“From Halbig to Sovaldi, this summer was a busy one for health policy and politics. We’ve made it easy to catch up, collecting all of the top stories you clicked on over the past few months. Together, they tell a story about the state of healthcare in the U.S., and offer clues as to where things may be headed when Congress returns in the fall.
Among them: The political battle over Obmacare has become more complicated for Republicans since the government cleaned up the Healthcare.gov mess, and with midterm elections around the corner, the focus will be on how much either party continues to attack or ignore the law. There are policy, legal and business matters to be settled as well – the employer mandate is under attack from the left and the right, the courts have been a wildcard for the health law to this point and could continue to be so, and employers and employees are finding themselves wading through the on-the-ground impacts of the law. That doesn’t even get to our top three storylines of the summer, so be sure to click through to find out what tops the list.”
“When the Affordable Care Act’s insurance exchanges reopen enrollment this fall, many companies will look to tap the growing prominence of Hispanic consumers. Healthcare companies that use technology wisely and partner with brands already familiar to Hispanics will have the advantage in reaching the nation’s fastest-growing demographic group.
Although the US Hispanic pocketbook packs a punch–$1.2 trillion in purchasing power in 2013, more than any other ethnic group1 –the health industry has yet to win the Hispanic consumer and their dollar. More than 10 million Hispanics could gain health insurance coverage under the ACA through Medicaid expansion and the marketplaces, which are entering year two. Yet, Hispanics only accounted for 7.4%–about 400,000–of more than 5 million enrollees in the federal marketplaces last year.2,3
For businesses aiming to succeed in the new health economy, Hispanics represent unparalleled growth opportunities. Some firms are already developing focused strategies that cater to this important group—who are mobile savvy, cost conscious, and prefer receiving care in alternative settings.”
“The Assembly this week approved a bill to limit narrow networks in California’s health plans.
The legislation already passed a Senate vote and is expected to get concurrence today on the Senate floor and move to the governor’s desk for final approval.
SB 964 by Sen. Ed Hernandez (D-West Covina) directs the Department of Managed Health Care to develop standardized methodologies for health insurers to file required annual reports on timeliness compliance, and requires DMHC to review and post findings on those reports. It also eliminates an exemption on Medi-Cal managed care plan audits and requires DMHC to coordinate those plans’ surveys, as well.
“I introduced the bill in response to complaints we’ve heard about inadequate networks in the Medi-Cal program, as well as at Covered California,” Hernandez said. “By increasing oversight and network adequacy enforcement, SB 964 will help consumers select the right plan for themselves and access the care they need.”
Assembly member Rob Bonta (D-Oakland) introduced the measure Tuesday on the Assembly floor, and said the bill came in response to numerous public complaints.
“Since 2012 there have been hundreds of complaints about access and inadequate networks,” Bonta said.”
“The price tag of the Cover Oregon health insurance exchange fiasco continues to grow.
As Clyde Hamstreet, the corporate turnaround expert hired to lead Cover Oregon in April, wraps up his work he leaves behind a stabilized agency – and a hefty bill.
Initially signed to a $100,000 contract, Hamstreet ended up staying longer than expected, with two associates joining him at Cover Oregon after Gov. John Kitzhaber essentially forced out three top officials there in a public display of house-cleaning.
Through July, Hamstreet has billed $598,699 on an amended $750,00 contract. He hasn’t submitted his August invoice. He says the price tag was driven by the exchange’s increasing needs, as his firm stayed longer and did more than initially planned.
“We didn’t do this job to make a lot of money off the state,” he said Thursday. “Our philosophy was to try and help get the boat righted and try to help clean things up and basically help the state. … It turned out to be a bigger engagement than I expected.””
“A lack of transparency in describing and fixing technical problems became an issue in Thursday’s Washington Health Benefit Exchange Board meeting.
Board member Bill Hinkle grew testy at what he said was mutual staff back-patting and excuses for the problems still plaguing thousands of accounts.
“C’mon you guys, let’s quit blowing smoke here,” Hinkle said. “I’m tired of patting people on the back….We’re not doing great yet.”
Board member Teresa Mosqueda pressed staff for numbers of enrollees affected by technical problems.
“We really need to have the data in front of us to manage some of these issues,” she said. “I’m going to ask this question again – what is the total number of individuals affected by this, so we have a sense of how well we’re doing?”
The answer appeared to stun some board members: Glitches and technical problems have affected as many as 28,000 people trying to buy health insurance through the Washington Healthplanfinder online marketplace, said associate operations director Brad Finnegan.
In answer to a question, Finnegan conceded that that means one out of every five people has had a problem.”
“When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network. (Plans that are grandfathered under the law don’t have to abide by these provisions.)
That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect.
Although the law protects patients from higher out-of-network cost sharing in the emergency room, if they’re admitted to the hospital, patients may owe out-of-network rates for the hospital stay, says Angela Gardner, an associate professor of emergency medicine at the University of Texas Southwestern in Dallas who is the former president of the American College of Emergency Physicians.”
“Federal officials have reached an agreement with Pennsylvania Gov. Tom Corbett over his plan to use federal funds to pay for private health insurance coverage for up to 600,000 residents, the governor said on Thursday.
The deal highlights a growing number of Republican governors who are finding ways to accept money under President Barack Obama’s Affordable Care Act, despite political opposition that has so far prevented nearly half of U.S. states from moving forward with the Medicaid expansion plan.
Corbett sought a waiver in February to use those expansion funds to instead subsidize private health insurance for low-income residents.”
“Hundreds of thousands of people risk losing their new health insurance policies if they don’t resubmit citizenship or immigration information to the government by the end of next week — but the federal Healthcare.gov site remains so glitchy that they are having a tough time complying.
Consumers are being forced to send their information multiple times, and many can’t access their accounts at all, immigration law experts and insurance agents say.
The Centers for Medicare and Medicaid Services sent letters to about 310,000 consumers two weeks ago, telling them they need to submit proof of their citizenship or immigration status by Sept. 5 or their insurance will be canceled at the end of the month.
CMS spokesman Aaron Albright says letters were sent only to people for whom the government has no citizenship or immigration documentation. Yet agents and others who assisted immigrants with applications say they know documentation was sent during enrollment.
Marielena Hincapie, executive director of the National Immigration Law Center, says the problems don’t lie with the consumers. The federal databases for the Department of Homeland Security and the Social Security Administration are outdated, have mismatched Social Security numbers and names, and often transpose names for those from other countries, especially refugees from Africa, she says.”
“Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest — and costliest — patients from enrolling.
Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul.
Advocates and industry insiders say these practices may dissuade the neediest from signing up and make it likelier that the customers these insurers do serve will be healthier — and less expensive.
“It’s the same insurance companies that are up to the same strategies: Take in as much premium as possible and pay out as little as possible,” said Jerry Flanagan, an attorney with the advocacy group Consumer Watchdog.”
“Bill Jacobs spent four nights in a hospital in Florida battling pneumonia. His kids visited each day, fluffed his pillows, brought his favorite Sudoku puzzles and got regular updates from his nurses and doctors. Imagine their surprise when they found out that their 86-year-old father was never actually admitted; instead, he was treated as an outpatient under what Medicare refers to as “observation status.”
What difference does that make? Actually, more than you might think. If your parents are on Medicare, the difference between being considered an inpatient or an observation patient could be thousands of dollars out of their pocket, if not more.
First, Medicare Part A will cover all hospital services, less the deductible, but only if you’re admitted to the hospital as an inpatient. The one-time deductible covers all hospital services for the first 60 days in the hospital. Doctors’ charges are covered under Medicare Part B. After you meet the deductible for Part B, you’ll then owe 20 percent of the Medicare-approved amount for doctor services, according to the Centers for Medicare and Medicaid Services’ Are You A Hospital Inpatient Or Outpatient?”