Articles on the implementation of ObamaCare.
“SALEM, Ore. — Oracle Corp. has sued the state of Oregon in a fight over the state’s health insurance exchange, saying government officials are using the technology company’s software despite $23 million in disputed bills.
Oracle’s breach-of-contract lawsuit against Cover Oregon was filed Friday in federal court in Portland. It alleges that state officials repeatedly promised to pay the company but have not done so.
The lawsuit seeks payment of the disputed $23 million plus interest, along with other unspecified damages.
Oregon’s health-insurance enrollment website was never launched to the general public. State officials have blamed Oracle, but the company says the state’s bad management is responsible.
Gov. John Kitzhaber has called for the state to sue Oracle and recover some of the $134 million it has already paid to the Redwood City, California, company.
In June, Oregon issued legal demands for documents that could become evidence in a possible lawsuit against Oracle under the state’s False Claims Act.”
“The Affordable Care Act—also known as Obamacare—is “not an affordable product” for many people and it does not fix the underlying problems causing high health-care costs, Aetna Chairman and CEO Mark Bertolini told CNBC on Wednesday.
“If we’re going to fix health care, we’ve got to get at the delivery of care and the cost of care,” Bertolini said in a “Squawk Box” interview. “The ACA does none of that. The only person who’s really going to drive that is the consumer and the decisions they make.”
“Getting everybody insured should probably be our goal, but you have to have a more affordable system,” he added. “We have a 1950[-style] health care system in the Unites States.”
Aetna said Tuesday that its medical spending rose more than estimates in the second quarter, due in part to the higher costs of covering patients who bought insurance under Obamacare for the first time. But the third-largest U.S. health insurer also reported better-than-expected earnings and revenue in the second quarter and raised full-year guidance.”
“More Americans are enrolled in individual health insurance plans. In part, though, that’s because under Obamacare fewer are enrolled in group plans. And one health care analyst says this may be the beginning of a trend.
WellPoint Inc., the Indianapolis-based health insurance giant, reported in its latest quarterly earnings that its small-group business fell more than expected.
WellPoint said it ended 218,000 (or 12 percent) of those plans because employers dropped their group health coverage, and cited Obamacare’s tax credits as a reason for the shift, J.K. Wall wrote in the Indianapolis Business Journal.
Edmund Haislmaier, senior research fellow in health policy studies at The Heritage Foundation, told The Daily Signal that the drop in WellPoint’s employer group coverage “is in line with what we were seeing in the first quarter” for the insurance industry — a decrease in group plans but an increase in individual plans.
Haislmaier said many smaller businesses have dropped group coverage plans in instances where they have a higher number of low-income workers who would qualify for subsidies to buy insurance on Obamacare’s federal and state-run exchanges.”
“With the Nov. 15 kick-off for this year’s health law enrollment season fast approaching, the need for more training for the people who help consumers navigate the health insurance marketplace is growing increasingly clear.
For example, 92 percent of health insurance marketplace assister programs say they want more preparation than they received last year, according to survey findings released last month by the Kaiser Family Foundation.
This figure, highlighted during an Aug. 5 briefing, came out of a larger survey conducted after the first open enrollment period concluded last spring. The survey polled people who supervised assistance efforts by navigators, in-person assisters, certified application counselors, federally qualified health centers and federal enrollment assistance programs which were promoting federal and state-based health care exchanges.”
“Mixups on a health plan bought through the state’s insurance exchange have left a Las Vegas family facing more than $1 million in medical bills.
For Kynell and Amber Smith and their five children, the Nevada Health Link has been a six-month nightmare with no end in sight.
“I have spent countless hours on the phone trying to get this resolved,” said Kynell Smith, an aircraft parts salesman. “I have contacted and pleaded with elected officials to help and was told I may have to sue to get this resolved. What kind of answer is that?”
The family’s troubles began in February, when Amber Smith delivered daughter Kinsley five weeks prematurely. Kinsley spent 10 days in Summerlin Hospital’s neonatal intensive care unit, and Amber’s 40-day hospital stay included two surgeries.
The Smiths bought insurance from Anthem Blue Cross through Nevada Health Link in October and made two premium payments in January. Yet the claims are being denied because Amber’s birth year is listed incorrectly on the family’s insurance identification cards, Smith said. It’s one year off — written as 1978, when it should be 1979.
Nor has Smith been able to get baby Kinsley added to the family’s insurance, despite “dozens of calls” to Nevada Health Link and Anthem. So despite never missing a $1,300 premium payment, the Smiths are on the hook for all of Kinsley’s follow-up care. What’s more, some of Amber’s specialists have unexpectedly abandoned provider networks, leaving the family with unexpected out-of-pocket expenses, he said.
The family’s grand total? Roughly $1.2 million.”
“A new congressional report has estimated that more than 25 million Americans without health insurance will not be made to pay a penalty in 2016 due to an exploding number of ObamaCare exemptions.
The Wall Street Journal, citing an analysis by the Congressional Budget Office and the Joint Committee on Taxation, reported that the number of people expected to pay the fine in 2016 has dwindled to four million people from the report’s previous projection of six million. Approximately 30 million Americans are believed to be without health insurance.
The latest report is likely to spark fresh concerns among insurers, who have maintained that the number of exemptions to the law’s individual mandate are resulting in fewer young, healthy people signing up for health insurance. An insurance pool skewed toward older, comparatively unhealthy people is likely to result in premiums rising.
Under the Affordable Care Act, the fine for not purchasing health insurance is either $95 per adult or 1 percent of family income, whichever is greater. That amount is set to increase to $695 per adult or 2.5 percent of family income in 2016, with a total family penalty capped at $2,085.”
“As the backlash over narrow physician networks continues to make headlines and lawmakers start the August recess, a new nationwide survey found 76 percent of likely voters support a bipartisan proposal to give Medicare patients better medication access and more choice of pharmacy.
Bait-and-switch. That’s the common refrain expressed by patients in recent articles about the narrow network trend, from Morning Consult to The New York Times to USA TODAY. Patients report either not knowing or being misinformed about restrictions on their access to the doctor of their choice. As a result some are racking up significant, unanticipated out-of-pocket costs. Now both regulators and insurance plans alike are reassessing the situation and contemplating adjustments for 2015.
It’s not just doctors, however. Patient access to medication and consultations on its proper use with the pharmacist they know and trust are also suffering. Particularly in Medicare drug plans, insurance middlemen are telling some patients to pay more – sometimes significantly more – or switch pharmacies, even if it means traveling 20 miles or more.
But perhaps unlike the physician narrow network conundrum, there is an easy, obvious solution to the narrow pharmacy network issue in Medicare drug plans: H.R. 4577, the Ensuring Seniors Access to Local Pharmacies Act.
The bipartisan proposal would give seniors in medically underserved areas more convenient access to medication at discounted or “preferred” copays at additional pharmacies that are willing to accept the plan’s terms and conditions. Currently, independent community pharmacies are usually locked out of these smaller or “preferred” networks. Moreover, when community pharmacists offer to accept the same terms and conditions they are still kept out. Independent pharmacies make up approximately half of all rural pharmacies, so their patients must pay this “rural tax” or travel great distances to reach a “preferred” pharmacy.
Three out of four likely voters (76 percent) support this proposal, according to a recent nationwide opinion survey conducted by Penn Schoen Berland, or PSB Research. Support runs across party lines as well as demographic ones, such as gender and age.”
“Kansas was one of just three states that saw their rates of people without health insurance go up since last year, according to a new survey.
And, if the poll results are accurate, Kansas was the one whose rates went up the most.
The data, collected as part of the Gallup-Healthways Well-Being Index, show that the uninsured population in Kansas rose from 12.5 percent in 2013 to 17.6 percent by midyear 2014 — a whopping increase of 5.1 percentage points.
Even Kansas Insurance Commissioner Sandy Praeger confesses she’s surprised, although she says there may be several possible explanations for the data.
One, she said, is that the state’s own estimate of a 12 percent uninsured rate was off the mark because, before Obamacare kicked in, uninsured people inaccurately reported being insured.
“We’ve had a woodwork effect in Kansas of more people, even under our stingy Medicaid rules, applying for Medicaid under the old rules who didn’t apply before, just because there’s greater discussion around insurance now,” she said.
“So it may be that people are more aware of what it means to have insurance and are less likely to self-report that they have insurance when they are in fact uninsured. And it may be the way the pollsters asked them the question that made them more likely, I don’t know.””
“One of Medicare’s attempts to improve medical quality –by rewarding or penalizing hospitals — did not lead to improvements in the first nine months of the program, a study has found.
The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that. Hospitals were judged both on how they compare to others and how much they are improving.
The program is one of several payment initiatives instituted by the health law. Others include penalties for hospitals that have high rates of Medicare patients readmitted within 30 days and penalties that will go into effect this fall for hospitals with high rates of patient injuries or infections.”
“Businesses with fewer than 50 workers are exempt from the most stringent requirements for larger employers under the federal health-care law. But that doesn’t mean they’re off the hook entirely.
Smaller employers aren’t required under the Affordable Care Act to offer coverage for their full-time workers—as larger firms must by 2016 or face penalties, for instance. But many owners of small ventures and startup entrepreneurs are nonetheless facing big changes to how they obtain their own health coverage, as well as to the benefits they’re able to offer employees.
“It’s a myth that smaller firms aren’t being hit” by the health law, albeit in less obvious ways, says James Schutzer, president of the New York State Association of Health Underwriters, referring to employers with fewer than 50 workers.
Several thousand of the nation’s smallest business owners—sole proprietors and the self-employed—were kicked off their small-business plans by carriers earlier this year. That is because new guidelines define “employers” as having at least two full-time employees, not including a spouse, in order to be eligible for group plans.”