Category: Investigations

“California’s health insurance exchange is canceling Obamacare coverage for 10,474 people who failed to prove their citizenship or legal residency in the U.S..
Covered California, the state-run insurance exchange, enrolled more than 1.2 million people during the rollout of the Affordable Care Act this year. For most consumers, the exchange said, it could verify citizenship or immigration status instantly with a federal data hub.
But more than 148,000 enrollees were lacking proof of eligibility and needed to submit documentation. People living in the U.S. illegally aren’t eligible for health law coverage.””

“In an effort to slow health care spending, more employers are looking at capping what they pay for certain procedures — like joint replacements — and requiring insured workers who choose hospitals or medical facilities that exceed the cap to pay the difference themselves.
But a study out Thursday finds employers might be disappointed with the overall savings. While the idea, known as “reference pricing,” does highlight the huge variation in what hospitals and other medical providers charge for the same services, the report says, it does little to lower overall health care spending.
“It’s zeroing in on a piece of the health spending puzzle that is critical, the unreasonably high negotiated prices paid by health plans … but it’s not going to get you there if you need to save a lot of money,” said co-author Chapin White.”

“Sandra Grooms recently got a call from her oncologist’s office. The chemotherapy drugs he wanted to use on her metastatic breast cancer were covered by her health plan, with one catch: Her share of the cost would be $976 for each 14-day supply of the two pills.
“I said, ‘I can’t afford it,’ ” said Grooms, 52, who is insured through her job as a general manager at a janitorial supply company in Augusta, Ga. “I was very upset.”
Even with insurance, some patients are struggling to pay for prescription drugs for conditions such as cancer, arthritis, multiple sclerosis or HIV/AIDS, as insurers and employers shift more of the cost of high-priced pharmaceuticals to the patients who take them.”

“Senate Republican Leader Mitch McConnell (Ky.) said Monday he wouldn’t mind if the state healthcare insurance exchange known as Kentucky Kynect stayed but reiterated his call for the full repeal of ObamaCare.
Policy experts have questioned the feasibility of preserving the popular state exchange while also repealing the 2010 Patient Protection and Affordable Care Act, which set it up and similar exchanges around the country.
“Kentucky Kynect is a website. It was paid for by a two-hundred-and-some-odd-million-dollar grant from the federal government. The website can continue but in my view the best interests of the country would be achieved by pulling out ObamaCare root and branch,” McConnell said in a debate with Alison Lundergan Grimes, the Democratic candidate for Senate.”

“On November 15, open enrollment in the Obamacare exchanges begins again. Before the second act of our national healthcare drama commences, let’s review what we’ve learned in Act I.
For starters, everyone now knows that federal officials are challenged when it comes to setting up a website. But they’ve demonstrated the ability to dole out a huge amount of taxpayers’ money for millions of people signing up for Medicaid, a welfare program. And they’ve proved they can send hundreds of millions of federal taxpayers’ dollars to their bureaucratic counterparts in states, like Maryland and Oregon, that can’t manage their own exchanges. But there are many other lessons to be gleaned from Year One of Obamacare.”

“WASHINGTON — They have health insurance, but still no peace of mind. Overall, 1 in 4 privately insured adults say they doubt they could pay for a major unexpected illness or injury.
A new poll from The Associated Press-NORC Center for Public Affairs Research may help explain why President Barack Obama faces such strong headwinds in trying to persuade the public that his health care law is holding down costs.
The survey found the biggest financial worries among people with so-called high-deductible plans that require patients to pay a big chunk of their medical bills each year before insurance kicks in.”

“HealthCare.gov, the website for health insurance under President Barack Obama’s health care law, has been revamped as its second enrollment season approaches. But things are still complicated, since other major provisions of the Affordable Care Act are taking effect for the first time. A look at some of the website and program changes ahead:
Old: 76 online screens to muddle through in insurance application.
New: 16 screens — for the basic application that most new customers will use. But about a third of those new customers are expected to have more complicated cases, and how they’ll fare remains to be seen.
Old: Prone to crashing, even with relatively few users.
New: Built to withstand last season’s peak loads and beyond, at least 125,000 simultaneous users. Actual performance still to be demonstrated.
Old: Six-month open enrollment season, extended to accommodate customers bogged down by website glitches or stuck in line at the last minute.
New: Shorter open enrollment season, just three months, from Nov. 15 to Feb. 15.”

“With the second Obamacare open-enrollment beginning on November 15th, the enrollment system’s testing begins with insurance companies this week.
Of course, last year the enrollment system testing was a real mess resulting in a humiliating Obamacare launch for the administration.
Up until now I wasn’t expecting any major problems with HealthCare.gov’s consumer enrollment system given all of the lessons learned and the new people running things.
But apparently, the administration is pretty worried about what could happen.”

“The Obama administration has already debuted its new, improved version of HealthCare.gov, but still won’t release premium rates on the website until after the Nov. 4 elections.
The Department of Health and Human Services unveiled the updated federal Obamacare exchange on Wednesday. The website is, by all accounts, in much better condition than last year.
HHS secretary Sylvia Burwell has said that the administration has put the new version of HealthCare.gov through its paces. And the administration has allowed insurers to test the site out themselves — although they made clear that insurance companies are not allowed to share their results with the media.”

“Faced with the rising costs of generic prescription drugs, health insurers increasingly are turning to tiers and preferred lists on their formularies to keep costs down. Those strategies previously were used only for brand-name and specialty drugs. Experts say those approaches will increase out-of-pocket costs for patients and could make them less likely to adhere to drug regimens.
For years, insurers have encouraged patients to choose generic drugs because they were less expensive than their brand-name counterparts, and most prescription drugs currently used are generics.
But over the past year the cost of generic drugs has skyrocketed, including for products that have been on the market for many years. A study by Pembroke Consulting comparing CMS data for average generic drug acquisition costs between July 2013 and July 2014 found that half of the generic drugs listed rose in cost, with the median increase nearly 12%. Some drug prices saw extreme increases. For instance, the per-unit price for a 500 mg capsule of tetracycline, a common antibiotic, increased from $0.05 cents to $8.59, a more than 17,000 % increase.”