Articles on the implementation of ObamaCare.
“CMS decided not to include some payments disputed by doctors and teaching hospitals in the Open Payments database published Tuesday (Sept. 30) in order to give physicians and hospitals more time to review the information, but the highly anticipated database includes de-identified data in cases where it was unclear exactly to which physician the payments should have been linked.
The Open Payments site will include 4.4 million payments valued at almost $3.5 billion, according to CMS. Payments from drug and device makers, as well as group purchasing organizations, which were disputed by physicians or hospitals and not corrected before the end of the review and dispute period (Sept. 11) were not included in the most recent batch of Open Payments data because of timing issues, CMS officials said on a call.”
“The federal exchange is set to cut thousands of individuals from its coverage rolls this week because of unresolved inconsistencies related to immigration status, with HHS saying 115,000 will lose coverage as of Tuesday (Sept. 30). Tuesday is also the deadline for about 279,000 households to submit current income information to the exchange or risk seeing changes in their tax credits and cost-sharing subsidies that could result in higher costs for enrollees.
Furthering the saga on coverage data matching issues, the National Immigration Law Center has filed an administrative complaint under the ACA’s anti-discrimination section due to HHS’ failure to communicate with consumers in languages other than English and Spanish. The center also filed a Freedom of Information Act request in order to glean more insight into why that decision was made.”
“Finding a doctor who takes Obamacare coverage could be just as frustrating for Californians in 2015 as the health-law expansion enters its second year..
The state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state’s insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans.”
“When it comes to health insurance exchanges, there’s nothing like the first time to grab voters’ attention and enthusiasm.
Morning Consult polling found 47 percent of voters say they are not at all likely to purchase health insurance through an online exchange this year. In the weeks before the start of open enrollment in 2013, that figure was 19 percentage points lower, with only 28 percent saying they were not at all likely to purchase insurance on the exchange. Voters’ stated likelihood of buying insurance decreased across all categories from 2013 to 2014.”
“You wake up feeling gross – stuffy and full of aches. A quick Google search of your symptoms confirms that yes, you probably have a cold and not the plague. But what if you were directed to a site that had a legitimate sounding name but wasn’t really accurate at all?
It sounds like a problem from the ancient days of the Internet. Since then people have learned that .gov leads to bona fide government sites, but .com could be anyone selling you anything.
How do you feel about .health? A new slew of web domains is coming down the pike, like “.health,” “.doctor,” and “.clinic.” They’re not required to have any medical credentials. That’s deeply worrying to some public health advocates.”
“After the rocky rollout last fall of the ObamaCare website, the administration wants to re-enroll those already in the system in hopes of avoiding another technological embarrassment.
But analysts warn that just blindly re-enrolling could mean trouble for consumers.
“This notion of just sit back and re-enroll is really misleading and I think could cause a lot of harm to people,” said Bob Laszewski of Health Policy and Strategy Associates.
“The automatic renewal, it’s easy, it will keep people getting ObamaCare,” added Rosemary Gibson of the Hastings Center. “But you have to trust but verify. You have to go look. You just can’t be on automatic pilot for health insurance.””
“When Fabrizio Mancinelli applied for health insurance through California’s online marketplace nine months ago, he ran into a frustrating snag.
An Italian composer and self-described computer geek, Mancinelli said he was surprised to find there wasn’t a clear way to upload a copy of his O-1 visa. The document, which grants temporary residency status to people with extraordinary talents in the sciences and arts, was part of his proof to the government to that he was eligible for coverage.
So, the 35 year-old Sherman Oaks resident wrote in his application that he’d be happy to send along any further documentation.
Months went by without word from the state. Then last week he came home from vacation to find a notice telling him he was at risk of losing the Anthem Blue Cross plan he’d purchased.”
“Three Blue Cross Blue Shield plans operated by Health Care Service Corporation have decided to discontinue their “transitional” non-ACA compliant plans at the end of this year and cancellation notices will be sent to affected policyholders “shortly,” a company spokesperson tells Inside Health Policy. HCSC says the decision was made to help keep premiums for ACA plans affordable, because moving those enrollees into compliant plans will result in a more balanced mix of individuals.
Transitional plans that were on the market this year from Blue Cross Blue Shield of Texas, Blue Cross Blue Shield of New Mexico and Blue Cross Blue Shield of Oklahoma will be discontinued effective Jan. 1. One source tracking state developments said the Blues appear to be discontinuing the plans on its own volition. The Blues participated aggressively in the exchanges in the first year while many other carriers remained cautious about entering the new markets, though that is beginning to change for 2015. All of the aforementioned states are using the federal exchange for 2015 open enrollment for individual plans.”
“The Affordable Care Act changed the rules on how health insurance plans dealt with pre-existing conditions, outlawing the practice of turning away patients with expensive conditions or charging them a drastically higher cost for coverage. But an editorial alleges some health insurance companies operating on the new marketplaces created by Obamacare may have found a loophole that allows them to discourage sick patients from enrolling in a specific plan.
The change has to do with how drugs are categorized in health systems. From the editorial published online at the American Journal of Managed Care:
“For many years, most insurers had formularies that consisted of only three tiers: Tier 1 was for generic drugs (lowest copay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest copay). Generic drugs were automatically placed in Tier 1, thereby ensuring that patients had access to medically appropriate therapies at the lowest possible cost. In these three-tier plans, all generic drugs were de facto “preferred.” Now, however, a number of insurers have split their all-generics tier into a bottom tier consisting of “preferred” generics, and a second tier consisting of “non-preferred” generics, paralleling the similar split that one typically finds with branded products. Copays for generic drugs in the “non-preferred” tier are characteristically much higher than those for drugs in the first tier.””
“The government’s own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability – but also came away with respect for some of the health insurance site’s security features.
Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud.”