“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.

Details

“James Lansberry didn’t blink an eye when the Supreme Court handed down its Hobby Lobby decision last month.
The vice president of Samaritan Ministries, which provides health coverage for more than 37,000 families nationwide, said even though his organization applauds the decision, “it doesn’t have any effect on us.”
Samaritan Ministries, and other health sharing groups like it, cater to a small-but-growing group of Americans who have chosen to opt out of the Affordable Care Act. Not only do these organizations ignore the contraception mandate, they also bypass nearly all the hallmark provisions of Obamacare.
Dr. Andrea Miller, medical director and vice president of Christian Care Ministries, said “the biggest thing to understand” is these groups do not provide insurance.

Details

““Direct primary care” is a rapidly growing alternative to the traditional “fee-for-service” model of paying for medical care. Instead of the patient or his insurance plan paying the doctor separately for each visit or service, the patient pays the physician a set monthly fee. In exchange, the physician is available to consult with and treat the patient as necessary.
For patients, the benefits of direct primary care are greater access to their doctors and more convenient and personalized care.

Details

“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.”

Details

“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.

Details

“A trio of academics from one of the nation’s premier business schools recently concluded that the exchanges are costing women age 55 to 64 more than any other demographic group relative to individual insurance policies purchased before the Affordable Care Act took effect.
Their total expected premiums and out-of-pocket HIX costs rose by 50% and ranged from $2,185 to $2,738 compared to before health care reform, according to Mark Pauly, Scott Harrington, and Adam Leive of the University of Pennsylvania’s Wharton School.
The researchers, whose findings were published by the National Bureau of Economic Research, also found that premiums for the second-lowest silver-level policy were 67% higher for women in this age group than they were pre-ACA.
One possible explanation for these higher costs was community rating that lumped together older women with higher-cost individuals, such as childbearing women and sicker older men.

Details

“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.

Details

“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.

Details

“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.

Details

“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.

Details