“Nearly 400,000 people in Massachusetts will need to reapply for health insurance before the end of the year, and many of them probably do not even know it.
They are people who do not have employer-sponsored health insurance and who instead sought insurance through the state. After the Massachusetts insurance website failed last year, most of them were enrolled in temporary coverage that ends Dec. 31, which is why they must select a new plan.
This is the newest challenge facing the Massachusetts Health Connector, the state agency that provides an online place to shop for insurance, as it struggles to emerge from the disastrous rollout of its website last year. Now that state and federal officials have said that Massachusetts has software that will work, Connector leaders want to get people to log on and choose a plan, starting Nov. 15.
To reach them, the Connector plans to place 2 million robocalls and knock on 200,000 doors, along with making personal phone calls, sending mail, buying print and broadcast advertisements, and holding community meetings and enrollment fairs.
The campaign is estimated to cost $15 million to $19 million, money the state will seek from the federal government.”
“A mix-up of information about two physicians with the same name in different states has opened a window on wide-ranging technical problems the CMS is facing with its Open Payments website reporting industry payments to doctors and teaching hospitals. Registration for the system, which was scheduled…”
NOTE: This article is behind a paywall.
“Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way, according a report released Wednesday from Standard & Poor’s Rating Services.
The rating agency warned the healthcare sector was at “a tipping point where negative forces have started to outweigh many providers’ ability to implement sufficient countermeasures.” Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate.
In particular, stand-alone providers are under greater pressure from physician departures, rising bad debt, and higher employee benefit costs.”
“AUSTIN — A legislative committee is examining market-based alternatives to providing low-income Texans with health care since the state has rejected the expansion of Medicaid under the federal Affordable Care Act.
Members of the state Senate Health and Human Services committee plan Thursday to discuss alternatives to the law critics call “Obamacare.”
Some ideas include expanding Medicaid block grants and waivers. Lawmakers are seeking to hold health costs in-check while improving access to care.”
“Medicaid expansion continues to be a hot-button issue in the 38th District Virginia Senate race, as candidates try to define their positions on a subject that has divided the district — and the state — since the seat was vacated unexpectedly earlier this year.
The June resignation of former Sen. Phillip Puckett, D-Russell County, threw the balanced Senate into Republican control and affected the Senate vote on whether to expand Medicaid. When he resigned, Puckett said it was because of family reasons — his daughter sought to be a judge and the Senate makes the appointments — but others said it was to accept a job with the Virginia Tobacco Commission, which did not happen.
The resignation came just days before the General Assembly voted to pass the budget without Medicaid expansion. Expansion would extend Medicaid coverage to more people who make too much for Medicaid currently, but not enough to pay for coverage — some 400,000 Virginians.
Now, as three candidates vie for Puckett’s seat in the Aug. 19 special election, the Medicaid expansion issue is still on the table.
The stakes are high and the race is being closely watched across the state and beyond.
The candidates are Ben Chafin, R-Hansonville, currently a junior member of the House of Delegates; Mike Hymes, a Democrat from Tazewell who is on the county’s board of supervisors; and Rick Mullins, an independent candidate who is waging his first campaign.”
“The Affordable Care Act—also known as Obamacare—is “not an affordable product” for many people and it does not fix the underlying problems causing high health-care costs, Aetna Chairman and CEO Mark Bertolini told CNBC on Wednesday.
“If we’re going to fix health care, we’ve got to get at the delivery of care and the cost of care,” Bertolini said in a “Squawk Box” interview. “The ACA does none of that. The only person who’s really going to drive that is the consumer and the decisions they make.”
“Getting everybody insured should probably be our goal, but you have to have a more affordable system,” he added. “We have a 1950[-style] health care system in the Unites States.”
Aetna said Tuesday that its medical spending rose more than estimates in the second quarter, due in part to the higher costs of covering patients who bought insurance under Obamacare for the first time. But the third-largest U.S. health insurer also reported better-than-expected earnings and revenue in the second quarter and raised full-year guidance.”
“More Americans are enrolled in individual health insurance plans. In part, though, that’s because under Obamacare fewer are enrolled in group plans. And one health care analyst says this may be the beginning of a trend.
WellPoint Inc., the Indianapolis-based health insurance giant, reported in its latest quarterly earnings that its small-group business fell more than expected.
WellPoint said it ended 218,000 (or 12 percent) of those plans because employers dropped their group health coverage, and cited Obamacare’s tax credits as a reason for the shift, J.K. Wall wrote in the Indianapolis Business Journal.
Edmund Haislmaier, senior research fellow in health policy studies at The Heritage Foundation, told The Daily Signal that the drop in WellPoint’s employer group coverage “is in line with what we were seeing in the first quarter” for the insurance industry — a decrease in group plans but an increase in individual plans.
Haislmaier said many smaller businesses have dropped group coverage plans in instances where they have a higher number of low-income workers who would qualify for subsidies to buy insurance on Obamacare’s federal and state-run exchanges.”
“James Lansberry didn’t blink an eye when the Supreme Court handed down its Hobby Lobby decision last month.
The vice president of Samaritan Ministries, which provides health coverage for more than 37,000 families nationwide, said even though his organization applauds the decision, “it doesn’t have any effect on us.”
Samaritan Ministries, and other health sharing groups like it, cater to a small-but-growing group of Americans who have chosen to opt out of the Affordable Care Act. Not only do these organizations ignore the contraception mandate, they also bypass nearly all the hallmark provisions of Obamacare.
Dr. Andrea Miller, medical director and vice president of Christian Care Ministries, said “the biggest thing to understand” is these groups do not provide insurance. Instead, they “facilitate the direct sharing of medical cost between people of like beliefs.”
Because of this distinction, the Alliance for Health Care Sharing Ministries successfully lobbied Congress for a religious exemption in 2009. This allows medical sharing groups to provide a form of coverage but dodge the deluge of Obamacare regulations governing the insurance industry.
Lansberry calls this exemption the last “isle of freedom” in health care and a “miracle straight from God’s own hand.””
“Mixups on a health plan bought through the state’s insurance exchange have left a Las Vegas family facing more than $1 million in medical bills.
For Kynell and Amber Smith and their five children, the Nevada Health Link has been a six-month nightmare with no end in sight.
“I have spent countless hours on the phone trying to get this resolved,” said Kynell Smith, an aircraft parts salesman. “I have contacted and pleaded with elected officials to help and was told I may have to sue to get this resolved. What kind of answer is that?”
The family’s troubles began in February, when Amber Smith delivered daughter Kinsley five weeks prematurely. Kinsley spent 10 days in Summerlin Hospital’s neonatal intensive care unit, and Amber’s 40-day hospital stay included two surgeries.
The Smiths bought insurance from Anthem Blue Cross through Nevada Health Link in October and made two premium payments in January. Yet the claims are being denied because Amber’s birth year is listed incorrectly on the family’s insurance identification cards, Smith said. It’s one year off — written as 1978, when it should be 1979.
Nor has Smith been able to get baby Kinsley added to the family’s insurance, despite “dozens of calls” to Nevada Health Link and Anthem. So despite never missing a $1,300 premium payment, the Smiths are on the hook for all of Kinsley’s follow-up care. What’s more, some of Amber’s specialists have unexpectedly abandoned provider networks, leaving the family with unexpected out-of-pocket expenses, he said.
The family’s grand total? Roughly $1.2 million.”
“As the backlash over narrow physician networks continues to make headlines and lawmakers start the August recess, a new nationwide survey found 76 percent of likely voters support a bipartisan proposal to give Medicare patients better medication access and more choice of pharmacy.
Bait-and-switch. That’s the common refrain expressed by patients in recent articles about the narrow network trend, from Morning Consult to The New York Times to USA TODAY. Patients report either not knowing or being misinformed about restrictions on their access to the doctor of their choice. As a result some are racking up significant, unanticipated out-of-pocket costs. Now both regulators and insurance plans alike are reassessing the situation and contemplating adjustments for 2015.
It’s not just doctors, however. Patient access to medication and consultations on its proper use with the pharmacist they know and trust are also suffering. Particularly in Medicare drug plans, insurance middlemen are telling some patients to pay more – sometimes significantly more – or switch pharmacies, even if it means traveling 20 miles or more.
But perhaps unlike the physician narrow network conundrum, there is an easy, obvious solution to the narrow pharmacy network issue in Medicare drug plans: H.R. 4577, the Ensuring Seniors Access to Local Pharmacies Act.
The bipartisan proposal would give seniors in medically underserved areas more convenient access to medication at discounted or “preferred” copays at additional pharmacies that are willing to accept the plan’s terms and conditions. Currently, independent community pharmacies are usually locked out of these smaller or “preferred” networks. Moreover, when community pharmacists offer to accept the same terms and conditions they are still kept out. Independent pharmacies make up approximately half of all rural pharmacies, so their patients must pay this “rural tax” or travel great distances to reach a “preferred” pharmacy.
Three out of four likely voters (76 percent) support this proposal, according to a recent nationwide opinion survey conducted by Penn Schoen Berland, or PSB Research. Support runs across party lines as well as demographic ones, such as gender and age.”