Category Archives: Health Insurance

States target asthma care as number of patients grow

Washington is one of the few states that has made the Asthma and Allergy Foundation of America honor roll of states that have adopted comprehensive public policies supporting people with asthma, food allergies, anaphylaxis risk and related allergic diseases in schools.

Illustration of the lungs in blueBy Michael Ollove
Stateline Staff Writer

April 16, 2014 

In a valley wedged between the Mississippi and Missouri rivers, St. Louis often finds itself beset by a stationary air mass that only a severe storm of some kind can dislodge.

St. Louis is also an industrial city with high humidity, so it’s no wonder it usually makes the list of worst places for asthmatics to live.

But the state has also pioneered advances in addressing asthma treatment and costs. Two years ago, the Missouri legislature became the first to allow schools to stock quick-relief asthma medications for emergencies.  Continue reading

Share

FAQ on ACOs: Accountable Care Organizations, explained

Accountable care organizations are practically a footnote in the health law, but advocates say they’ll be critical to holding down the cost of care while improving quality

By Jenny Gold
KHN Staff Writer
APR 16, 2014

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

A doctor walking through a mazeThe law takes a carrot-and-stick approach by encouraging the formation of Accountable Care Organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy. About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up.

An estimated 14 percent of the U.S. population is now being served by an ACO. You may even be in one and not know it.

While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town.  

ACOs have become one of the most talked about new ideas in Obamacare. Here are answers to some of the more common questions about how they work:  Continue reading

Share

Patients often win if they appeal a denied health claim

The health law set national rules for appealing a denied claim, and advocates say consumers should take advantage of them

rejected

Image: sundesigns

By Pauline Bartolone, Capital Public Radio

APR 14, 2014

This KHN story was produced in collaboration with NPR

SACRAMENTO, Calif. — Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.

To help make sure a patient’s claims aren’t improperly denied, the Affordable Care Act creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer.

For Tony Simek, a software engineer in El Mirage, Ariz., appealing was the only way he was able to get additional treatment for sleep apnea.  Continue reading

Share

Focus one exchange enrollment overlooks millions who bought private insurance

ACA health reform logoBy Annie Feidt, APRN

Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is exceedingly complicated.

The Obama administration is tracking the number of plans purchased on the federal website healthcare.gov and on the state marketplaces, and this month reported that It had exceeded expectations by signing up 7.5 million people. In addition, federal officials have said that 3 million people have enrolled in Medicaid since October.

But often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers — and that number could be substantial. Continue reading

Share

Q: Do I face a penalty if my kids’ CHIP coverage starts in April?

Cute Baby Boy Isolated on WhiteBy Michelle Andrews

Q. I understand that I won’t have to pay a penalty for not having insurance because I signed up for coverage before the end of open enrollment.

But what about my kids? Their CHIP coverage didn’t start until April.  Continue reading

Share

State exchange directors offer enrollment snapshots

 Washington MapRichard K. Onizuka from the Washington Health Benefit Exchange reports that 136,497 of Washington state’s 146,000 new enrollees have already paid their premiums. Almost twice as many people, 268,000, gained Medicaid coverage, he added, and 8,000 people signed up on March 31.

 

By Lisa Gillespie
APRIL 11TH, 2014,

The Obama administration is touting the success of the health law’s open enrollment, which signed up  at least 7.5 million Americans for health coverage through the online insurance marketplaces.

But the experience varied according to states and Families USA brought together five state exchange directors Thursday to talk about what they’ve seen so far. These states – Kentucky, New York, Washington, California and Connecticut — all had functioning exchanges and pursued that health law’s Medicaid expansion.  Continue reading

Share

Sebelius Resigns; Obama To Name OMB Chief Burwell To Head HHS

Sec. Kathleen Sebelius

Secretary Kathleen Sebelius

By Mary Agnes Carey
KHN Staff Writer
April 10, 2014

After a five-year tenure that included the flawed rollout of the health care law and stormy relations with Capitol Hill Republicans, Department of Health and Human Services Secretary Kathleen Sebelius is resigning, a White House official said late Thursday.

President Barack Obama plans to nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to replace Sebelius, the official said.  Continue reading

Share

Medicare records provide tantalizing details of payments to doctors

doctor money examine 300By Jordan Rau
KHN Staff Writer
April 9, 2014

Medicare’s release Wednesday of millions of records of payments made to the nation’s doctors comes as the government is looking to find more cost-efficient ways to pay physicians, particularly specialists.

The federal government published data tracing the $77 billion that Medicare paid to physicians, drug testing companies and other medical practitioners throughout 2012, and what services they were being reimbursed for.

The data cover 888,000 different practitioners. More than 6,000 procedures are included, and the full database is so large that it requires statistical software to analyze it.

While the database provides tantalizing details, showing for instance the huge amount ophthalmologists are paid to treat a common eye disorder, experts cautioned that the data can be easily misunderstood and could lead to some doctors’ incomes being unfairly pilloried.  Continue reading

Share

Primary care Shortage? Not for the insured, study finds

stethoscope doctor's bag chest x-rayBy Elana Gordon, WHYY
April 9, 2014

Researchers posing as nonelderly adult patients made nearly 13,000 calls to primary care practices across Pennsylvania, New Jersey and eight other states between fall 2012 and spring of last year.

What they found may provide some comfort amid growing concerns of doctor shortages, especially as more people gain coverage through the Affordable Care Act, potentially straining the health system.  Continue reading

Share

Tried to sign up but couldn’t finish by the deadline?

Washington Healthplanfinder outlines steps you need to take to qualify for special enrollment

From Washington Healthplanfinder:

Coverage is hereWith the deadline to enroll in a Qualified Health Plan through wahealthplanfinder.org now passed, Washington Healthplanfinder is reaching out to residents who couldn’t complete their application by March 31 with important guidance to qualify for a special enrollment.

Washingtonians who were prevented from submitting their application by the deadline should complete these steps as soon as possible to qualify for coverage that begins May 1, 2014. Continue reading

Share

Obama administration retreats on private Medicare rate cuts

Twenty-dollar bill in a pill bottleBy Jay Hancock
KHN

April 8, 2014 – Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members.  Continue reading

Share

You have insurance, now what?

Blank checklist on clipboard, with large red ticks, and room for text.By Britt Olson
Coverage is Here
Public Health – Seattle & King County

Maybe you have never had health insurance. Or perhaps it has been so long since you were last covered that you don’t recall how to use your policy or what to expect when you do.

Enrolling in an insurance plan is just the starting point for your journey through the health system.

To smooth your trip through the medical complex, and to maximize the benefits of your new insurance policy, here are some tips:  Continue reading

Share

Decoding the high-stakes debate over Medicare Advantage cuts

United States Capitol BuildingBy Jay Hancock
KHN Staff Writer

APR 07, 2014

This KHN story was produced in collaboration with 

In high-visibility ad campaigns, insurers maintain that reduced payment rates, which are expected to be announced Monday, will do real harm. What should beneficiaries expect?  Continue reading

Share

Co-op health plans see early success

coOp_health_logo_RGBBy Eric Whitney

POLSON, Mont. – The names of the big health insurance companies are familiar – Blue Cross, Aetna, United Healthcare.

But what about CoOportunity Health, or Health Republic Insurance of New York?

These are among 23 new health insurance companies that started under the Affordable Care Act.

They’re all nonprofit, member-owned cooperatives, and the aim is to create more competition and drive prices down.  Continue reading

Share