The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

“Americans living in rural areas will be a key target as states and nonprofit groups strategize how to enroll more people in health law insurance plans this fall.
Though millions of people signed up for private insurance or Medicaid in the first year of the Affordable Care Act, millions of others did not. Many live in rural areas where people “face more barriers,” said Laurie Martin, a RAND Corp. senior policy researcher. Brock Slabach, a senior vice president at the National Rural Health Association, said “the feds are particularly concerned about this.”
Distance is one problem: Residents have to travel farther to get face-to-face assistance from the so-called navigators and assisters hired to help consumers figure out the process. And Internet access is sometimes spotty, discouraging online enrollment.
But the most significant barriers may stem directly from state decisions about whether to expand Medicaid eligibility — more than 20 states chose not to — and whether to operate their own health exchanges. States that embraced those parts of the law generally had more federal resources as well as funds generated by their online marketplaces for outreach efforts to boost enrollment, including those aimed at consumers in less accessible areas, and more coverage options, through Medicaid, for which these consumers might be eligible.”

“Congress is returning to Washington with just two months left before ObamaCare’s second enrollment period.
For most of the lawmakers’ August recess, news on the Affordable Care Act and other healthcare debates was fairly quiet.
But that ended for Republicans with the Sept. 4 announcement that a hacker had breached part of HealthCare.gov in July.
Though the exchange was not specifically targeted and no personal data was stolen, the GOP sees an opening to hammer the administration over the site’s security.
House Oversight Committee Chairman Darrell Issa (R-Calif.) has already called Marilyn Tavenner, Centers for Medicare and Medicaid Services administrator, to testify on the matter later this month.
The topic is also likely to dominate Republican remarks at a hearing Wednesday on the Affordable Care Act’s implementation, hosted by the Ways and Means Subcommittee on Health.
The House Republican Conference also plans to zing the healthcare law in at least one set of votes this week.
Majority Leader Kevin McCarthy (R-Calif.) said the chamber will consider a measure to allow insurers to continue offering certain small-group health plans that might not comply with ObamaCare’s rules.
The legislation is a Republican response to President Obama’s much-criticized remark that people could keep their plans under the reform.”

Rep. Bill Cassidy (R-La.), the measure’s sponsor, is challenging Sen. Mary Landrieu (D-La.) in November; the issue will undoubtedly play a role in that campaign.”

“Large businesses expect to pay between 4 and 5 percent more for health-care benefits for their employees in 2015 after making adjustments to their plans, according to employer surveys conducted this summer.
Few employers plan to stop providing benefits with the advent of federal health insurance mandates, as some once feared, but a third say they are considering cutting or reducing subsidies for employee family members, and the data suggest that employees are paying more each year in out-of-pocket health care expenses.
The figures come from separate electronic surveys given to thousands of mid- to large-size firms across the country by Towers Watson, the National Business Group on Health and PriceWaterhouseCoopers, consulting groups that engage with businesses on health insurance issues.
Bracing themselves for an excise tax on high-cost plans coming in 2018 under the Affordable Care Act, 81 percent of employers surveyed by Towers Watson said they plan to moderately or significantly alter health-care benefits to reduce their costs.”

“RICHMOND, Va. — Virginia Gov. Terry McAuliffe is set to unveil his plan to increase health care coverage for the state’s poor.
The Democratic governor will speak publicly Monday on his plans for health care expansion.
The governor unsuccessfully tried to persuade Republican lawmakers to expand Medicaid during this year’s legislative session. The impasse led to a protracted stalemate over the state budget that ended with a GOP victory.”

“When Congress returns this week, action in both chambers will mostly be a show for the voters back home ahead of the midterm election. In the House, that will include a vote on a bill to allow insurance companies to continue offering any plan that was sold in the group market in 2013.
Noticeably absent from congressional politicking in the next few weeks is the Affordable Care Act’s risk corridor program, which was, as recently as a few months ago, a major Republican criticism of the law. But that doesn’t mean the “insurer bailout” fight is dead. Republicans in both chambers are quietly working to challenge the legality and projected cost of the program. And that could tee up the issue to become a bargaining chip in the budget fights to come at the end of this year, regardless of who wins the Senate.
The Affordable Care Act’s risk corridor program runs from 2014 through 2016, and was established to encourage insurers to take a chance on covering an unknown population — the Americans who would be purchasing insurance on state and federal exchanges. The program collects funds from qualified health plans that bring in more money than they paid for medical claims, and then pays that money to plans with claims that cost more than they brought it from consumers.
But what happens if there isn’t enough money from well-performing insurers to pay all of the insurers that missed the mark? The federal government is on the hook, but where they find the money to pay those insurers is a question being debated throughout Washington. That’s because the law did not give the federal government a clear appropriation to spend money to make up for losses. And Republicans are, of course, very unlikely to give them one.”

“MADISON, Wis. — Nearly 26,000 adults who lost Medicaid coverage through Wisconsin’s BadgerCare Plus program after being kicked off earlier this year will have more time to sign up for private subsidized insurance, the federal government announced Thursday.
The U.S. Centers for Medicare and Medicaid Services said it was establishing a special enrollment period through Nov. 2 for those people to sign up under the federal exchange created under the health overhaul law.
The Wisconsin Department of Health Services estimates that about 25,800 out of 63,000 adults who lost that coverage had yet to sign up for subsidized insurance plans under the federal law.
They lost coverage after Gov. Scott Walker and the Republican-controlled Legislature tightened income eligibility for the state’s Medicaid coverage from 200 percent of poverty to 100 percent. That made the income cutoff for coverage $11,670 for an individual and $23,850 for a family of four.”

“According to figures released today by the Washington Health Benefit Exchange, 24,072 people have been dropped from coverage through the Healthplanfinder insurance exchange since those plans took effect in January 2014. Of that number, 8,310 were disenrolled because of non-payment of premiums, 7,735 voluntarily ended their coverage, and 8,027 were determined to no longer be eligible for a qualified health plan. Most of those determined to be no longer eligible were qualified instead for Medicaid.
The exchange also said 11,497 individuals have gained coverage through the exchange since the open enrollment period ended on March 31. These additions largely involved provisions allowing enrollment after a qualifying life event, such as a moving to a new state or changes in family size.”

“The Cover Oregon board on Thursday moved toward keeping the health insurance exchange semi-independent rather than having state agencies take it over.
That position, if confirmed in a vote that could take place later this month, would be a significant rebuff of Gov. John Kitzhaber. In a statement Thursday, Kitzhaber said having state agencies take over the exchange “offers the lowest-risk path.”
Whatever the board’s vote, it could have ramifications for control of the exchange as well as for the November elections, political observers say.
For months the board had been debating what to recommend to the Legislature about its future. In March, Kitzhaber asked the board to examine their governance structure and determine whether changes were called for.”

“In the shrub steppe of Grand Coulee on the banks of the Columbia River, Wash., the town’s two family doctors practice at an unrelenting pace, working on call every other night and every other weekend.
In the coastal town of Port Angeles, the doctor shortage is so acute that a clinic is turning away 250 callers a week seeking a physician.
George and Lynne Rudesill are two of those people. Since learning earlier this summer that their primary-care doctor in Sequim was retiring, the couple have scrambled to find a replacement. Their calls are being met with waiting lists hundreds of people long or advice to call again in a month.
“I’m going to have to drive all the way to Silverdale or Bremerton to see a doctor,” George Rudesill said, citing cities that are about 70 or more miles away from home. “This area is in a medical crisis right now.”
Rural areas have long been strapped for doctors, but now the Affordable Care Act (ACA) is further straining those limited resources. More people with insurance means more people will want to connect with a doctor — just as aging baby boomers require more care and the doctors are retiring.”

“Consumers may soon find a surprise in their mailbox: a notice that their health plan is being canceled.
Last year, many consumers who thought their health plans would be canceled because they didn’t meet the standards of the health law got a reprieve. Following stinging criticism for appearing to renege on a promise that people who liked their existing plans could keep them, President Barack Obama backed off plans to require all individual and small group plans that had not been in place before the health law to meet new standards starting in 2014. The administration initially announced a transitional policy that, with state approval, would allow insurers to renew plans that didn’t comply with coverage or cost standards starting in December 2013 and continue doing so until October 2014. Then in March, the administration said it would extend the transitional policy for two more years, meaning that some people will be able to hang onto their non-compliant plans through 2017.”