Global health news – August 5th

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Court ruling adds urgency to state exchange decisions

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A federal appeals court ruling could jeopardize billions of dollars in federal health insurance subsidies for millions of people, depending on where they live.

ACA health reform logoBy Christine Vestal
Stateline

As states ready their health insurance exchanges for a second open enrollment season in November, many have more to worry about than the computer glitches that plagued them last year.

Only 14 states – including Washington state — have established state exchanges and are on firm legal ground, according the decision, Halbig v. Burwell.

Last month’s federal appeals court ruling that said language in the Affordable Care Act allows only state-run exchanges to give consumers tax credits to help pay for policy premiums is spurring several states to solidify their state-based credentials.

“Until now, it was inconsequential what you were called,” said Larry Levitt, vice president at the Kaiser Family Foundation. “All of a sudden, it may matter.”

states

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Health spending going up? Or down?

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Analysts who fear health spending is accelerating got plenty of evidence in Wall Street’s second-quarter results to support their thesis.

But so did folks who hope spending is still under control.

Now everybody’s trying to sort out the mixed message.

The answer matters because deficit debates and affordability concerns revolve around forecasts that health spending will speed up as the economy revives. If it doesn’t, the future looks better for consumers, employers and taxpayers.

Everybody’s trying to sort out the mixed message.

To hear hospitals tell it — based on earning reports issued over the last two weeks — we might be heading back toward the painful, 8 percent spending increases of the early 2000s. (National health spending rose only 3.7 percent in 2012, the most recent year for complete results.) Continue reading

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A doctor’s perspective on ACA exchange plans

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 This story is part of a partnership that includes WNPR , NPR and Kaiser Health News.]

On a recent afternoon at his office in Hartford, Conn., Dr. Doug Gerard examines a patient complaining of joint pain. Gerard, an internist, checks her out, asks her a few questions about her symptoms and then orders a few tests before sending her on her way.

For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80.

And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates.

I don’t think most physicians know what they’re being reimbursed.

That’s not something he’s willing to accept.

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Gerard says. “You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

Three insurers offered plans on Connecticut’s ACA marketplace in 2014and Gerard is only accepting one. He won’t say which, but he will say it pays the highest rate to doctors.

“I don’t think most physicians know what they’re being reimbursed. Only when they start seeing some of those rates come through will they realize how low the rates are they agreed to.”

Gerard’s decision to reject two plans is something officials in Connecticut are concerned about. Continue reading

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Health news headlines – August 4th

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Global health news – August 4th

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Women’s health week – 48: Drugs

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tacuin womenFrom the Office of Research on Women’s Health

As with many other diseases, the likelihood of becoming addicted differs from person to person, and between males and females.

For substance abuse overall, men are about twice as likely as women to be dependent on most illicit drugs and/or alcohol.

When someone first begins using drugs, addiction does not seem like a dangerous disease, and a person may perceive what seem to be positive effects of drug use. Continue reading

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The week’s top five stories

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Credit: Dan Shirly

Credit: Dan Shirly

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With job-based coverage, can I still qualify for cost-sharing subsidies

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Q. I understand that having access to affordable employer-sponsored coverage doesn’t prohibit me from purchasing coverage on the exchange, but it does eliminate access to premium tax credits that I might otherwise be eligible for.

What about cost-sharing subsidies?

If I could qualify for a plan with cost-sharing subsidies on the exchange, would I be eligible for one of those plans instead of taking the coverage offered by my employer?

A. No, you wouldn’t be eligible. Continue reading

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Health news headlines – August 2nd

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Global health news – August 2nd

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Group Health state’s market leader in health insurance

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Group Health IconAccording to the Office of the Insurance Commissioner, the top three health insurance companies in Washington state by market share are: 

  • Group Health Cooperative Group, with 20 percent of the market and $3.2 million in written premiums.
  • Cambia Health Solutions, Inc., which includes Regence Blue Shield, with 16 percent of the market and $2.6 million in written premiums.
  • Premera Blue Cross Group, with 15 percent of the market and $2.4 million in written premiums.

For more information go here.

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What’s been the local impact of the Affordable Care Act?

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California congressman Rep. Henry Waxman, a Democrat, has released a report detailing the impact of the Affordable Care Act broken down by congressional district.

Below are details from the report on the health law’s impact in the 7th district, represented by Congressman Jim McDermott, a strong supporter of the law, and the 8th district, represented by Congressman David Reichert, who has voted repeatedly to repeal the law.

For information about other districts go here.

In District  7 – Jim McDermottScreen Shot 2014-08-01 at 8.47.35 AM

As a result of the law:

  • There are 27,000 district residents who were previously uninsured now have health coverage because of the Affordable Care Act.
  • Overall, the number of uninsured district residents has declined by 35%.
  • Approximately 13,300 individuals purchased coverage through the new health insurance marketplace.
  • 31,700 enrolled in Medicaid
  • 7,600 young adults were able to retain coverage through their parents’ plans.
  • For more than 79% of the individuals enrolled in the health insurance marketplace, financial assistance was available that substantially reduced the cost of coverage – in many cases to less than $100 per month.
  • 295,000 individuals in the district – including 42,000 children and 132,000 women – now have health insurance that covers preventive services without any co-pays, coinsurance, or deductible.
  • 5,700 seniors in the district received Medicare Part D prescription drug discounts worth $8.9 million.
  • 94,000 seniors in the district are now eligible for Medicare preventive services without paying any co-pays, coinsurance, or deductible
  • 279,000 individuals in the district are protected by ACA provisions that prevent insurance companies from spending more than 20% of their premiums on profits and administrative overhead.
  • Because of these protections, over 5,700 individuals in the district received approximately $250,000 in insurance company rebates
  • Up to 26,000 children in the district with preexisting health conditions can no longer be denied coverage by health insurers.
  • 279,000 individuals in the district now have insurance that cannot place annual or lifetime limits on their coverage.

District 8 – Dave ReichertScreen Shot 2014-08-01 at 8.48.16 AM

  • 28,000 district residents who were previously uninsured now have health coverage.
  • Overall, the number of uninsured district residents has declined by 35%.
  • Approximately 13,900 individuals purchased coverage through the new health insurance marketplace
  • 33,000 enrolled in Medicaid
  • 5,400 young adults were able to retain coverage through their parents’ plans.
  • For more than 79% of the individuals enrolled in the health insurance marketplace, financial assistance was available that substantially reduced the cost of coverage – in many cases to less than $100 per month.
  • 286,000 individuals in the district – including 63,000 children and 114,000 women – now have health insurance that covers preventive services without any co-pays, coinsurance, or deductible.
  • 6,900 seniors in the district received Medicare Part D prescription drug discounts worth $9.9 million.
  • 100,000 seniors in the district are now eligible for Medicare preventive services without paying any co-pays, coinsurance, or deductible.
  • 252,000 individuals in the district are protected by ACA provisions that prevent insurance companies from spending more than 20% of their premiums on profits and administrative overhead.
  • Because of these protections, over 6,900 individuals in the district received approximately $240,000 in insurance company rebates.
  • Up to 42,000 children in the district with preexisting health conditions can no longer be denied coverage by health insurers.
  • 252,000 individuals in the district now have insurance that cannot place annual or lifetime limits on their coverage.

 

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California exchange rates up modest 4.2 Percent

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Flag_of_CaliforniaBy Pauline Bartolone, Capital Public Radio
AUGUST 1ST, 2014

Covered California says health care premiums will go up modestly for most people buying coverage on the state exchange next year by an average of 4.2 percent.

“We enrolled a lot of people, they’re healthy, and that’s kept rates down,” Covered California Executive Director Peter Lee said at a press conference on Thursday in Sacramento to announce the rates.

“We enrolled a lot of people, they’re healthy, and that’s kept rates down.”

About 1.4 million people purchased insurance on the marketplace in California for 2014, the first year Affordable Care Act insurance was available.

California is one of the states that created its own exchange, and it is an “active purchaser” under the law, which means it can negotiate with insurers directly on rates. Continue reading

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Unfavorable views of health law spike in July: poll

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ACA health reform logoBy Jordan Rau
KHN / AUGUST 1ST, 2014

The health law’s unpopularity among the public rose sharply in July with a surge of disapproval from people who had been agnostic about it in recent months, a poll released Friday shows. The law is as unpopular as it has been since it was enacted four years ago.

The poll from the Kaiser Family Foundation found that 53 percent of the public had an unfavorable view of the law in Julythe highest level since the law was passed in 2010.

Fewer than four in 10 people were aware that people getting insurance through the law had a choice among private plans.

It was up from 45 percent in June. (KHN is an editorially independent program of the foundation.)

The law’s unpopularity hit similar levels several times since passing, most recently in January when 50 percent of people disliked it.

Support for the law in July remained about the same as in June, with 37 percent supporting it. Continue reading

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