Articles on the implementation of ObamaCare.
“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.”
“Well, who could have seen this coming? Thankfully, at this point, the reports say there has been no release of personal information. I can’t say I’m terribly heartened:”
“Last week, the Obama Administration announced the appointment of a new chief executive officer (CEO) for the federal health insurance marketplace under the Affordable Care Act (ACA). Kevin Counihan—who headed up Connecticut’s health insurance exchange, which worked quite well—will fill the newly created position.
Calling this position a CEO represents semantic gymnastics of a sort. That’s because CEOs generally have near-total autonomy to manage an organization, reporting only to a board of directors. Nothing like that really exists in government, short of the president. In this case, the new CEO reports to the administrator of the Centers for Medicare and Medicaid Services, so he is firmly ensconced in the normal federal agency bureaucracy. That may be a positive, because it respects the traditional lines of authority and accountability that help the government function.”
“Enrolling in Missouri’s Medicaid program has not been easy.
Many applicants have experienced a barrage of problems when trying to sign up for the program, including long delays until coverage kicks in, lost paperwork and a lack of one-on-one interaction with caseworkers. State officials have blamed a new computer system used to process Medicaid applications.
But there is another reason why some Missourians struggle to get help.
When Deborah Weaver, 28, had issues enrolling in the state’s Medicaid coverage for pregnant women, a switch from her Medicaid disability coverage, she was directed to use a toll-free number, 1-855-373-4636. When she called, Weaver endured long waits and received no guidance.
“I called them three or four times and each time it would take a minimum of 15 to 20 minutes to get through to a human being, only to be given the runaround,” Weaver said.
One time the wait dragged on for so long, Weaver ended the call, worried she was racking up too many minutes on her family’s cellphone plan.”
“It’s not a news flash that health insurance can be complex and confusing. But the health insurance maze can be a problem, especially if you have never had health insurance before or have not had it for a long time. That’s the case for about half of the uninsured and for many people enrolling in the new insurance marketplaces set up under the Affordable Care Act.
37% of enrollees don’t know the amount of their deductible. The deductibles in the plans sold on the exchanges are large; on average $2,300 for single coverage in the most popular plan, a Silver plan. For many people their deductible will be as important to their family budgets and their ability to get health care as the premium they pay, especially if they get a premium subsidy as most do in the exchanges. If people don’t understand their deductibles and copays they may pick a plan based solely on the premium and be in for a nasty surprise when they begin to use care and their deductible hits. It can also be important to know if services such as some physician visits and tests or generic drugs are exempt from the deductible.
Speaking of the subsidies, 46% of enrollees in the new insurance marketplaces say they’re getting a subsidy, when official numbers indicate about 85% actually get them. And even among those who know they’re receiving a subsidy, 47% don’t know the amount of the subsidy. A political implication is that many people getting help from the ACA don’t know it.
Many enrollees also don’t grasp basic insurance terms. A study of people eligible to enroll in the marketplaces showed that many were not confident in their understanding of a premium (36%), deductible (31%), copayment (28%), coinsurance (48%), maximum annual out-of-pocket spending (38%), provider network (36%), covered services (35%), annual limits on services (39%) or excluded services (40%).”