Winston-Salem Journal: Winston-Salem News, Sports, Entertainment, Politics, Classifieds

August 28, 2014

Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest – and costliest – patients from enrolling.

Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul.

Advocates and industry insiders say these practices may dissuade the neediest from signing up and make it likelier that the customers these insurers do serve will be healthier — and less expensive.

via Winston-Salem Journal: Winston-Salem News, Sports, Entertainment, Politics, Classifieds.


Churn and the ACA | The Health Care Blog

August 12, 2014

Different eligibility criteria for different populations can also cause a churn challenge, especially for families. Most states have different Medicaid eligibility limits for children than for adults. This means that if a family’s income increases, or a child ages out of CHIP coverage, the eligibility for the parents may change, while the eligibility for the children may not. This scenario results in split families, wherein the children have one type of coverage and adults have a different type. In many states, this means understanding the details, benefits and cost structures of two types of coverage, often from different companies, in the same household.

So what can we do to safeguard consumers from these disruptions? Fortunately, states have resources in their toolkits to mitigate the impacts of churn. They can work to maintain continuity of care for individuals, and they can make sure that insurance remains affordable when people jump from one coverage source to another.

via Churn and the ACA | The Health Care Blog.


Newly Insured by Health Law, Millions Face a Learning Curve – NYTimes.com

August 2, 2014

“I’ve had one doctor appointment since I got this insurance, and I had to pay $60,” Ms. Shabazz told Daniel Flynn, a counselor with the health network, the Health Federation of Philadelphia. “I don’t have $60.”Mr. Flynn spent almost two hours going over her Independence Blue Cross plan, which he explained had a “very complicated” network that grouped doctors and hospitals into three tiers. Ms. Shabazz, who has epilepsy, had not understood when she chose the plan that her doctors were in the most expensive tier.“None of that was explained when I signed up,” she said. “This is the first I’m hearing it.”

via Newly Insured by Health Law, Millions Face a Learning Curve – NYTimes.com.


Health Reform and Changes in Health Insurance Coverage in 2014 — NEJM

July 23, 2014

In this analysis of nationally representative survey data from January 2012 through June 2014, we found a significant decline in the uninsured rate among nonelderly adults that coincided with the initial open-enrollment period under the ACA. These changes remained highly significant after adjustment for potential confounders such as employment, demographic characteristics, and income. As compared with the baseline trend, the uninsured rate declined by 5.2 percentage points by the second quarter of 2014, a 26% relative decline from the 2012–2013 period. Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, our sensitivity analyses imply a wide range from 7.3 to 17.2 million adults.

via Health Reform and Changes in Health Insurance Coverage in 2014 — NEJM.


Lies, Damned Lies, And ObamaCare Statistics – Amy Ridenour’s National Center Blog – A Conservative Blog

July 22, 2014

With apologies to Mark Twain, there are lies, there are damned lies, and then there are ObamaCare statistics. Case in point is a column written by Vicki Simons touting the supposed positive effects of ObamaCare: The positive results of ACA:

— 20 million more American have access to health care than before ACA was passed.

— 8 million people have signed up for health coverage through the state and federal marketplaces; 32,000 in New Mexico.

— 4.8 million more have signed up for Medicaid coverage; 103,00 total in New Mexico. As of March 31, 2014, there were 642,489 residents enrolled in Medicaid or CHIP.

— 3 million now have coverage by staying on their parents’ plan; 26,000 in New Mexico.

Not a single one of those is accurate.

via Lies, Damned Lies, And ObamaCare Statistics – Amy Ridenour’s National Center Blog – A Conservative Blog.


To Prevent Surprise Bills, New Health Law Rules Could Widen Insurer Networks – NYTimes.com

July 21, 2014

The Obama administration and state insurance regulators are developing stricter standards to address the concerns of consumers who say that many health plans under the Affordable Care Act have unduly limited their choices of doctors and hospitals, leaving them with unexpected medical bills.Federal officials said the new standards would be similar to those used by the government to determine whether Medicare Advantage plans had enough doctors and hospitals in their networks. These private plans, sold by companies like UnitedHealth and Humana, provide comprehensive care to 16 million of the 54 million Medicare beneficiaries.States are free to adopt additional standards of their own, and Washington did so in late April.

via To Prevent Surprise Bills, New Health Law Rules Could Widen Insurer Networks – NYTimes.com.


Obamacare Misses Its Target on the Uninsured by Half | The Weekly Standard

July 16, 2014

Only in Washington could something that fails to hit even half of its original target be considered a gasp-inducing success.  No wonder Obamacare is every bit as unpopular now as it was before the party that passed it took its initial Obamacare-induced “shellacking” four years ago.It’s time for a well-conceived conservative alternative that will fix what the government had broken even before Obamacare was passed, shift things in a conservative direction from the pre-Obamacare status quo, and lead to the full repeal of perhaps the worst legislation in American history.

via Obamacare Misses Its Target on the Uninsured by Half | The Weekly Standard.


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