to an analysis by the Kaiser Family Foundation, which has compiled premium prices from around the country. (KHN is an editorially independent program of the foundation.)

Alaska health premiums, at $488 per month the highest in the nation, are triple those in Phoenix ($166).

The most and least expensive regions are determined by the monthly premium for the least expensive “silver” level plan, which is the type most consumers buy and covers on average 70 percent of medical expenses. Premiums in the priciest areas are triple those in the least expensive areas.

Along with the three southwestern cities, the places with the lowest premiums include Louisville, Ky., Pittsburgh and western Pennsylvania, Knoxville and Memphis, Tenn., and Minneapolis-St. Paul and many of its suburbs, the analysis found.

Starting this month, the cheapest silver plan for a 40-year-old in Alaska costs $488 a month. (Not everyone will have to pay that much because the health law subsidizes premiums for low-and moderate-income people.) A 40-year-old Phoenix resident could pay as little as $166 for the same level plan.

Highest and Lowest Premiums

Here are the 10 most and least expensive regions in the country – with the counties listed in parenthesis – based on premium prices for the lowest-cost silver plan. Regions are counties that share the same price for the same lowest-cost-plan and are either geographically contiguous or are part of the same rating area created by the state.

Premiums are listed for 40-year-olds; and for most states the difference in prices stays the same for people of any age. Vermont and two upstate New York areas— Ithaca and Plattsburgh—also are among the 10 most expensive places, although those states do not let insurers adjust premiums based on the consumer’s age, making comparisons inexact.

Older residents in those states will end up getting better deals than in most places, while younger ones tend to pay more.

10 Highest Premiums

$488 Alaska (entire state)
$459 Ithaca, NY (Tompkins)
$456 Bay St. Louis, Mississippi (Hancock)
$446 Plattsburgh, NY (Clinton)
$440 Rural Wyoming (Albany, Big Horn, Campbell, Carbon, Converse, Crook, Fremont, Goshen, Hot Springs, Johnson, Lincoln, Niobrara, Park, Platte, Sheridan, Sublette, Sweetwater, Teton, Uinta, Washakie, and Weston)
$428 Vermont (entire state)
$418 Rural Nevada (Churchill, Elko, Eureka, Humboldt, Lander, Mineral, Pershing, and White Pine)
$412 Casper, Wyoming (Natrona)
$410 Inland California (Imperial, Inyo, and Mono)
$401 Cheyenne, Wyoming (Laramie)

10 Lowest Premiums

$166 Phoenix, Ariz. (Maricopa)
$167 Albuquerque, N.M. (Bernalillo, Sandoval, Torrance, and Valencia)
$167 Louisville, Ky. (Bullitt, Jefferson, Oldham, and Shelby)
$170 Tucson, Ariz. (Pima and Santa Cruz)
$170 Pittsburgh, Pa. (Allegheny and Erie)
$179 Western Pennsylvania (Beaver, Butler, Washington, Westmoreland, Armstrong, Crawford, Fayette, Greene, Indiana, Lawrence, McKean, Mercer, and Warren)
$181 Knoxville and Eastern Tennessee (Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Roane, Scott, Sevier, and Union)
$181 Minneapolis-St. Paul (Anoka, Benton, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne, Stearns, Washington, and Wright)
$184 Memphis and suburbs (Fayette, Haywood, Lauderdale, Shelby, and Tipton)
$189 North of Minneapolis (Chisago and Isanti)

That three-fold spread is similar to the gap between last year’s most expensive area — in the Colorado mountain resort region, where 40-year-olds paid $483—and the least expensive, the Minneapolis-St. Paul metro area, where they paid $154. Continue reading

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Today’s the January 15 deadline. Don’t miss it.

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Today’s the January 15 deadline. Don’t miss it.

If you don’t enroll in a health insurance plan before the end of open enrollment, you won’t have coverage for 2015, and you could have to pay for all of your medical expenses for the year. Enroll today before it’s too late.

HCGOV Apply Now

4 out of 5 people got financial assistance to help lower the cost of premiums in the first month of open enrollment.

Join the nearly 6.8 million people who have already signed up through HealthCare.gov.

This is too important to put off. Enroll today so your coverage can begin on the first of the month.

The HealthCare.gov Team


Need help? See tips for getting started.

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