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December 5, 2013 at 11:08 AM
At the end of my daughter’s annual checkup this year, her doctor asked if we had any concerns. Almost as an afterthought I mentioned the little wart at the end of one of her toes (note to self: get my kid flip- flops for the gym pool and showers!).No problem, said the pediatrician. In a flash she pared away some of wart with a small scalpel and froze what remained with liquid nitrogen on a Q-Tip. It took five minutes.
Historically, I have been a lazy health-care shopper. My family has always had insurance through employers and we’re generally healthy. I never ask what something will cost (chances are the doc won’t know anyhow) and I rarely scrutinize doctor’s bills.
That’s before I got the wart invoice.
Our doctor’s office billed $269 for the procedure, which was coded as “DESTRUCTION EG, LASER SURGERY.” Our insurance carrier, Aetna, got that reduced to $204.40, and that’s what we’re going to have to pay. For wart removal.
The New York Times this week published two more articles on the cost of U.S. medical care in its “Paying Till It Hurts” series. The series compares the costs of various procedures at hospitals and clinics around the country, and between nations. It’s terrifying. A story Monday delved into stitches costing $500 a piece. An article yesterday documented ambulance rides lasting two blocks and costing $900.
November 20, 2013 at 4:05 PM
After President Obama last week announced that states would have the option of asking insurers to revive canceled health-insurance plans, Washington’s insurance commissioner immediately nixed the idea.
Commissioner Mike Kreidler explained his decision, saying Washington’s Healthplanfinder insurance exchange is working, and that allowing a bunch of people to re-up on plans deemed insufficient threatens the success of the new system.
The premise of the Affordable Care Act (ACA) is that nearly everyone has comprehensive insurance coverage through insurance plans or public programs, sharing the costs for medical care among the old and young, the healthy and ill. Kreidler had numerous questions and concerns about how changing the rules for insurance plans work work this late in the game.
So what did the rest of the nation do? The New York Times has a nifty graphic illustrating who’s doing what. It turns out seven other states have joined Washington’s thanks-but-no-thanks position, including New York, Vermont, Massachusetts, Indiana, Rhode Island, Maryland and Minnesota. Those open to extending the plans include Oregon, Hawaii, Texas, Florida, Utah, Wyoming, Arkansas, Tennessee, Kentucky, Ohio, Georgia, South Carolina and North Carolina.
November 14, 2013 at 5:23 PM
President Obama came out with the surprising decision this morning to allow insurance companies to revive health plans that have already been canceled. But he left it up to state insurance commissioners to decide whether to resurrect these policies — which don’t comply with the Affordable Care Act — or continue as planned and encourage people to buy new coverage with a broader range of benefits.
Washington’s commissioner Mike Kreidler opted to stay the course, and he didn’t mince words in making his choice:
I understand that many people are upset by the notices they have recently received from their health plans and they may not need the new benefits today. But I have serious concerns about how President Obama’s proposal would be implemented and more significantly, its potential impact on the overall stability of our health insurance market.
In Washington state, most of the 290,000 people with individual policies already have received letters from their insurance companies telling them their plans are being canceled at the end of the year. These plans failed to meet all of the new health insurance requirements, including providing 10 “essential benefits” such as maternity care, prescription drugs and preventive care, and limiting out-of-pocket expenses at $6,350 per person.
All 90,181 people with insurance coverage from Regence BlueShield have learned their plans will be canceled, as did all 60,000 people covered by Group Health Cooperative. Some 77,000 people with LifeWise Health Plan, a subsidiary of Premera Blue Cross, also learned their plans were being scrapped.
November 8, 2013 at 10:22 AM
Washington state has gotten plenty of props for a health-insurance website that works better than most. At last count, 55,000 residents had enrolled in Medicaid or individual insurance through the state exchange.
Yet Washington Healthplanfinder has its limitations. Some of the search functions, for example, still don’t quite seem to work reliably, including the option to “customize my search.” And by design, the site is built only to let you search for plans inside the insurance exchange, but not outside (plans outside are not eligible for federal tax subsidies).
So what’s a health-insurance consumer to do in the new world of the Affordable Care Act? One option is to ditch the official sites and explore the sometimes deceptive but potentially informative world of the private sector. That’s right folks, you can go rogue.
The best site for comparative shopping that we at HealthCare Checkup have found bills itself as the “Washington Health Insurance Exchange,” but make no mistake, this is a private site run by an insurance broker named Vernon Bonfield. In small print on his home page, Bonfield explains that the site is NOT a government site, but someone stumbling on the page could easily be confused. State Insurance Commissioner Mike Kreidler and Gov. Jay Inslee have both criticized the site as being misleadingly similar to the state page.
That said, Bonfield’s site makes it easy to call up health-insurance plans inside and outside of the exchange for side-by-side comparisons. His site also includes a calculator for entering your income level and estimating your potential tax break to defray premium costs. You don’t need to share your name or otherwise register to use the site.
Brokers like Bonfield are licensed to represent specific insurance companies, and are paid commissions from those companies for selling their products. Their job is to advise consumers on which plan they should buy based on their health care needs and financial constraints.
By comparison, the “in-person assisters” and “navigators” who are trained to help people maneuver the state’s exchange site are not allowed to suggest which plan would be best to purchase. Healthplanfinder can help you locate brokers and navigators near you, and the state has a database to doublecheck that your broker is legit and to find out which insurance companies they can represent.
Other sites offer similar services for comparing and shopping for health plans, including the national company eHealth, though their site only gives insurance options for “featured” companies, unless you look for the fine print and ask it to display all of the plans available.
A government-provided option for comparing plans inside and outside of the exchange is available on the Office of the Insurance Commissioner’s webpage, but you have to click on links for each insurance company and there doesn’t appear to be an easy way to do side-by-side comparisons of premiums, deductibles, co-pays and all that good stuff.
For folks trying to navigate the new world of individual insurance plans, it can feel like the Wild West out there. There’s still uncertainty about what the rules mean and how they’re being interpreted by insurance companies. The government has shifted deadlines and there’s pressure for them to make more changes. It can be tough to track who the players are and the names of new programs.
If you’ve discovered other sites or resources to help sort out your insurance options, please let us know, and be sure to stay tuned for updates and explanations as the health-care overhaul continues to unfold.
October 29, 2013 at 8:00 PM
Compared to the dismal performance of the federal website created to sign people up for health insurance, the Washington state exchange has scored favorable reviews and thousands of people are enrolling online. Between the Oct. 1 launch date and Oct. 25, nearly 49,000 state residents had enrolled in Medicaid or an insurance plan through Washington Healthplanfinder.
“We tried to create an experience that was user friendly and that people were familiar with,” said Bethany Frey, a spokeswoman for the state exchange. She said they were aiming for a hybrid between the travel site Expedia and Turbo-Tax.
While the Washington exchange is racking up enrollees, we wondered how easily and accurately the whole machine was running. So we broke down the process of shopping and signing up for health care coverage step by step. Based on our experience, feedback from consumers and state officials, here’s how Healthplanfinder rates:
Browse plans without creating an account
Score: Needs improvement
By simply entering your birth date, Zip code, gender and income, the exchange will pull up all of the available plans, the cost of the premiums, and an estimate of the federal tax credits you qualify for.
In browsing mode, you can see which insurance plans you qualify for, premiums, deductibles and co-pays. A link to “more information on this plan” gives additional details on costs for maternity care, diabetes, prescription drugs, emergency room visits, and more.
There are a couple of weaknesses to the browsing. You have to re-enter your personal information each time you return to the site, and it automatically closes the site if you stop browsing for more than 15 minutes. You can select one doctor or one hospital and the site will show which plans they are covered by, but it won’t allow searches for multiple providers at once. It also can be tricky to move back and forth between screens.
October 11, 2013 at 8:08 PM
A week after the bumpy roll out of the new health-insurance exchanges, Americans are viewing the Affordable Care Act more favorably. A poll by the Wall Street Journal and NBC found that 38 percent of respondents supported the health- care overhaul, up from 31 percent in September and 34 percent in July.
The fraction of Americans opposed to Obamacare has been gradually ticking down from 49 percent in June to 43 percent this week.
Results from the poll, which has been ongoing for a few years, bounce around a lot so it’s hard to say if these trends will hold.
Blue-leaning Washington has responded more favorably to the changes in health-care law, with 45 percent approving of the changes while 42 percent of those surveyed were opposed, according to a September Elway Poll conducted for The Seattle Times.
At the same time, a separate poll found that 40 percent of Americans thought the launch of the insurance exchanges has not gone well. In Washington and other states, many people trying to sign up for insurance when the marketplaces opened Oct. 1 found the websites weren’t working.
Website operators have largely fixed the problems here and elsewhere. By Oct. 7, Washington state officials reported that 9,452 people had enrolled in insurance plans or for Medicaid through Healthplanfinder.
In addition to the health-insurance exchanges that aim to provide coverage for millions of Americans who have gone without, the Affordable Care Act encompasses a suite of changes in U.S. health care. Other provisions include requirements that insurance pay for certain kinds of preventative care, ban companies from denying coverage to people with pre-existing medical problems, and remove life-time limits on health-insurance claims.
One interesting point to note is the phrasing of the questions regarding the ACA. Washington’s Elway Poll presented the issue with rather neutral language, asking: “Overall, do you generally approve or disapprove of the Affordable Care Act?” while the WSJ/NBC poll asked: “Now as you may know, Barack Obama’s health care plan was passed by Congress and signed into law in 2010. From what you have heard about the new health care law, do you think it is a good idea or a bad idea?”
Since the question is asked the same way over time in the WSJ/NBC poll, the trend info is certainly legit. But given how negatively people feel about Obamacare as contrasted with the Affordable Care Act, despite the fact that they’re the same thing (see this entertaining spot from Jimmy Kimmel if you doubt this is true), one wonders how the national numbers might stack up if the pollster used different language.
Some 800 adults participated in the WSJ/NBC poll, which was conducted Oct. 7-9 and included land-line and cell-phone respondents. The poll has an overall margin of error of plus-minus 3.5 percentage points.
September 28, 2013 at 8:01 PM
Like it or not, these days you can’t avoid talk of health care reform. That’s because on Tuesday, the states roll out their new health insurance exchanges, a key piece of the Affordable Care Act. So whether you’ve been meticulously tracking the details of Obamacare, or have passively allowed the news stories and TV, radio and online ads wash over you, take our quiz and see how you rate! (Answers are at the end of the quiz.)
1. How long is the open enrollment for the new insurance exchanges?
a. 3 months, Oct. 1 to Jan. 1, 2014.
b. 6 months, Oct. 1 to Mar. 31, 2014.
c. 1 year, beginning Oct. 1.
d. It never closes.
2. Who will be penalized if they are uninsured and don’t buy insurance?
a. Medicare recipients.
b. Native Americans.
c. Prison inmates.
d. College students.
e. All of the above.
3. The Affordable Care Act requires insurance plans do all of the following except:
a. Allow you to go to any doctor and hospital that you want.
b. Cannot deny coverage based on pre-existing conditions.
c. Pays for preventive care including mammograms, colonscopies and flu shots, with no cost sharing.
d. Cannot impose annual or lifetime coverage limits.
e. Must limit out-of-pocket costs.
4. Who is eligible for financial help paying for health insurance?
a. A family of four earning up to $120,200.
b. Undocumented immigrants.
c. Individuals earning up to $45,950.
d. Those under age 30 buying a “catastrophic” plan.
5. Which businesses must buy insurance for their employees beginning in 2014?
a. Those with 50 or more full-time equivalent employees.
b. Those with a gross income of $500,000 or more.
c. Those unwilling to pay a per-employee fine.
d. None of the above.
6. True or false: If lawmakers don’t pass funding legislation and the federal government shuts down, the insurance exchanges will not open Tuesday and the Affordable Care Act will be defeated.
7. True or false: You must buy your insurance from within the state’s exchange if you want to take advantage of any subsidies.
8. True or false: All insurance plans must pay for maternity care, including devices called breast pumps that help nursing mothers.
9. True or false: The Affordable Care Act requires all hospital gowns to reach mid thigh and include at least three ties for sufficient closure, or the institution faces a per-gown fine.
10. True or false: “Obamacare” is a term of endearment originally bestowed by ACA supporters who believe President Obama wants everyone to be healthy.
1. b. The exchange is open extra long during this first enrollment period. It reopens again in later 2014 from Oct. 15 to Dec. 7, and during these same dates in years following.
2. d. College students do need insurance, which they often can get through school, and the law now allows parents to include their kids on their insurance plans until they’re 26. Other folks exempt from purchasing insurance include Medicaid recipients, those covered by military and veteran plans, people opposed to insurance and health care for religious reasons, undocumented immigrants, and certain low-income residents.
3. a. If you have a doctor, clinic or hospital that you really love, check to make sure they’re part of the plan you want to purchase because they will limit the docs and places they’ll cover.
4. c. A family of four can earn up to $94,200 and likely still qualify for subsidies.
5. d. The “employer mandate” was delayed until 2015, when companies with 50 or more full time workers will need to provide insurance coverage or pay a fine.
6. False. Much of the money needed to launch the insurance exchanges has already been spent, and most of the programs are paid for with “mandatory funding” not tied to the current spending debate.
7. True. Insurance coverage will be available “outside” of the exchange, but it won’t qualify for benefits that reduce premiums.
8. True. There’s a long list of benefits that insurance now must cover — remember that the official title of the new law is the “Patient Protection and Affordable Care Act” so these provisions fall under the Patient Protection idea of the reform. Plans inside and out of the exchange must cover: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and treatment of substance abuse disorders, including behavioral health treatment, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, pediatric services, including oral and vision care.
9. False. Maybe this will show up in future reforms, but it ain’t likely.
How many did you get right?
10, a perfect score: Grab your lollipop from the receptionist, and congrats.
7 to 9 correct: ‘Tis only a flesh wound. You’ll survive, and now you know better how the ACA works.
4 to 6 correct: Carefully read the Times’ handy user’s guide and call me in the morning.
2 to 3 correct: Update your will and inform your next of kin — your prognosis is not good.
0-1 correct answer: You really missed the hospital gown and/or the Obamacare question? You are declared DOA!
September 18, 2013 at 10:03 AM
The 15 percent of Washington households that lack Internet access might be missing out on trivial matters such as videos of the latest celebrity gaff or Facebook updates from nearly forgotten high school friends. But come next month, these residents are also going to have a harder time signing up for health insurance available as a result of the Affordable Care Act, or Obamacare.
In Washington state, new insurance plans for residents who are uninsured or who don’t get health insurance through work will only be available through an online portal called the Washington Healthplanfinder.
While much of the state struggles to remember which of their passwords goes with which email address, others don’t have a single email account — a requirement of enrolling in the insurance exchange.
“First we need a list of free emails,” said Carol Allen, a community health educator with King County, during a recent Healthplanfinder training session in Seattle. Luckily, free email is readily available through Google, Yahoo and others.
But you still need to get these folks aboard the Internet (And, of course, if you are reading this blog, you are.)
A report called “Exploring the Digital Nation” released this summer by the U.S. Commerce Department found that:
“Compared to the national adoption rate, white and Asian American households, and high-income and highly educated households, had higher computer ownership and broadband adoption rates in both urban and rural areas. Rural African American and Hispanic households with low incomes reported the lowest computer and broadband adoption rates.”
And as Seattle Times health reporter Carol Ostrom recently blogged, Washington ranks high nationally for the percentage of under-age-65 Hispanics without insurance, and the percentage of people under age 65 living at or below the poverty level without insurance — just the people who have a harder time getting online.
What to do? It seems reasonable to send folks online to register for health insurance, particularly given that they need to be able to compare more than 40 plans to figure out which one they want, and they need to do things like enter income information to calculate what their insurance would cost or if they qualify for Medicaid or tax credits.
So local governments are partnering with community groups, health clinics, libraries and other services to provide in-person help for people who might struggle to navigate this system (see this story I recently wrote about the issue). In King County, 23 community groups will help educate and recruit uninsured residents. One partner is Sea Mar Community Health Centers, which has about 60 health facilities across the Puget Sound region.
To bridge the digital divide, Rudy Vasquez, director of Sea Mar’s managed-care operations, said they’ll be installing computer kiosks at many of their health clinics so patients can research and enroll in health insurance plans onsite.
“It’s trying to create a smooth pathway for them to access assistance,” Vasquez said.
September 10, 2013 at 1:31 PM
Mom’s the one who can get you to tuck in your shirt, fasten your seatbelt and call Granny to wish her a happy birthday. But can she get her grown-up kids to buy medical insurance?
Health-care officials hope so.
As the launch date for the overhaul of U.S. health coverage approaches, state and federal leaders are counting on the persuasive power of moms to boost the number of healthy young people enrolled in insurance plans. Physically robust youths get sick, but they typically need less expensive, less frequent medical attention than other age groups. That means the premiums paid by young adults can help offset insurance companies’ costs for sicker, older subscribers.
Given their vigor, 19- to 25-year-olds historically have shunned insurance payments and are the least-covered demographic nationally. Approximately 28 percent of this population lacks health insurance, according to the U.S. Census. In Washington, more than 29 percent of this group was uninsured in 2011.
Enter mom as the potential fix.
Health and Human Services Secretary Kathleen Sebelius has been working the mom angle on multiple fronts. In June, Sebelius – herself a mother of two grown sons – discussed with reporters strategies for convincing young people to sign up for health insurance.
“We know that for instance – and I take this very personally – that moms can be influential with that demographic group,” said Sebelius, as quoted in Politico. The Obama administration has reportedly set the goal of enrolling 2.7 million healthy people ages 18 to 35 in insurance programs.
In Chicago in July, speaking at the woman-focused BlogHer conference, Sebelius again made her pitch that women will play a key role in expanding insurance rolls.
“One of the most trusted voices is mothers,” she said, according to The Associated Press. “We’re trying to get a lot of information into women’s hands because women often purchase the health care for their family.”
Washington state leaders have picked up the mantra. At a recent healthcare summit in Seattle, Michael Marchand, communications director with the state’s Health Benefit Exchange, rattled off slogans for getting residents enrolled. They included messages of affordability, gaining health and financial security, that you won’t go bankrupt if you get sick, and because “mom says so.”
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