Topic: Affordable Care Act
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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.
December 3, 2013 at 7:00 PM
Washington Insurance Commissioner Mike Kreidler, who refused President Obama’s offer to let people keep discontinued health plans, will testify before the U.S. House Ways and Means Health Subcommittee early Wednesday morning about how the Affordable Care Act is working in Washington.
Kreidler was invited to testify by Rep. Jim McDermott, a Democrat from Seattle, who serves as the ranking member on the subcommittee.
Kreidler, a Democrat, may face some uncomfortable questions from some subcommittee members, some of whom are hearing from disgruntled constituents whose insurance plans were pulled because they didn’t meet the ACA’s requirements.
The New York Times noted a “fresh wave of legal challenges” to the law, as well as a hearing to be held by the House Judiciary Committee to examine whether President Barack Obama is properly using his executive powers to alter provisions of the law. The committee also will examine the theory behind the lawsuits — that tax credits or subsidies cannot be granted to people who purchase insurance through the federal exchange.
Washington is among a minority of states with its own state exchange.
About two-thirds of the 290,000 Washington residents who currently buy individual insurance plans were covered by “catastrophic” policies with limited benefits, the state insurance office says. Most of them learned this fall that their policies were being discontinued.
The discontinued plans likely insure healthier people, since insurers formerly could reject people with health problems. Kreidler, and insurers generally, said that allowing the discontinued policies to continue — and to keep those policyholders out of the marketplace — could disrupt the stability of the market, since insurers carefully priced plans based on projections of the health of their enrollees, among other things.
In addition, letting people keep “bare bones” plans, Kreidler said, was not in keeping with the consumer protections of the Affordable Care Act, which mandated coverage of such areas as prescription drugs and maternity care.
The hearing, at 7 a.m. PST, will be streamed live; to watch, click here.
December 2, 2013 at 6:04 PM
Anticipating the coming wave of patients under the Affordable Care Act, Group Health and Bartell Drugs are building three in-store, walk-in retail clinics in Seattle, Bellevue and Ballard. The clinics will be open to the general public and charge a set price for minor illnesses and treatments for common injuries.
The “CareClinics,” staffed with Advanced Registered Nurse Practitioners (ARNPs), will charge $75 per visit for a list of common conditions, including colds and flu, sinus infections, allergies, burns, rashes and cuts, pinkeye, sore throat, head lice, warts, sprains and strains, bronchitis, ear infections and urinary-tract and intestinal infections. Care is available to patients age 2 and over.
The clinic will collect co-payments and bill most insurers for non-Group Health members, and create an electronic medical-record file through Epic, the most commonly used type of system, that can be forwarded to a patient’s primary-care or specialty provider, said Dr. Wellesley Chapman, medical director for the clinics. The idea is to make it convenient and easy for the customer, he said, an concept more common in the retail world than in health care. ”I think we can agree that health care in general is not built around customer service,” he said.
The first site is slated to open in mid-January at Bartell Drugs in University Village. In the next two months, the partnership plans to open clinics at Crossroads in Bellevue and at a new Bartell Drugs in Ballard.
Patients have said they want more choices and more transparency, said Group Health President and CEO Scott Armstrong, who said the clinics are “a sensible extension of the things we’re doing well already.”
Too many patients go to emergency rooms for simple problems that could be easily treated at such a clinic, he said, and a many are admitted for problems that were preventable. “If your goal is to advance the overall health of a population of patients, then you should be doing exactly what Group Health is doing,” he said.
Helen Neville, Bartell Drug’s senior vice president of marketing, said her company, like Group Health, has long valued customer service. And customers were saying they wanted more options for convenient access to health care. “This is the right idea and the right partnership.”
The clinics likely will be open the same hours as the in-store pharmacies, and decisions about expanding the program will be made after a six-month evaluation, the two companies said.
In early January, the partnership will launch www.care-clinic.org for more information.
November 15, 2013 at 7:16 PM
Late Friday, interview requests were still pouring in for State Insurance Commissioner Mike Kreidler, who turned down President Obama’s rule change to allow insurers to keep discontinued individual health insurance plans.
The old plans were discontinued by insurers because they didn’t include a variety of benefits required by the Affordable Care Act, or in other ways didn’t meet the standards of the federal law.
Calls came in all day, and there were plenty of questions on the “Ask Mike” feature on the commissioner’s website. Many were from people unhappy with Kreidler’s stand, but nobody threw rocks or picketed the office, said his spokeswoman, Stephanie Marquis, who was half-expecting something unpleasant. “We’re so polarized as a nation. It’s a little bit unnerving.”
What made people mad were those notices from insurers that their plans had been scrapped, she said. Some of the letters simply told people their plans would be replaced with a more expensive one, but didn’t let them know that taking that plan wasn’t their only choice, and that they might find a less expensive option on the Washington Healthplanfinder exchange site.
“I wish we could have required the companies to send a particular letter,” Marquis said. But Kreidler’s office doesn’t have the authority to do that, she noted.
Most people who had been in the individual market for some time might well believe that the replacement offered was their only choice. “In the past, you had to take that,” she said. “But now you don’t.”
After Kreidler made his announcement Thursday morning, news organizations lined up for interviews, including The New York Times, The Washington Post, NPR, local TV, radio and newspaper outlets, and, late on Friday, Al Jazeera America, she said.
Kreidler’s two cents, Marquis said, went roughly like this: “He understands the president was put in a very hard place. And of the bills before Congress, the proposal Obama made was the least egregious. But even that couldn’t be done without tremendous upheaval in (Washington’s) market. And even if they say ‘you can keep your plan,’ that doesn’t mean your rates don’t go up — just like they have every other year.”
The one call Kreidler didn’t get? President Obama.
“I was hoping the president would call and thank him,” Marquis said. “Why not? He’s standing up for the law!”
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 7:19 PM
If you’re considering signing up for health insurance through the Affordable Care Act, and would rather talk to a human being than deal only with a website, an event Saturday in Kent could be of help.
Experts from Public Health – Seattle & King County and other organizations will answer questions about insurance plans and financial aid, and help people sign up for coverage.
The event in Kent will run from 2 to 5 p.m. inside a giant trailer parked at the Kent Memorial Park Building, 850 Central Ave. N.
If you think you might enroll or just want to check eligibility, make sure to bring the following information and documents:
■Names, birthdays, address and contact info for all the members of your household;
■Social Security numbers;
■Passport, alien, or other immigration numbers for any immigrants in the country lawfully who need health-care coverage;
■Estimated tax status for 2012, 2013 and 2014 for all household members;
■Income information for 2012, 2013 and 2014 for all adults and all minors age 14 or older who are required to file a tax return;
■Information about health insurance available to your family (Employer-sponsored insurance, Medicare, TriCare, PeaceCorps insurance, etc.)
South King County has the county’s highest concentrations of people without health insurance, with rates approaching 30 percent in some areas, according to the health agency.
The Washington Healthplanfinder event in Kent is an effort of Public Health – Seattle & King County and these partner organizations: Global to Local, HealthPoint, SeaMar, International Community Health Services, WithinReach Washington and World Relief.
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 25, 2013 at 7:00 AM
Are you still trying to figure out what the Affordable Care Act will mean for you? As the online marketplace or health-insurance exchange gets ready to open next Tuesday for those looking to buy individual coverage, you likely have questions.
Here are the basics, 20 things to know about the Affordable Care Act, one of several pieces that appeared in our special user’s guide this week. That should help, but maybe you’re also hoping to ask some questions directly of a representative from the state.
Here are two opportunities in North Seattle we’ve heard about: This Sunday, and again on Nov. 10, Carolyn Smith from the Office of the Insurance Commissioner will make a 45-minute presentation about what the health-care law will change and what it won’t. Her talk will be followed by a 45-minute Q & A period. Both events run from 3 to 4:30 p.m at Wedgwood Community Church, 8201 30th Ave., NE.
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.
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