“DEARBORN, Mich.–Signing people up for health insurance is the easy part of Rawha Abouarabi’s job ministering to immigrants and Arab Americans in this manufacturing hub along the Rouge River.
Nagat Sahouba, a medical assistant for the Arab Community Center for Economic and Social Services, takes down a client’s information for an appointment in the center’s clinic in Dearborn, Mich. on Aug. 7, 2014 (Photo by Marissa Evans/KHN).
But many of those she’s enrolled are surprised and indignant when they go to the doctor and are asked to a pay a bill— perhaps a copayment. They insist they’ve already paid their monthly insurance premium.
“They call us and say, ‘it’s a scam’,” says Abouarabi, an insurance navigator for the Arab Community Center for Economic & Social Services (ACCESS), a nonprofit agency that specializes in helping the largest Arab-American population in any U.S. city.
That’s just one example of the confusion immigrants face as they try to navigate the U.S. health care system. Even after signing up for insurance through the Affordable Care Act, advocates find that explaining to clients that they will still have to pay out of their own pockets each time they go to the doctor or get lab tests requires more than translating words like “premium” and “deductible” for non-English speakers.
“This whole concept of insurance doesn’t exist in the Eastern world,” said Madiha Tariq, public health manager for ACCESS. “People are always confused about the health care system when they come to this country.””

“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.”

“Thursday’s announcement that Pennsylvania will expand its Medicaid program brings the country one state closer to the original expansion outlined under Obamacare. But because of the Supreme Court’s 2012 decision making the expansion a voluntary program, there are still 23 states that haven’t expanded public health insurance to all of their low-income residents.
The expansion in Pennsylvania will add about 500,000 low-income to adults to the Medicaid rolls. According to numbers from the Kaiser Family Foundation, about 281,000 of those people were falling into what’s known as the “coverage gap”— people who don’t qualify for Medicaid but also don’t get subsidies for purchasing insurance on their own, either. About 4.5 million people across the country fall into this coverage gap, according to Kaiser.”

“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.”

“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.”

“When she was eight weeks old, Ashlyn Whitney suffered a severe respiratory-tract infection that put her in an intensive care unit for 12 days.
“Because she was so young, she couldn’t handle it,” Ashlyn’s mother, Nicole Whitney, recalled. “They had to give her oxygen.”
The baby, now a year old, recovered from her illness, known as respiratory syncytial virus.The bill for her treatment at the West Boca Medical Center in Palm Beach County came to about $100,000 — a sum that included almost $4,000 in fees for her birth and pre- and post-natal care — but every dime of the tab was picked up by a medical bill-sharing organization set up for its Christian membership.
Such religious groups are exempt from the Affordable Care Act’s mandate that most Americans obtain health insurance or pay a penalty. Although as many as 30 million Americans will remain without health insurance by 2016, despite the best efforts of the ACA’s proponents, all but about seven million of them will be spared having to join the new system because of exemptions created by the act itself, according to an analysis by the Congressional Budget Office and the staff of the Joint Committee on Taxation.”

“As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.
The move is prompted by concerns that offering free or discounted care to low-income, uninsured patients might dissuade them from getting government-subsidized coverage. It also reflects hospitals’ strong financial interest in having more patients covered by insurance as the federal government makes big cuts in funding for uncompensated care.
If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University.
Most hospitals are still wrestling with that question, but a few have changed their programs, Cunningham says.”

“When the Obama administration in November 2013 decided to allow states to decide if individuals could keep noncompliant insurance plans, speculation began about what effect that decision would have on premiums and enrollment for plans that did comply with provisions of the Patient Protection and Affordable Care Act. Subsequently, the administration this March gave states the option of a maximum two-year extension into 2016.
Early indications of how many individuals opted to keep those plans have begun to emerge as have signs of the effect on premiums. As with so much else related to the ACA, the results depend on what state is being discussed.
Twenty-five states are allowing noncompliant plans to continue through 2015, which creates a continuing impact for insurers attempting to formulate premium levels in 2014, according to data compiled by America’s Health Insurance Plans, an insurer trade group. Twenty-one states are taking the full extension option, through 2016, according to AHIP.
North Dakota has seen 61% of individual policyholders of noncompliant plans from insurers Sanford Health Plan and Medica opt to retain their plans, while 92% of group policyholders chose to stay on their noncompliant plans, said Rebecca Ternes, the state Insurance Department’s deputy commissioner.”

NOTE: This story is behind a pay wall.
“Most of the political class seems to have decided that ObamaCare is working well enough, the opposition is fading, and the subsidies and regulation are settling in as the latest wing of the entitlement state. This flight from reality can’t last forever, especially as the evidence continues to pile up that the law is harming the labor market.
On Thursday the Federal Reserve Bank of Philadelphia reported the results of a special business survey on the Affordable Care Act and its influence on employment, compensation and benefits. Liberals claim ObamaCare is of little consequence to jobs, but the Philly Fed went to the source and asked employers qualitative questions about how they are responding in practice.
The bank reports that 78.8% of businesses in the district have made no change to the number of workers they employ as the specific result of ObamaCare and 3% are hiring more. More troubling, 18.2% are cutting jobs and employees. Some 18% shifted the composition of their workforce to a higher proportion of part-time labor. And 88.2% of the roughly half of businesses that modified their health plans as a result of ObamaCare passed along the costs through increasing the employee contribution to premiums, an effective cut in wages.
Those results are consistent with a New York Fed survey, also out this week, that asked “How, if at all, are you changing (or have you changed) any of the following because of the effects that the ACA is having on your business?” For “number of workers you employ,” 21% of Empire State manufacturers and 16.9% of service firms answered “reducing.””

“The Affordable Care Act (ACA) presents employers and potential employees with a variety of new rewards and penalties. These are, in part, exactly what the law intended: by penalizing potential employees for not purchasing health insurance, and employers for not providing it, the law aims to increase the fraction of the population with health insurance.
Yet these same rewards and penalties have additional effects, including on the incentive to work; Mulligan
(2014), for example, suggests that the ACA may reduce employment by 3 percent on average and have a range of
positive and negative effects on average hours worked.
In the work summarized here, I quantify the number of people who will have essentially no short-term financial reward from working more than 29 hours, since this would either render them ineligible for the ACA’s assistance or increase
the penalties that may be owed by their employer.
This is the first paper to show that the ACA will put millions of workers in the economically extreme situation of having
zero short-term financial reward (or less) to working full-time rather than part-time.”