Category Archives: Health Insurance

Medicaid’s raise for primary care docs to disappear

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Twenty-dollar bill in a pill bottleBy Michael Ollove
Stateline

A temporary bump in Medicaid fees paid to primary care doctors, an Affordable Care Act provision intended to get more physicians to accept Medicaid patients, will expire at the end of this month.

Congress did not extend the higher rates, so unless states take action themselves or the new Congress revisits the issue, primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January, according to a new report from the Urban Institute.

Unless action is taken primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January.

Whether the expiration of the fee increase will make a difference in physician participation in Medicaid is unknown. That is because there hasn’t been enough time to analyze whether the hike actually convinced primary care doctors to take Medicaid patients.

“It’s expiring before it’s been evaluated,” said Sandra Decker, a researcher at the National Center for Health Statistics, an arm of the Centers for Disease Control and Prevention.

Decker, who has published widely on the Medicaid physician workforce, said she will analyze the impact of the fee increase, but doubts her results will be complete before the end of next year.

Still, she noted, past evidence indicates that Medicaid pay increases spur participation by physicians. She predicted that the lower fees will make it harder for Medicaid patients to find doctors willing to see them or that they will have to endure long waits to see doctors who accept Medicaid patients.

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Public easily swayed by arguments for and against employer mandate, poll

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Yes-No-MaybeBy Julie Rovner
KHN

Just days before the requirement for most large employers to provide health insurance takes effect, a new poll finds the public easily swayed over arguments for and against the policy.

Six in 10 respondents to the monthly tracking poll from the Kaiser Family Foundation (Kaiser Health News is an editorially independent program of the foundation) said they generally favor the requirement that firms with more than 100 workers pay a fine if they do not offer workers coverage.

But minimal follow-up information can have a major effect on their viewpoint, the poll found.

kaiser poll

For example, when people who support the “employer mandate” were told that employers might respond to the requirement by moving workers from full-time to part time, support dropped from 60 percent to 27 percent.

And when people who disapprove of the policy were told that most large employers will not be affected because they already provide insurance, support surged to 76 percent.

Opinion also remains malleable about the requirement for most people to have health insurance – the so-called “individual mandate.”

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State wins $65 million to improve health care

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Washington MapFrom the Washington State Health Care Authority

Washington won a $65 million grant to bolster health care innovation in the state, Gov. Jay Inslee announced today.

Awarded by the Center for Medicare and Medicaid Innovation (CMMI), the federal grant supports the Healthier Washington project developed through a collaboration of state leaders, the Legislature, health care systems and community members.

Healthier Washington’s purpose is to achieve the “Triple Aim” for the state’s population: better health, better care, and lower costs.

Goals of the plan:

  1. Build healthier communities and people through prevention and early attention to disease
  2. Integrate care and social supports for individuals who have both physical and behavioral health needs
  3. Reward quality heath care over quantity, with state government leading by example as Washington’s largest purchaser of health care

Washington is one of 11 states to get the four-year testing grant, which begins in February 2015. The Washington State Health Care Authority (HCA) will serve as lead agency for the grant.

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10 reasons why healthcare isn’t a free market – Modern Healthcare

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Photo by Sanja Gjenero

Photo by Sanja Gjenero

No. 1: Nobody in the middle of a heart attack shouts, “Let’s go shopping!” Some other reasons, writes Merrill Goozner in Modern Healthcare are: Comparison shopping is complex, doctors belong to professional guilds, and most care is delivered locally so foreign competition can’t drive down prices.

10 reasons why healthcare isn’t a free market – Modern Healthcare.

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Some states retreat on mental health spending

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By Michael Ollove
Stateline

Fewer states increased their spending on mental health programs this year compared to last year, when a spate of horrific shootings by assailants with histories of mental illness prompted a greater focus on the shortcomings of the country’s mental health system.

Screen Shot 2014-12-15 at 9.49.48 AM

From State Mental Health Legislation 2014 Trends, Themes & Effective Practices – NAMI

Some states slashed their mental health budgets significantly this year. At the same time, however, a number of states adopted mental health measures in 2014 that won plaudits from behavioral health advocates.

survey of state spending published last week by the National Alliance on Mental Illness (NAMI) found that 29 states plus the District of Columbia increased their spending on mental health in fiscal year 2015. A year earlier, 37 states plus D.C. increased their mental health budgets.

NAMI warned that the momentum to improve state mental health services, which was especially powerful after the December 2012 Sandy Hook massacre in Connecticut, has slowed.

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Many Obamacare plans setting out-of-pocket limits below cap

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Photo by nyuszika

Photo by nyuszika

By Michelle Andrews
KHN

Consumers shopping on the health insurance marketplaces will find many plans with out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health.

Seventy-four percent of 2015 silver level plans’ out-of-pocket spending caps are below the $6,600 spending limit allowed for individual plans and $13,200 maximum for family plans, according to Avalere, a consulting firm.

The average out-of-pocket maximum for 2015 individual silver plans will be $5,853, says Caroline Pearson, a vice president at Avalere. Silver was the most popular plan type this year, selected by about two-thirds of enrollees.

After a policyholder reaches the out-of-pocket spending limit during the year, the insurer pays all the bills, unless, for example, they involve doctors and hospitals not in the health plan’s network.

The vast majority of other plans also feature lower limits on out-of-pocket spending—which includes deductibles, copayments and co-insurance, but not premiums. S

eventy-one percent of bronze plan spending limits were below the allowed maximum (with an average spending limit for single coverage of $6,381), as were 94 percent of gold plans (average limit, $4,458) and 98 percent of platinum plans (average limit, $2,145).

Avalere said the average spending limits for single coverage were in most cases close to those for 2014 plans: bronze ($6,330); silver ($5,877); gold ($4,443) and platinum, $2,795.

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Washington insurance exchange enrolls nearly 60,000

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WA_Healthplanfinder_RGBNearly 60,000 residents have signed up for health insurance or renewed their coverage for 2015 through the Washington state health insurance exchange, wahealthplanfinder.org, Washington Healthplanfinder today said Thursday.

In addition, 480,000 new adults have accessed coverage through the state’s Medicaid program, Washington Apple Health, and more than 60 percent of Washington Apple Health clients have been automatically renewed via the online marketplace.

Residents who qualify for coverage must select and pay for a plan by Dec. 23 at 4:59 p.m. for coverage starting on Jan. 1, 2015.

Based on data from the first open enrollment period, enrollments are expected to surge considerably ahead of the Dec. 23 deadline. Washington Apple Health enrollment is year-round.

Washington Healthplanfinder has received approximately 16,000 site visits per day, while the Customer Support Center has received an average of 10,000 calls a day.”

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With 1.5 Million Sign-Ups So Far, Obamacare Enrollment Is Brisk

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Shopping CartBy Phil Galewitz
KHN

With less than a week until the deadline to buy individual health insurance that begins Jan. 1, experts say sign-ups are on course to hit or exceed the Obama administration’s projection of about 9 million enrollees in 2015.

Several weeks into the second year of the Affordable Care Act’s insurance exchanges, about 1.5 million people have enrolled in coverage, according to data from state and federal exchanges.

” . . . sign-ups are on track to “far exceed” the Obama administration’s 9 million projection.”

As of Dec. 5, almost 1.4 million had enrolled through the federal insurance exchange, which serves 37 states, the Centers for Medicare & Medicaid Services reported Wednesday.

Another 183,000 chose plans through state exchanges, including nearly 49,000 in California, according to a Kaiser Health News analysis of state exchange data.  Enrollment figures were not available for exchanges in New York, Idaho and Rhode Island.

“Exchange enrollment is far ahead of 2014’s pace due to improved technology performance,” said Caroline Pearson, vice president of Avalere Health, a consulting firm.

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Obamacare co-ops cut prices, challenge traditional insurers

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Shopping CartBy Phil Galewitz
KHN

When Anna Duleep went shopping recently for 2015 health coverage on the Connecticut insurance exchange, she was pleasantly surprised to find a less expensive plan.

To get the savings, the substitute math teacher had to change from for-profit giant Anthem Blue Cross and Blue Shield to a fledgling carrier she’d never heard of. Still, Duleep, 37, liked saving $10 on her monthly premium of about $400 and knowing that her new plan, HealthyCT, is a nonprofit governed by consumers. She also liked that all her doctors participate. “I just figured, ‘why not change?’” she said.

Two dozen co-ops, which received $1.9 billion in federal loans, were designed to compete with established carriers and lower prices.

HealthyCT, which cut its 2015 premiums by an average of 8.5 percent, is one of at least a half dozen co-ops created through the Affordable Care Act that have lowered 2015 premiums in a bid to boost membership in their second year of operation.

But those low premiums are upsetting so-called “legacy” insurance plans like Blue Cross and Blue Shield affiliates that have traditionally dominated insurance markets.

Idaho Blue Cross CEO Zelda Geyer-Sylvia said that while she welcomes competition, it’s not fair to have to compete against a carrier getting millions in low-interest federal loans.

“It’s unfortunate, because this is going to be very disruptive to the market,” Geyer-Sylvia said about Montana Health CO-OP, which moved into Idaho this year and undercut competitors’ rates.

The co-ops say that’s just what Congress intended when it tucked them into the health law to mollify those seeking a government-run insurance plan. “Lower prices for consumers are very good news,” said Jan VanRiper, chief executive of the National Alliance of State Health CO-OPs (NASHCO), a trade group. Continue reading

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Wellness programs at work are popular – but do they work?

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yoga-office-570By Julie Rovner
KHN

If you get health insurance at work, chances are you have some sort of wellness plan, too.

But so far there’s no real evidence as to whether these plans work.

One thing we do know is that wellness is particularly popular with employers right now, as they seek ways to slow the rise of health spending. These initiatives can range from urging workers to use the stairs all the way to requiring comprehensive health screenings.

The 2014 survey of employers by the Kaiser Family Foundation found that 98 percent of large employers and 73 percent of smaller employers offer at least one wellness program. (Kaiser Health News is an editorially independent program of KFF.)

What makes wellness plans so popular?

It really is part of their strategy to help employees be healthy, productive, and engaged,” says Maria Ghazal, vice president and counsel at the Business Roundtable, whose members are CEOs of large firms. “And it’s really part of their strategy to be successful companies.”

And there’s another reason wellness has gotten so pervasive, said health consultant Al Lewis. It’s a big industry. Continue reading

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Don’t miss out on subsidies because uncertainty about job-based plans

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insurance-confusion-570By Michelle Andrews
KHN

Confusion about whether some types of job-based coverage disqualify consumers from signing up for subsidized insurance through the health law’s marketplaces may lead some people to buy skimpier employer plans instead.

In recent weeks, some assisters who help consumers find coverage say people are being told by their employers that their bare-bones plans – which, for example, may cover preventive benefits only — meet “minimum essential coverage” requirements. That’s the type of coverage most people must have to satisfy the health law’s requirement that they have health insurance.

The problem is that consumers mistakenly think that having access to such coverage means they don’t qualify for subsidies if they want to buy a policy on the exchanges instead.

But that’s not necessarily the case.

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States focus on ‘super-utilizers’ to reduce Medicaid costs

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Sign for an emergency room.By Michael Ollove
Stateline

In health policy circles, they are called “super-utilizers,” but the name isn’t meant to connote any special powers. Just the opposite.

They are people whose complex medical problems make them disproportionately heavy users of expensive health care services, particularly emergency room treatment and in-patient hospitalizations.

At least 15 states, including Washington established “health homes,” or teams of providers responsible for coordinating the care of most complicated and costly of patients.

The cost of treating them is huge: Just 5 percent of Medicaid’s 68 million beneficiaries account for 60 percent of the overall spending on the program.

Using a provision of the Affordable Care Act, many state Medicaid agencies are trying to diminish use of medical services by super-utilizers by better managing their care.

The goal is to not only reduce costs, but to achieve better health outcomes for these patients.

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