“Devin Payne had gone years without health insurance – having little need and not much money to pay for it.
Then Payne, who had a wife and four children, realized she could no longer live as a man.
In her early 40s, she changed her name, began wearing long skirts and grew out her sandy blond hair. And she started taking female hormones, which caused her breasts to develop and the muscle mass on her 6-foot one-inch frame to shrink.
The next step was gender reassignment surgery. For that, Payne, who is now 44, said she needed health coverage. “It is not a simple, easy, magical surgery,” said Payne, a photographer who lives in Palm Springs. “Trying to do this without insurance is a big risk. Things can go wrong … not having the money to pay for it would be awful.”
Payne learned in the fall that she might qualify for subsidies through the state’s new insurance marketplace, Covered California, because her income fell under the limit of $46,000 a year. She eagerly signed up in March for a Blue Shield plan for about $230 a month, and began making preparations for the surgery that would change her life.”
“As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.
The move is prompted by concerns that offering free or discounted care to low-income, uninsured patients might dissuade them from getting government-subsidized coverage. It also reflects hospitals’ strong financial interest in having more patients covered by insurance as the federal government makes big cuts in funding for uncompensated care.
If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University.
Most hospitals are still wrestling with that question, but a few have changed their programs, Cunningham says.”
“Listing to a panel discussion sponsored by the Greensboro Chamber of Commerce Tuesday morning, I heard reference to a metaphor for the Affordable Care Act that I’ve heard a number of time before — the three-legged stool.
Describing the different core components of the health care reform law, three primary tenets offer their support to the law, with, each complementing and reliant upon the others, and the stool falling over if one of the legs falters.
They are: guaranteed issue and community rating (meaning an insurer can’t deny coverage or charge astronomical rates coverage because of pre-existing conditions), the individual mandate (everyone must have coverage or face a fine) and subsidies (financial assistance from the federal government to help low-income consumers can pay for coverage).
I’ve sat in on numerous, similar discussions, and had heard the metaphor before. But it wasn’t until comments from panelist Mark Hall, a professor at Wake Forest University School of Law and a leading health care policy scholar specializing in health care reform, that I realized I was missing a key part of that image.
Those are the three legs — what’s the seat represent?
As Hall noted, if you go by what the law is called, the “Affordable Care” Act, you’d be mistaken.
“One thing it doesn’t do is it doesn’t make care more affordable,” Hall said said during the discussion, which was organized by Pilot Benefits. “Mistake number one was to call it that. It doesn’t change in any significant way how doctors and hospitals are paid.”
As Hall noted, while many opponents might criticize the bill for not reducing health care spending, “the main point is it does not affect how health care is delivered or paid for. … That point is lost on about half of the population.'”
“Supporters of President Obama’s health care law have been touting proposed insurance rates for 2015 — arguing that they aren’t as high as some of the dire warnings of the law’s critics.
But it’s worth considering some additional context.
Data compiled by the Health Research Institute of PricewaterhouseCoopers from about 29 states plus the District of Columbia show that the average premium increase for insurance starting next year is currently 8.2 percent. But within that average, there’s a wide range.
In Arizona, for instance, the average premium increase submitted was 11.2 percent, but rates ranged from a decrease of 23 percent to a spike of 27 percent. In Arkansas, where the average increase was 11.2 percent, some consumers could see their premiums soar by 50 percent.
Defenders of Obamacare argue that rates typically went up annually before the law went into effect.
However, it’s important to keep in mind that it was Obama himself who repeatedly promised that premiums would go down by an average of $2,500 per family.”
“A clinic in Minneapolis that provides medical care to thousands of uninsured and underinsured people is closing its doors next week, in large part because more people are obtaining health insurance through the Affordable Care Act and seeking care elsewhere.
When the Neighborhood Involvement Program shuts down Aug. 29, the 3,000 patients that visit its Uptown clinic will be without a medical provider. But its dental and mental health clinics, as well as its senior and youth programs, will continue operating in Uptown.
But managers of the NIP Community Medical Clinic say many people still need the low-cost care and customer service they provide. Medical bills at the clinic on Hennepin Avenue are as easy to understand as a restaurant check, with a price list like a menu: $10 for a strep test, for example, and $80 for a basic doctor visit. If a patient’s monthly income is less than $1,900 dollars, those fees drop considerably.”
“How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?
Not much, as it turns out, but that hasn’t stopped some from trying.
Kaiser Health News readers still write in regularly about this.
In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina, works for three weeks at a time by releasing hormones similar to those used by birth control pills. She said her insurer told her she would be responsible for her contraceptive expenses unless she chooses an oral generic birth control pill. The NuvaRing costs between $15 and $80 a month, according to Planned Parenthood.
Under the health law, health plans have to cover the full range of FDA-approved birth control methods without any cost sharing by women, unless the plan falls into a limited number of categories that are excluded, either because it’s grandfathered under the law or it’s for is a religious employer or house of worship. Following the recent Supreme Court decision in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.”
“Democrats generally are not campaigning on the Affordable Care Act, but in a new campaign ad Arkansas Sen. Mark Pryor does just that.
Some have commented on the fact that Mr. Pryor does not mention the ACA by name in the ad, referring to it as “a law he helped pass.” Just as interesting is the part of the law the ad features: its protections for people with pre-existing medical conditions. With all of the focus on the ACA’s rollout problems last fall and the ACA’s coverage expansion, we have not heard much about “pre-x” in some time, but in many respects it’s the mega benefit in the law.”
“Patient advocacy groups say health insurers are violating ObamaCare by discriminating against those with chronic diseases, and the groups are forcing the administration to respond.
A Health and Human Services spokesperson cited by The Associated Press says a response is nearly prepped for advocacy organizations fighting AIDS, leukemia, epilepsy and other diseases.
Groups such as the National Health Law Program and the AIDS Institute have filed complaints with the administration claiming insurers are in violation of the Affordable Care Act’s provisions that prevent them from discriminating against people with pre-existing conditions and chronic diseases.
They argue certain drugs are put on higher tiers, requiring patients with chronic diseases to pay bigger out-of-pocket costs. In some cases, they say, the co-pay for such drugs can be 30 percent or higher.
America’s Health Insurance Plans (AHIP), the largest health insurance lobby group, countered the claim by arguing that patients have the option to select a range of health plans that may suit their budgets better.”
“Obamacare challengers in the Halbig case have asked the D.C. Circuit Court of Appeals not to review a three-judge panel’s ruling against federal exchange subsidies, instead calling for “final resolution by the Supreme Court.”
The backstory: one month ago a divided three-judge panel prohibited Obamacare subsidies for residents buying from the federal exchange. The Obama administration asked the full D.C. Circuit bench to rehear the case, which is reserved for matters of exceptional importance.
The challengers don’t want that, because if they lose at the D.C. Circuit it would make the Supreme Court less likely to take the case.
“There is no doubt that this case is of great national importance. Not due to the legal principles at stake—this is a straightforward statutory construction case under well-established principles—but rather due to its policy implications for ongoing implementation of the Affordable Care Act (‘ACA’). Those implications, however, are precisely why rehearing would not be appropriate here, as Judges of this Court have recognized in many analogous cases,” the plaintiffs wrote in the brief filed Monday.
The Obama administration has an advantage in an en banc — or full bench — ruling: it would feature eight Democratic-appointed judges and five Republican-appointed judges. Now that the 4th Circuit Court of Appeals has ruled in favor of the federal subsidies, the only way the challengers can win is at the Supreme Court. The plaintiffs at the 4th Circuit have already asked the justices to take the case, which the Halbig plaintiffs pointed out.”