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"disqusTitle": "Medi-Cal Patients Flocking to ERs More Than Before ACA",
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"content": "\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The revised Republican bill to repeal and replace the Affordable Care Act will leave 23 million more people uninsured over the next decade than if that act, also known as Obamacare, were to remain in place. The GOP bill would also reduce the deficit by $119 billion.\u003c/p>\n\u003cp>That’s what the nonpartisan Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf\">reported on Wednesday\u003c/a> in its latest score of the American Health Care Act. The CBO’s assessment raises potential concerns about the bill. The agency reports that the bill could destabilize individual insurance markets in some states, leaving unhealthy Americans unable to buy insurance. The CBO also notes that the AHCA could mean some Americans would buy coverage that doesn’t cover “major medical risks.” Because of those policies’ skimpy coverage, the CBO doesn’t count those people as insured in this report.\u003c/p>\n\u003cp>The fate of the bill rests in part on this score, as House Republicans passed their most recent version of the bill without waiting for the CBO to report the bill’s estimated price tag. Three weeks after passing the bill, however, they have not sent the bill on to the Senate yet, because budget rules dictate that if its deficit savings did not reach $2 billion (and that $2 billion had to come from particular spending categories), the bill would be dead upon arrival in the upper chamber.\u003c/p>\n\u003cp>The deficit reduction in the latest version of the bill represents a decline from previous versions. When the CBO \u003ca href=\"https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf\">first scored the AHCA\u003c/a>, it said the plan would save $337 billion over 10 years. Later revisions reduced those savings \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628.pdf\">to $150 billion\u003c/a>.\u003c/p>\n\u003cp>By far the biggest savings would come from Medicaid, which serves low-income Americans. That program would face $884 billion in cuts. Cutbacks in subsidies for individual health insurance would likewise help cut $276 billion. But those are offset in large part by bigger costs, including the repeal of many of Obamacare’s taxes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The revised Republican bill to repeal and replace the Affordable Care Act will leave 23 million more people uninsured over the next decade than if that act, also known as Obamacare, were to remain in place. The GOP bill would also reduce the deficit by $119 billion.\u003c/p>\n\u003cp>That’s what the nonpartisan Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf\">reported on Wednesday\u003c/a> in its latest score of the American Health Care Act. The CBO’s assessment raises potential concerns about the bill. The agency reports that the bill could destabilize individual insurance markets in some states, leaving unhealthy Americans unable to buy insurance. The CBO also notes that the AHCA could mean some Americans would buy coverage that doesn’t cover “major medical risks.” Because of those policies’ skimpy coverage, the CBO doesn’t count those people as insured in this report.\u003c/p>\n\u003cp>The fate of the bill rests in part on this score, as House Republicans passed their most recent version of the bill without waiting for the CBO to report the bill’s estimated price tag. Three weeks after passing the bill, however, they have not sent the bill on to the Senate yet, because budget rules dictate that if its deficit savings did not reach $2 billion (and that $2 billion had to come from particular spending categories), the bill would be dead upon arrival in the upper chamber.\u003c/p>\n\u003cp>The deficit reduction in the latest version of the bill represents a decline from previous versions. When the CBO \u003ca href=\"https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf\">first scored the AHCA\u003c/a>, it said the plan would save $337 billion over 10 years. Later revisions reduced those savings \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628.pdf\">to $150 billion\u003c/a>.\u003c/p>\n\u003cp>By far the biggest savings would come from Medicaid, which serves low-income Americans. That program would face $884 billion in cuts. Cutbacks in subsidies for individual health insurance would likewise help cut $276 billion. But those are offset in large part by bigger costs, including the repeal of many of Obamacare’s taxes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Your Cheat Sheet on the Republican Health Care Plan (And Its Impact on California)",
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"content": "\u003cp>\u003cstrong>Updated Tuesday, March 14, 3 p.m.:\u003c/strong> California health officials are sounding the alarm about the potential impacts of the Republican health proposal on the state's uninsured rate.\u003c/p>\n\u003cp>\"We are deeply troubled,\" said Covered California's executive director, Peter V. Lee. He was referring to the latest numbers from the Congressional Budget Office, which on Monday estimated the GOP bill would cause 24 million Americans to lose health coverage by 2026.\u003c/p>\n\u003cp>Lee's staff is still analyzing exactly how many of those 24 million will be Californians.\u003c/p>\n\u003cp>But the CBO analysis does reveal that the average federal subsidy —to help lower-income Americans purchase health insurance on exchanges like Covered California — would drop 40 percent under the Republican bill as currently written.\u003c/p>\n\u003cp>Those consumers include 1.7 million Californians.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"While we are still doing an analysis ... the likely effect of basing subsidies on age alone — rather than considering income and where an individual lives — is that it will make coverage unaffordable and in many cases, put coverage out of reach,” Lee said Tuesday.\u003cem> \u003c/em>\u003c/p>\n\u003cp>By embracing President Obama's Affordable Care Act, California decreased its uninsured rate from 17 percent to 7 percent. Twelve percent of Covered California enrollees receive more than $10,000 per household, and 16 percent of individuals receive more than $6,000 per year in tax credits.\u003c/p>\n\u003cp>\u003cstrong>Original post, March 7: \u003c/strong>The Republican bill is complicated. But don't worry. We’ve dug into the details to simplify this complex issue and create a cheat sheet for you.\u003c/p>\n\u003cp>\u003cstrong>What does the Republican bill do?\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>No more individual mandate, meaning no tax penalty for not being covered.\u003c/li>\n\u003cli>Large employers don’t have to cover workers anymore, and there isn't a penalty if they don’t.\u003c/li>\n\u003cli>Eliminates federal funding for expansion of Medicaid, which 31 states took advantage of. Starting in 2020, no more people who qualify as \"expansion\" adults can join.\u003c/li>\n\u003cli>Caps the subsidies that people can get to buy their own individual coverage on insurance marketplaces (known as \u003cem>Covered California \u003c/em>here.) Subsidies are flat tax credits that vary only by age: younger people will get $2,000 and the amount rises to a maximum of $4,000 for people over 60. Subsidies under the Affordable Care Act (ACA) took into account income and the local price of health insurance. They could be as high as 10,000 or more.\n\u003cul>\n\u003cli>What does this mean? People who previously got subsidies could pay more for their health plans than they were paying in the past.\u003c/li>\n\u003cli>Who won't be able to get those new subsidies? Individuals making more than $75,000 a year or more and couples making more than $150,000 a year.\u003c/li>\n\u003c/ul>\n\u003c/li>\n\u003cli>Bans federal funding for providers that offer abortion, like Planned Parenthood, for one year. That provision would eliminate 80 percent of California Planned Parenthood’s total budget. Since federal funds don't generally pay for abortion anyway, the bill is talking about cutting federal funds for all of Planned Parenthood's \u003cem>other \u003c/em>services: contraception, cervical cancer screenings, etc.\u003c/li>\n\u003cli>Cuts taxes that were put in place by the ACA to pay for the subsidies and Medicaid expansion. Specifically, it cuts those taxes on insurance, pharmaceutical and medical device companies, and wealthy families.\u003c/li>\n\u003cli>\u003cstrong>What \u003cem>doesn't\u003c/em> the bill do? It \u003cem>does not\u003c/em> eliminate some ACA favorites: \u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Children can stay on their parents' insurance until age 26.\u003c/li>\n\u003cli>Insurers still can't put dollar caps on annual medical expenses or lifetime medical expenses.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What are some other important changes?\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>People with pre-existing conditions still cannot be denied coverage (like under the ACA) — but if they have a gap in their coverage they will have to pay 30 percent more for the insurance than other consumers, for one year.\u003c/li>\n\u003cli>ACA allowed insurers to charge older people \u003cem>three times\u003c/em> as much for insurance premiums as younger people. The new bill allows them to charge up to \u003cem>five times\u003c/em> as much. This is significant because the new bill only offers subsidies for older people that are, at most, \u003cem>twice\u003c/em> as much as those offered younger people. It appears at first that older adults get more money in tax credits, but those dollars won't go as far towards purchasing the higher-priced insurance they will be offered.\u003c/li>\n\u003cli>How Medicaid is funded overall, even for traditional patients. The federal government will give each state a fixed amount, called a “cap,” for each Medicaid patient’s yearly care, and no more (that cap could go up every year, but only by the rate of medical inflation in cities).\u003cstrong> \u003c/strong>Right now, Medicaid pays all the medical bills, no matter the cost. This will affect a group of very poor and/or disabled people that were never affected by ACA in the first place, experts say.\u003c/li>\n\u003cli>Some Medicaid plans may no longer offers some benefits, such as substance abuse. This has raised alarm bells because of the country's ongoing problem with opioid abuse.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What's notably missing from the bill?\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>It does not include any analysis of the bill’s effect on insurance coverage, but an \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/06/518864390/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies\" target=\"_blank\">outside analysis\u003c/a> (from \u003ca href=\"http://www.mckinsey.com/\" target=\"_blank\">McKinsey & Company\u003c/a> and \u003ca href=\"http://avalere.com/\" target=\"_blank\">Avalere Health\u003c/a>\u003cstrong>) \u003c/strong>has predicted millions could lose coverage.\u003c/li>\n\u003cli>It\u003cstrong> \u003c/strong>does not include a cost estimate, so it's unknown what the effect on the deficit would be.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>How could California be affected? \u003c/strong>\u003c/p>\n\u003cp>Twenty million Americans got coverage through the law — one quarter of those, nearly 5 million, are in California. So the impact here will be huge.\u003c/p>\n\u003cul>\n\u003cli>The uninsured rate in California fell from 17 percent in 2013 to a historic low of 7.1 percent in 2016.\u003c/li>\n\u003cli>Latinos benefited most: The number of Latinos in California who were uninsured fell by 1.5 million, and the uninsured rate in this population fell from 23 percent to 12 percent.\u003c/li>\n\u003cli>In San Francisco, the uninsured rate \u003ca href=\"http://caph.org/wp-content/uploads/2017/02/sfhn-aca-final-profile.pdf\" target=\"_blank\">fell \u003c/a>from 9.2 percent to 4.8 percent.\n\u003cul>\n\u003cli>What is this bill’s effect on San Francisco Health Network, the citywide system of 14 public clinics that also includes Zuckerberg San Francisco General Hospital? That system would \u003ca href=\"http://caph.org/wp-content/uploads/2017/02/sfhn-aca-final-profile.pdf\" target=\"_blank\">lose \u003c/a>$125 million a year in revenue\u003cstrong>.\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003c/li>\n\u003c/ul>\n\u003cp>Overall, the new bill is likely to significantly increase the number of people who are uninsured. And in the past, when there were more uninsured, it significantly increased the personal bankruptcy rate and pushed the burden of care into ERs and safety-net clinics — which ultimately are paid for by the\u003cstrong> \u003c/strong>state and local taxpayers. Insurance costs also increase for everyone.\u003c/p>\n\u003cp>\u003cstrong>How does the Affordable Care Act work in California now, and what would change?\u003c/strong>\u003c/p>\n\u003cp>Under the current law, 3.7 million adults became newly eligible for Medi-Cal. The new bill would stop federal payment for those newly eligible adults by 2020. If California decided on its own to keep those people on the insurance rolls, it would cost the state an additional $8 billion a year in federal funding.\u003c/p>\n\u003cp>An additional 1.2 million Californians get financial help from the ACA to buy individual insurance policies through Covered California. Those Californians are getting about $5 billion in federal aid, in the form of monthly subsidies and other assistance. The Republican bill would replace those subsidies, which track the cost of health care in California, with flat tax credits across the U.S. The credits would give an individual between $2,000 and $4,000 to buy a plan (depending on their age), no matter the cost of the plan.\u003c/p>\n\u003cp>\u003cstrong>What is the potential economic impact? \u003c/strong>\u003c/p>\n\u003cp>A \u003ca href=\"http://laborcenter.berkeley.edu/pdf/2016/Californias-Projected-Economic-Losses-under-ACA-Repeal.pdf\" target=\"_blank\">net loss\u003c/a> of 209,000 jobs in California, according to the UC Berkeley Labor Center. The majority of jobs would be lost from the health care industry, but ripple effects would be felt in food service, janitorial services and accounting firms.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Sources: \u003c/strong>California Health Care Foundation, Kaiser Family Foundation, UC Berkeley Labor Center, House of Representatives Ways and Means Committee, House of Representatives Energy and Commerce Committee, news reports.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Updated Tuesday, March 14, 3 p.m.:\u003c/strong> California health officials are sounding the alarm about the potential impacts of the Republican health proposal on the state's uninsured rate.\u003c/p>\n\u003cp>\"We are deeply troubled,\" said Covered California's executive director, Peter V. Lee. He was referring to the latest numbers from the Congressional Budget Office, which on Monday estimated the GOP bill would cause 24 million Americans to lose health coverage by 2026.\u003c/p>\n\u003cp>Lee's staff is still analyzing exactly how many of those 24 million will be Californians.\u003c/p>\n\u003cp>But the CBO analysis does reveal that the average federal subsidy —to help lower-income Americans purchase health insurance on exchanges like Covered California — would drop 40 percent under the Republican bill as currently written.\u003c/p>\n\u003cp>Those consumers include 1.7 million Californians.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"While we are still doing an analysis ... the likely effect of basing subsidies on age alone — rather than considering income and where an individual lives — is that it will make coverage unaffordable and in many cases, put coverage out of reach,” Lee said Tuesday.\u003cem> \u003c/em>\u003c/p>\n\u003cp>By embracing President Obama's Affordable Care Act, California decreased its uninsured rate from 17 percent to 7 percent. Twelve percent of Covered California enrollees receive more than $10,000 per household, and 16 percent of individuals receive more than $6,000 per year in tax credits.\u003c/p>\n\u003cp>\u003cstrong>Original post, March 7: \u003c/strong>The Republican bill is complicated. But don't worry. We’ve dug into the details to simplify this complex issue and create a cheat sheet for you.\u003c/p>\n\u003cp>\u003cstrong>What does the Republican bill do?\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>No more individual mandate, meaning no tax penalty for not being covered.\u003c/li>\n\u003cli>Large employers don’t have to cover workers anymore, and there isn't a penalty if they don’t.\u003c/li>\n\u003cli>Eliminates federal funding for expansion of Medicaid, which 31 states took advantage of. Starting in 2020, no more people who qualify as \"expansion\" adults can join.\u003c/li>\n\u003cli>Caps the subsidies that people can get to buy their own individual coverage on insurance marketplaces (known as \u003cem>Covered California \u003c/em>here.) Subsidies are flat tax credits that vary only by age: younger people will get $2,000 and the amount rises to a maximum of $4,000 for people over 60. Subsidies under the Affordable Care Act (ACA) took into account income and the local price of health insurance. They could be as high as 10,000 or more.\n\u003cul>\n\u003cli>What does this mean? People who previously got subsidies could pay more for their health plans than they were paying in the past.\u003c/li>\n\u003cli>Who won't be able to get those new subsidies? Individuals making more than $75,000 a year or more and couples making more than $150,000 a year.\u003c/li>\n\u003c/ul>\n\u003c/li>\n\u003cli>Bans federal funding for providers that offer abortion, like Planned Parenthood, for one year. That provision would eliminate 80 percent of California Planned Parenthood’s total budget. Since federal funds don't generally pay for abortion anyway, the bill is talking about cutting federal funds for all of Planned Parenthood's \u003cem>other \u003c/em>services: contraception, cervical cancer screenings, etc.\u003c/li>\n\u003cli>Cuts taxes that were put in place by the ACA to pay for the subsidies and Medicaid expansion. Specifically, it cuts those taxes on insurance, pharmaceutical and medical device companies, and wealthy families.\u003c/li>\n\u003cli>\u003cstrong>What \u003cem>doesn't\u003c/em> the bill do? It \u003cem>does not\u003c/em> eliminate some ACA favorites: \u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Children can stay on their parents' insurance until age 26.\u003c/li>\n\u003cli>Insurers still can't put dollar caps on annual medical expenses or lifetime medical expenses.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What are some other important changes?\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>People with pre-existing conditions still cannot be denied coverage (like under the ACA) — but if they have a gap in their coverage they will have to pay 30 percent more for the insurance than other consumers, for one year.\u003c/li>\n\u003cli>ACA allowed insurers to charge older people \u003cem>three times\u003c/em> as much for insurance premiums as younger people. The new bill allows them to charge up to \u003cem>five times\u003c/em> as much. This is significant because the new bill only offers subsidies for older people that are, at most, \u003cem>twice\u003c/em> as much as those offered younger people. It appears at first that older adults get more money in tax credits, but those dollars won't go as far towards purchasing the higher-priced insurance they will be offered.\u003c/li>\n\u003cli>How Medicaid is funded overall, even for traditional patients. The federal government will give each state a fixed amount, called a “cap,” for each Medicaid patient’s yearly care, and no more (that cap could go up every year, but only by the rate of medical inflation in cities).\u003cstrong> \u003c/strong>Right now, Medicaid pays all the medical bills, no matter the cost. This will affect a group of very poor and/or disabled people that were never affected by ACA in the first place, experts say.\u003c/li>\n\u003cli>Some Medicaid plans may no longer offers some benefits, such as substance abuse. This has raised alarm bells because of the country's ongoing problem with opioid abuse.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What's notably missing from the bill?\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>It does not include any analysis of the bill’s effect on insurance coverage, but an \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/06/518864390/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies\" target=\"_blank\">outside analysis\u003c/a> (from \u003ca href=\"http://www.mckinsey.com/\" target=\"_blank\">McKinsey & Company\u003c/a> and \u003ca href=\"http://avalere.com/\" target=\"_blank\">Avalere Health\u003c/a>\u003cstrong>) \u003c/strong>has predicted millions could lose coverage.\u003c/li>\n\u003cli>It\u003cstrong> \u003c/strong>does not include a cost estimate, so it's unknown what the effect on the deficit would be.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>How could California be affected? \u003c/strong>\u003c/p>\n\u003cp>Twenty million Americans got coverage through the law — one quarter of those, nearly 5 million, are in California. So the impact here will be huge.\u003c/p>\n\u003cul>\n\u003cli>The uninsured rate in California fell from 17 percent in 2013 to a historic low of 7.1 percent in 2016.\u003c/li>\n\u003cli>Latinos benefited most: The number of Latinos in California who were uninsured fell by 1.5 million, and the uninsured rate in this population fell from 23 percent to 12 percent.\u003c/li>\n\u003cli>In San Francisco, the uninsured rate \u003ca href=\"http://caph.org/wp-content/uploads/2017/02/sfhn-aca-final-profile.pdf\" target=\"_blank\">fell \u003c/a>from 9.2 percent to 4.8 percent.\n\u003cul>\n\u003cli>What is this bill’s effect on San Francisco Health Network, the citywide system of 14 public clinics that also includes Zuckerberg San Francisco General Hospital? That system would \u003ca href=\"http://caph.org/wp-content/uploads/2017/02/sfhn-aca-final-profile.pdf\" target=\"_blank\">lose \u003c/a>$125 million a year in revenue\u003cstrong>.\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003c/li>\n\u003c/ul>\n\u003cp>Overall, the new bill is likely to significantly increase the number of people who are uninsured. And in the past, when there were more uninsured, it significantly increased the personal bankruptcy rate and pushed the burden of care into ERs and safety-net clinics — which ultimately are paid for by the\u003cstrong> \u003c/strong>state and local taxpayers. Insurance costs also increase for everyone.\u003c/p>\n\u003cp>\u003cstrong>How does the Affordable Care Act work in California now, and what would change?\u003c/strong>\u003c/p>\n\u003cp>Under the current law, 3.7 million adults became newly eligible for Medi-Cal. The new bill would stop federal payment for those newly eligible adults by 2020. If California decided on its own to keep those people on the insurance rolls, it would cost the state an additional $8 billion a year in federal funding.\u003c/p>\n\u003cp>An additional 1.2 million Californians get financial help from the ACA to buy individual insurance policies through Covered California. Those Californians are getting about $5 billion in federal aid, in the form of monthly subsidies and other assistance. The Republican bill would replace those subsidies, which track the cost of health care in California, with flat tax credits across the U.S. The credits would give an individual between $2,000 and $4,000 to buy a plan (depending on their age), no matter the cost of the plan.\u003c/p>\n\u003cp>\u003cstrong>What is the potential economic impact? \u003c/strong>\u003c/p>\n\u003cp>A \u003ca href=\"http://laborcenter.berkeley.edu/pdf/2016/Californias-Projected-Economic-Losses-under-ACA-Repeal.pdf\" target=\"_blank\">net loss\u003c/a> of 209,000 jobs in California, according to the UC Berkeley Labor Center. The majority of jobs would be lost from the health care industry, but ripple effects would be felt in food service, janitorial services and accounting firms.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Sources: \u003c/strong>California Health Care Foundation, Kaiser Family Foundation, UC Berkeley Labor Center, House of Representatives Ways and Means Committee, House of Representatives Energy and Commerce Committee, news reports.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "what-happens-to-medi-cal-under-a-trump-administration",
"title": "What Happens to Medi-Cal Under a Trump Administration?",
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"headTitle": "What Happens to Medi-Cal Under a Trump Administration? | KQED",
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"content": "\u003cp>President-elect Donald Trump has vowed that he will repeal Obamacare and replace it with something “better.” Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.\u003c/p>\n\u003cp>Under the Affordable Care Act, 32 states expanded Medicaid, so that more people would qualify for the benefits. Health policy experts say states that embraced it the most could feel the changes the worst.\u003c/p>\n\u003cp>“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/292468414″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>Twenty million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s Medicaid program.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to cap that funding, and just give states one fixed grant.\u003c/p>\n\u003cp>“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.\u003c/p>\n\u003cp>In California, 62 percent of new Medi-Cal enrollees are Latino, African-American or Asian-American.\u003c/p>\n\u003cp>“The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.\u003c/p>\n\u003cp>Some states could pay doctors and hospitals less to save money. But in California, payment rates are already the second lowest in the country.\u003c/p>\n\u003cp>“California can’t really pay much less than it does to providers,” says Gerald Kominski, UCLA health policy professor. “These are going to be very, very difficult choices.”\u003c/p>\n\u003cp>Under one Republican plan, the amount of block grants would be based on Medi-Cal enrollment levels before the Affordable Care Act was implemented. Kominski says, in that scenario, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.\u003c/p>\n\u003cp>“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.\u003c/p>\n\u003cp>It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California is not an island,” says Anthony Wright, executive director of Health Access, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”\u003c/p>\n\n",
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"excerpt": "President-elect Donald Trump wants to change funding for Medicaid. Millions of low-income people could lose their health coverage. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President-elect Donald Trump has vowed that he will repeal Obamacare and replace it with something “better.” Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.\u003c/p>\n\u003cp>Under the Affordable Care Act, 32 states expanded Medicaid, so that more people would qualify for the benefits. Health policy experts say states that embraced it the most could feel the changes the worst.\u003c/p>\n\u003cp>“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/292468414″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/292468414″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Twenty million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s Medicaid program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to cap that funding, and just give states one fixed grant.\u003c/p>\n\u003cp>“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.\u003c/p>\n\u003cp>In California, 62 percent of new Medi-Cal enrollees are Latino, African-American or Asian-American.\u003c/p>\n\u003cp>“The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.\u003c/p>\n\u003cp>Some states could pay doctors and hospitals less to save money. But in California, payment rates are already the second lowest in the country.\u003c/p>\n\u003cp>“California can’t really pay much less than it does to providers,” says Gerald Kominski, UCLA health policy professor. “These are going to be very, very difficult choices.”\u003c/p>\n\u003cp>Under one Republican plan, the amount of block grants would be based on Medi-Cal enrollment levels before the Affordable Care Act was implemented. Kominski says, in that scenario, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.\u003c/p>\n\u003cp>“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.\u003c/p>\n\u003cp>It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California is not an island,” says Anthony Wright, executive director of Health Access, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Dr. Lorraine Page, believe it or not, makes house calls.\u003c/p>\n\u003cp>One place she visits is the home of Ann Caponio, a one-bedroom apartment in Half Moon Bay, California. You can tell a knitter lives there: baskets of wool and hanks of yarn adorn the room, and in the corner sits a wooden spinning wheel.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new model gains in popularity: no insurance but unlimited doctor visits are provided for a monthly fee.\u003c/aside>\n\u003cp>But arthritis has put an end to that hobby. And for a while, Caponio, 69, wasn't even getting out.\u003c/p>\n\u003cp>\"I kind of stopped going downtown,\" she says, in her Midland, Texas twang, a holdover from childhood. \"Omigod those stairs.\"\u003c/p>\n\u003cp>She's talking about a steep, 17-step staircase leading to her front door. Three hip replacements left negotiating them a dangerous proposition.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I tend to fall. And I fell on those damned stairs once.\"\u003c/p>\n\u003cp>And that's where Lorraine Page enters the picture.\u003c/p>\n\u003cp>Besides the house calls, Page provides a little more than Caponio might expect from a primary care doc available through Medicare. Page, for instance, has aided her patient with a number of safety issues, including helping her find someone to rig up a chairlift on those stairs. Now, she can sit on a seat at the top and glide to the bottom.\u003c/p>\n\u003cp>\"It opens up a whole new world for me,\" Caponio says.\u003c/p>\n\u003cp>\u003cstrong>A Different Model\u003c/strong>\u003c/p>\n\u003cp>A whole new world is what Dr. Page herself has been experiencing, ever since she left the traditional clinic setting to try something different. She does have a small office, but prefers to visit most of her patients in their homes.\u003c/p>\n\u003caside class=\"pullquote alignright\">When they learn they can get off the production line, 'Doctors will be in mass exodus.'\u003ccite>Dr. Pamela Wible\u003c/cite>\u003c/aside>\n\u003cp>She's one of a growing number of doctors who have cut loose from what she calls the \"assembly-line, volume approach\" that most of her colleagues have experienced. These breakaway docs are now using a health care delivery model called direct primary care. Page has cut back on the number of patients she sees, and spends more time with the ones she does. She doesn't take insurance and deals mostly in cash. Page charges each time she sees a patient, but most direct primary care doctors bill a monthly fee for unlimited visits.\u003c/p>\n\u003cp>In her previous practice, Page says, the pressure to see more patients in less time wore her down, as did the need for an army of support staff to process the copious paperwork required by insurance companies.\u003c/p>\n\u003cp>\"At our office, we had six full-time doctors. And we had seven full-time insurance people. So [that's] more than one full-time person trying to get reimbursement for patients I was seeing.\"\u003c/p>\n\u003cp>The benefits of leaving that bureaucratic load behind includes more time with patients but shorter days as her total load has been reduced. And she's doing the kind of family-care medicine for which she was trained.\u003c/p>\n\u003cp>\"And I enjoy it a lot more,\" Page says. \"Let's not minimize that.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"vPRJXQNXVX11c9sC2BeSG7GGPJpZybhw\"]\u003c/p>\n\u003cp>\u003cstrong>What Doctors Want\u003c/strong>\u003c/p>\n\u003cp>A 2012 \u003ca href=\"http://www.medscape.com/features/slideshow/compensation/2012/public\" target=\"_blank\">Medscape study\u003c/a> found that 46 percent of primary care physicians showed such dissatisfaction with their careers, they wouldn't pursue medicine if they could choose again. Another\u003ca href=\"http://www.physiciansfoundation.org/healthcare-research/a-survey-of-americas-physicians-practice-patterns-and-perspectives\" target=\"_blank\"> study\u003c/a>, from the Physicians Foundation, found 60 percent of primary care doctors would not recommend a career in medicine. Just six percent described the morale of their colleagues as positive.\u003c/p>\n\u003cp>Overall, says Wanda Filer, president of the American Academy of Family Physicians, primary care doctors feel overworked and ineffective. \"Most patients are just rushed out the door,\" she says. \"That's not what doctors want to do. This new model of care gets the physician and the patient out of that hamster-wheel model.\"\u003c/p>\n\u003cp>Filer says about three percent of the organization's 69,000 primary care doctors have made the move to direct primary care in the past couple of years, and that number is increasing rapidly as other physicians see it succeed.\u003c/p>\n\u003cp>In fact, Filer says, her organization has taken the unusual step of convening informational seminars for the large number of family doctors who have expressed interest in getting off the grid and starting a kinder, gentler practice.\u003c/p>\n\u003cp>\u003cb>Cash and Care\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_220077\" class=\"wp-caption alignright\" style=\"max-width: 357px\">\u003cimg class=\"wp-image-220077\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/emiliescott1-885x1180.jpg\" alt=\"Dr. Emilie Scott of Irvine, Calif.\" width=\"357\" height=\"476\">\u003cfigcaption class=\"wp-caption-text\">Dr. Emilie Scott of Irvine, Calif., says the direct primary care model has put 'the heart back in medicine' for her. (David Gorn/KQED) \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>While direct primary care has some similarities to \u003ca href=\"http://www.healthline.com/health-news/the-future-of-healthcare-could-be-in-concierge-medicine-063015\" target=\"_blank\">concierge medicine\u003c/a>, it differs in that direct primary care rejects insurance. And, because concierge medicine sprang from wealthy patients’ desire for greater access to their doctors, patients can \u003ca href=\"http://www.wsj.com/articles/SB10001424052702303471004579165470633112630\" target=\"_blank\">pay up to thousands of dollars a month\u003c/a> for same-day appointments, round-the-clock phone access, house calls and other services.\u003c/p>\n\u003cp>In contrast, direct primary care doctors charge a relatively small monthly fee. While that can be an extra cost for those who also need insurance to cover more serious medical problems, many patients have high-deductible plans, making the monthly expense of direct primary care a good deal, especially for those who go to the doctor a lot.\u003c/p>\n\u003cp>For doctors, the main idea behind direct primary care is to simplify -- scale down, deal mostly in cash and focus on taking better care of fewer patients. This includes a good deal of listening and analysis of how a patient's current environment or life situation may be affecting their health.\u003c/p>\n\u003cp>This type of service \u003ca href=\"http://www.kevinmd.com/blog/2011/07/direct-primary-care-reduces-primary-care-costs.html\" target=\"_blank\">took off as a movement\u003c/a> in 2011, and the model was first evaluated in a 2013 \u003ca href=\"http://www.chcf.org/publications/2013/04/retainer-direct-primary-care\" target=\"_blank\">study\u003c/a> by the California Health Care Foundation. It's gaining significant traction, says Laurence Baker, the chair of Stanford University's Department of Health Research and Policy.\u003c/p>\n\u003cp>\"Absolutely it's a growing segment of primary care,\" he says. \"The model we have is challenged in a lot of ways, the longer a patient waits to see a doctor, the shorter time spent with the doctor. So we have to think about what else we can do to change that.\u003c/p>\n\u003cp>\"I would be surprised if it took over the world,\" Baker added, \"But I certainly wouldn't be surprised if it grew substantially more in the next few years.\"\u003c/p>\n\u003cp>\u003cstrong>'Doctors Will Be in Mass Exodus'\u003c/strong>\u003c/p>\n\u003cp>The reason doctors need to see so many patients in rapid succession is because of huge overhead, says Pamela Wible, a physician in Eugene, Ore., who helps doctors set up their ideal practice using the direct primary care model. In fact, she says, most doctors see just a small fraction of gross earnings.\u003c/p>\n\u003cp>But the kind of streamlined operation found in direct primary care allows doctors to keep a greater share of the money coming in, she says, even if they make less overall than in a traditional practice.\u003c/p>\n\u003cp>\"My expenses are so low, they're now about 10 percent of my practice,\" Wible says. \"And it used to be 74 percent.\"\u003c/p>\n\u003cp>Wible says the direct primary care model has at its heart the relationship between doctor and patient. She says doctors \"will be in mass exodus\" once they learn they can run their practice differently and \"get off the production line.\"\u003c/p>\n\u003cp>Dr. Emilie Scott did just that, in March. She had worked in an academic medical setting for many years, then in a large group practice for another five before venturing out on her own.\u003c/p>\n\u003cp>There are no waiting room magazines in her tiny Irvine medical office, because there is no waiting room. And that's because there is no waiting.\u003c/p>\n\u003cp>She charges her patients $59 per month. Just five months in, she says, her practice is already breaking even.\u003c/p>\n\u003cp>\"For me, it puts the heart back in medicine,\" Scott says, grinning. In the past, \"I had to see patients in a rapid style, trying to get patients out the door. It wears on you.\"\u003c/p>\n\u003cp>She understands the fear some doctors have of taking the leap, in part because of the massive debt they've incurred from medical school. But, she says, \"The point here isn't to become a millionaire. You make a good living, and you can practice in line with your values.\"\u003c/p>\n\u003cp>Scott said some of her patients are surprised at how little her service costs.\u003c/p>\n\u003cp>\"I had one woman who said she couldn't afford it but said she'd listen, and then I explained it, and she was like, 'Are we on Candid Camera or something? What's the catch?'\"\u003c/p>\n\u003cp>\u003cstrong>Shrinking the Physician Pool?\u003c/strong>\u003c/p>\n\u003cp>Janet Coffman, a health policy professor at the University of California, San Francisco, says she doesn't expect direct primary care to explode on the medical scene. Rather, she believes it will make slow and steady inroads. She doesn't think insurance companies will fight the model, even though it cuts them out of the medical care delivery system.\u003c/p>\n\u003cp>But one major effect direct primary care could have, she said, is to further shrink the already inadequate pool of primary care physicians.\u003c/p>\n\u003cp>\"If I were an insurance company, I think I'd be more concerned about recruiting and keeping PCPs because of this,\" Coffman says.\u003c/p>\n\u003cp>Betsy Imholz, director of special projects for Consumers Union, agrees that could be a concern if direct primary care catches on.\u003c/p>\n\u003cp>“Primary care is one of the least lucrative areas for doctors to go into,” Imholz says, “and therefore sometimes difficult for insurers to get sufficient numbers of.”\u003c/p>\n\u003cp>Imholz sees some other potential problems with the model. While she understands why both doctors and patients are attracted to direct primary care — “the old \u003ca href=\"https://www.youtube.com/watch?v=Y10VEkyKd3w\" target=\"_blank\">Marcus Welby\u003c/a> model,” as she puts it — she thinks it’s a move in the opposite direction of the current push for an integrated health care system. Ideally, doctors would have access to patients’ electronic health records, and \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988\" target=\"_blank\">all-payer claims databases\u003c/a>, at least \u003ca href=\"http://www.commondreams.org/newswire/2016/08/03/all-six-states-keep-consumers-dark-cost-medical-procedures\" target=\"_blank\">theoretically\u003c/a>, would allow purchasers of insurance to compare costs.\u003c/p>\n\u003cp>“It goes against this coordinated care model that the Affordable Care Act and the U.S. is coming to,” she says, “having things not fragmented but coordinated [in a way that] enables us to check, make quality assessments.”\u003c/p>\n\u003cp>Imholz is also concerned this type of practice could attract healthier people, who might see direct primary care as a substitute for insurance rather than an extra. And that could deprive the ACA \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/theyre-sicker-plus-aca-enrollees-cost-more-in-care-major-insurer-finds/\" target=\"_blank\">risk pool \u003c/a>of the very type of patients \u003ca href=\"http://www.newsweek.com/obamacare-premiums-rise-10-percent-2017-490268\" target=\"_blank\">needed to keep cost increases manageable\u003c/a>.\u003c/p>\n\u003cp>Consumers in California, Imholz said, should also keep in mind a little-known benefit of the plans offered on the state’s health care exchange, Covered California: those plans are required to offer three visits outside of the deductible, costing only a co-pay.\u003c/p>\n\u003cp>Ultimately, she says, if patients do want to go the route of direct primary care, they should create their own \u003ca href=\"https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record\" target=\"_blank\">personal health record\u003c/a> for each visit, in case at some point they need to visit a specialist for a serious health problem.\u003c/p>\n\u003cp>As to whether direct primary care will positively impact patients' health, Laurence Baker says it's not clear whether or not the longer office and home visits end up providing better care.\u003c/p>\n\u003cp>\"I'm not sure we know if this makes you healthier at the end of the day,\" Baker says. \"It will make you happier, definitely, but the jury is still out about whether it improves outcomes.\"\u003c/p>\n\u003cp>\u003cstrong>'It's Lovely'\u003c/strong>\u003c/p>\n\u003cp>Back in Half Moon Bay, physician Lorraine Page says she doesn't need data. She tries to find the words for the improvement she has seen in her life and the lives of her patients.\u003c/p>\n\u003cp>\"It's … lovely,\" she says with a laugh. \"It's just lovely. The patients do better, I get to see the whole person, the whole family. It's true family practice. And it's very straightforward. I see the person, I get paid. It's simple.\"\u003c/p>\n\u003cp>This type of practice, she says, is what many young doctors-to-be have in mind when they first think about entering medicine.\u003c/p>\n\u003cp>It's an odd twist that Page's current work is considered the cutting- edge of primary care medicine, when it so closely resembles a kind of 1950s Norman Rockwell painting of what a general practitioner is.\u003c/p>\n\u003cp>Most doctors don't even think about what they want anymore, Page says. They get caught up in the system and don't realize there's another choice.\u003c/p>\n\u003cp>But leaving was surprisingly easy.\u003c/p>\n\u003cp>\"Look, your skills are in your mind,\" Page says. \"You can do that anywhere.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Lorraine Page, believe it or not, makes house calls.\u003c/p>\n\u003cp>One place she visits is the home of Ann Caponio, a one-bedroom apartment in Half Moon Bay, California. You can tell a knitter lives there: baskets of wool and hanks of yarn adorn the room, and in the corner sits a wooden spinning wheel.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new model gains in popularity: no insurance but unlimited doctor visits are provided for a monthly fee.\u003c/aside>\n\u003cp>But arthritis has put an end to that hobby. And for a while, Caponio, 69, wasn't even getting out.\u003c/p>\n\u003cp>\"I kind of stopped going downtown,\" she says, in her Midland, Texas twang, a holdover from childhood. \"Omigod those stairs.\"\u003c/p>\n\u003cp>She's talking about a steep, 17-step staircase leading to her front door. Three hip replacements left negotiating them a dangerous proposition.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I tend to fall. And I fell on those damned stairs once.\"\u003c/p>\n\u003cp>And that's where Lorraine Page enters the picture.\u003c/p>\n\u003cp>Besides the house calls, Page provides a little more than Caponio might expect from a primary care doc available through Medicare. Page, for instance, has aided her patient with a number of safety issues, including helping her find someone to rig up a chairlift on those stairs. Now, she can sit on a seat at the top and glide to the bottom.\u003c/p>\n\u003cp>\"It opens up a whole new world for me,\" Caponio says.\u003c/p>\n\u003cp>\u003cstrong>A Different Model\u003c/strong>\u003c/p>\n\u003cp>A whole new world is what Dr. Page herself has been experiencing, ever since she left the traditional clinic setting to try something different. She does have a small office, but prefers to visit most of her patients in their homes.\u003c/p>\n\u003caside class=\"pullquote alignright\">When they learn they can get off the production line, 'Doctors will be in mass exodus.'\u003ccite>Dr. Pamela Wible\u003c/cite>\u003c/aside>\n\u003cp>She's one of a growing number of doctors who have cut loose from what she calls the \"assembly-line, volume approach\" that most of her colleagues have experienced. These breakaway docs are now using a health care delivery model called direct primary care. Page has cut back on the number of patients she sees, and spends more time with the ones she does. She doesn't take insurance and deals mostly in cash. Page charges each time she sees a patient, but most direct primary care doctors bill a monthly fee for unlimited visits.\u003c/p>\n\u003cp>In her previous practice, Page says, the pressure to see more patients in less time wore her down, as did the need for an army of support staff to process the copious paperwork required by insurance companies.\u003c/p>\n\u003cp>\"At our office, we had six full-time doctors. And we had seven full-time insurance people. So [that's] more than one full-time person trying to get reimbursement for patients I was seeing.\"\u003c/p>\n\u003cp>The benefits of leaving that bureaucratic load behind includes more time with patients but shorter days as her total load has been reduced. And she's doing the kind of family-care medicine for which she was trained.\u003c/p>\n\u003cp>\"And I enjoy it a lot more,\" Page says. \"Let's not minimize that.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Doctors Want\u003c/strong>\u003c/p>\n\u003cp>A 2012 \u003ca href=\"http://www.medscape.com/features/slideshow/compensation/2012/public\" target=\"_blank\">Medscape study\u003c/a> found that 46 percent of primary care physicians showed such dissatisfaction with their careers, they wouldn't pursue medicine if they could choose again. Another\u003ca href=\"http://www.physiciansfoundation.org/healthcare-research/a-survey-of-americas-physicians-practice-patterns-and-perspectives\" target=\"_blank\"> study\u003c/a>, from the Physicians Foundation, found 60 percent of primary care doctors would not recommend a career in medicine. Just six percent described the morale of their colleagues as positive.\u003c/p>\n\u003cp>Overall, says Wanda Filer, president of the American Academy of Family Physicians, primary care doctors feel overworked and ineffective. \"Most patients are just rushed out the door,\" she says. \"That's not what doctors want to do. This new model of care gets the physician and the patient out of that hamster-wheel model.\"\u003c/p>\n\u003cp>Filer says about three percent of the organization's 69,000 primary care doctors have made the move to direct primary care in the past couple of years, and that number is increasing rapidly as other physicians see it succeed.\u003c/p>\n\u003cp>In fact, Filer says, her organization has taken the unusual step of convening informational seminars for the large number of family doctors who have expressed interest in getting off the grid and starting a kinder, gentler practice.\u003c/p>\n\u003cp>\u003cb>Cash and Care\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_220077\" class=\"wp-caption alignright\" style=\"max-width: 357px\">\u003cimg class=\"wp-image-220077\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/emiliescott1-885x1180.jpg\" alt=\"Dr. Emilie Scott of Irvine, Calif.\" width=\"357\" height=\"476\">\u003cfigcaption class=\"wp-caption-text\">Dr. Emilie Scott of Irvine, Calif., says the direct primary care model has put 'the heart back in medicine' for her. (David Gorn/KQED) \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>While direct primary care has some similarities to \u003ca href=\"http://www.healthline.com/health-news/the-future-of-healthcare-could-be-in-concierge-medicine-063015\" target=\"_blank\">concierge medicine\u003c/a>, it differs in that direct primary care rejects insurance. And, because concierge medicine sprang from wealthy patients’ desire for greater access to their doctors, patients can \u003ca href=\"http://www.wsj.com/articles/SB10001424052702303471004579165470633112630\" target=\"_blank\">pay up to thousands of dollars a month\u003c/a> for same-day appointments, round-the-clock phone access, house calls and other services.\u003c/p>\n\u003cp>In contrast, direct primary care doctors charge a relatively small monthly fee. While that can be an extra cost for those who also need insurance to cover more serious medical problems, many patients have high-deductible plans, making the monthly expense of direct primary care a good deal, especially for those who go to the doctor a lot.\u003c/p>\n\u003cp>For doctors, the main idea behind direct primary care is to simplify -- scale down, deal mostly in cash and focus on taking better care of fewer patients. This includes a good deal of listening and analysis of how a patient's current environment or life situation may be affecting their health.\u003c/p>\n\u003cp>This type of service \u003ca href=\"http://www.kevinmd.com/blog/2011/07/direct-primary-care-reduces-primary-care-costs.html\" target=\"_blank\">took off as a movement\u003c/a> in 2011, and the model was first evaluated in a 2013 \u003ca href=\"http://www.chcf.org/publications/2013/04/retainer-direct-primary-care\" target=\"_blank\">study\u003c/a> by the California Health Care Foundation. It's gaining significant traction, says Laurence Baker, the chair of Stanford University's Department of Health Research and Policy.\u003c/p>\n\u003cp>\"Absolutely it's a growing segment of primary care,\" he says. \"The model we have is challenged in a lot of ways, the longer a patient waits to see a doctor, the shorter time spent with the doctor. So we have to think about what else we can do to change that.\u003c/p>\n\u003cp>\"I would be surprised if it took over the world,\" Baker added, \"But I certainly wouldn't be surprised if it grew substantially more in the next few years.\"\u003c/p>\n\u003cp>\u003cstrong>'Doctors Will Be in Mass Exodus'\u003c/strong>\u003c/p>\n\u003cp>The reason doctors need to see so many patients in rapid succession is because of huge overhead, says Pamela Wible, a physician in Eugene, Ore., who helps doctors set up their ideal practice using the direct primary care model. In fact, she says, most doctors see just a small fraction of gross earnings.\u003c/p>\n\u003cp>But the kind of streamlined operation found in direct primary care allows doctors to keep a greater share of the money coming in, she says, even if they make less overall than in a traditional practice.\u003c/p>\n\u003cp>\"My expenses are so low, they're now about 10 percent of my practice,\" Wible says. \"And it used to be 74 percent.\"\u003c/p>\n\u003cp>Wible says the direct primary care model has at its heart the relationship between doctor and patient. She says doctors \"will be in mass exodus\" once they learn they can run their practice differently and \"get off the production line.\"\u003c/p>\n\u003cp>Dr. Emilie Scott did just that, in March. She had worked in an academic medical setting for many years, then in a large group practice for another five before venturing out on her own.\u003c/p>\n\u003cp>There are no waiting room magazines in her tiny Irvine medical office, because there is no waiting room. And that's because there is no waiting.\u003c/p>\n\u003cp>She charges her patients $59 per month. Just five months in, she says, her practice is already breaking even.\u003c/p>\n\u003cp>\"For me, it puts the heart back in medicine,\" Scott says, grinning. In the past, \"I had to see patients in a rapid style, trying to get patients out the door. It wears on you.\"\u003c/p>\n\u003cp>She understands the fear some doctors have of taking the leap, in part because of the massive debt they've incurred from medical school. But, she says, \"The point here isn't to become a millionaire. You make a good living, and you can practice in line with your values.\"\u003c/p>\n\u003cp>Scott said some of her patients are surprised at how little her service costs.\u003c/p>\n\u003cp>\"I had one woman who said she couldn't afford it but said she'd listen, and then I explained it, and she was like, 'Are we on Candid Camera or something? What's the catch?'\"\u003c/p>\n\u003cp>\u003cstrong>Shrinking the Physician Pool?\u003c/strong>\u003c/p>\n\u003cp>Janet Coffman, a health policy professor at the University of California, San Francisco, says she doesn't expect direct primary care to explode on the medical scene. Rather, she believes it will make slow and steady inroads. She doesn't think insurance companies will fight the model, even though it cuts them out of the medical care delivery system.\u003c/p>\n\u003cp>But one major effect direct primary care could have, she said, is to further shrink the already inadequate pool of primary care physicians.\u003c/p>\n\u003cp>\"If I were an insurance company, I think I'd be more concerned about recruiting and keeping PCPs because of this,\" Coffman says.\u003c/p>\n\u003cp>Betsy Imholz, director of special projects for Consumers Union, agrees that could be a concern if direct primary care catches on.\u003c/p>\n\u003cp>“Primary care is one of the least lucrative areas for doctors to go into,” Imholz says, “and therefore sometimes difficult for insurers to get sufficient numbers of.”\u003c/p>\n\u003cp>Imholz sees some other potential problems with the model. While she understands why both doctors and patients are attracted to direct primary care — “the old \u003ca href=\"https://www.youtube.com/watch?v=Y10VEkyKd3w\" target=\"_blank\">Marcus Welby\u003c/a> model,” as she puts it — she thinks it’s a move in the opposite direction of the current push for an integrated health care system. Ideally, doctors would have access to patients’ electronic health records, and \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988\" target=\"_blank\">all-payer claims databases\u003c/a>, at least \u003ca href=\"http://www.commondreams.org/newswire/2016/08/03/all-six-states-keep-consumers-dark-cost-medical-procedures\" target=\"_blank\">theoretically\u003c/a>, would allow purchasers of insurance to compare costs.\u003c/p>\n\u003cp>“It goes against this coordinated care model that the Affordable Care Act and the U.S. is coming to,” she says, “having things not fragmented but coordinated [in a way that] enables us to check, make quality assessments.”\u003c/p>\n\u003cp>Imholz is also concerned this type of practice could attract healthier people, who might see direct primary care as a substitute for insurance rather than an extra. And that could deprive the ACA \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/theyre-sicker-plus-aca-enrollees-cost-more-in-care-major-insurer-finds/\" target=\"_blank\">risk pool \u003c/a>of the very type of patients \u003ca href=\"http://www.newsweek.com/obamacare-premiums-rise-10-percent-2017-490268\" target=\"_blank\">needed to keep cost increases manageable\u003c/a>.\u003c/p>\n\u003cp>Consumers in California, Imholz said, should also keep in mind a little-known benefit of the plans offered on the state’s health care exchange, Covered California: those plans are required to offer three visits outside of the deductible, costing only a co-pay.\u003c/p>\n\u003cp>Ultimately, she says, if patients do want to go the route of direct primary care, they should create their own \u003ca href=\"https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record\" target=\"_blank\">personal health record\u003c/a> for each visit, in case at some point they need to visit a specialist for a serious health problem.\u003c/p>\n\u003cp>As to whether direct primary care will positively impact patients' health, Laurence Baker says it's not clear whether or not the longer office and home visits end up providing better care.\u003c/p>\n\u003cp>\"I'm not sure we know if this makes you healthier at the end of the day,\" Baker says. \"It will make you happier, definitely, but the jury is still out about whether it improves outcomes.\"\u003c/p>\n\u003cp>\u003cstrong>'It's Lovely'\u003c/strong>\u003c/p>\n\u003cp>Back in Half Moon Bay, physician Lorraine Page says she doesn't need data. She tries to find the words for the improvement she has seen in her life and the lives of her patients.\u003c/p>\n\u003cp>\"It's … lovely,\" she says with a laugh. \"It's just lovely. The patients do better, I get to see the whole person, the whole family. It's true family practice. And it's very straightforward. I see the person, I get paid. It's simple.\"\u003c/p>\n\u003cp>This type of practice, she says, is what many young doctors-to-be have in mind when they first think about entering medicine.\u003c/p>\n\u003cp>It's an odd twist that Page's current work is considered the cutting- edge of primary care medicine, when it so closely resembles a kind of 1950s Norman Rockwell painting of what a general practitioner is.\u003c/p>\n\u003cp>Most doctors don't even think about what they want anymore, Page says. They get caught up in the system and don't realize there's another choice.\u003c/p>\n\u003cp>But leaving was surprisingly easy.\u003c/p>\n\u003cp>\"Look, your skills are in your mind,\" Page says. \"You can do that anywhere.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Proposed Anthem-Cigna Merger Under Scrutiny in California",
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"content": "\u003cp>Last week, state regulators signed off on Centene’s $7 billion purchase of fellow health insurer Health Net.\u003c/p>\n\u003cp>But that’s a dinky deal compared to Anthem’s proposed $54 billion acquisition of Cigna, which Tuesday undergoes public review by the California Department of Insurance and its politically ambitious commissioner, Dave Jones.\u003c/p>\n\u003cp>The stakes are high. A rejection by California — given the state’s huge market — could jeopardize the acquisition altogether.\u003c/p>\n\u003cp>Eyes are now on Jones, who plans to run for state attorney general in 2018. Last week he said the Centene-Health Net deal could enhance competition in California. Centene currently has almost no market share in California but does have financial stability from its out-of-state business, so it would bring an infusion of “new capital and new resources” to take over Health Net and take on market share leaders.\u003c/p>\n\u003cp>More than three-quarters of the private insurance market in California now belongs to Kaiser Permanente (42 percent), Anthem Blue Cross (20 percent) and Blue Shield of California (15 percent). Centene’s acquisition of Health Net, the fourth-largest insurer in the state (6 percent), could help it compete with the Big Three, Jones said. In the case of Anthem, though, that logic would work against it, because merger approval would mean one of the Big Three would just get more powerful, according to Shana Charles, health policy professor at California State University Fullerton.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“For the regulators, the big question is whether or not a merger would make the market more competitive,” she said. “Because Anthem is so big in California, that’s going to be a big concern.”\u003c/p>\n\u003cp>Jones has fashioned himself as a consumer advocate challenging the power of big insurers. “He has consistently played that role,” Charles said. “So really, this is a perfect opportunity for him.”\u003c/p>\n\u003cp>Several factors weigh against the Anthem/Cigna and Aetna/Humana deals, consumer advocates said.\u003c/p>\n\u003cp>“For the Anthem/Cigna deal, there is overlap in market share, and that wasn’t the case with Centene,” said Tam Ma, attorney for the Sacramento-based advocacy nonprofit Health Access California. Since Cigna and Anthem compete for subscribers, Ma said the Anthem deal would reduce health insurance competition in 31 counties in California.\u003c/p>\n\u003cp>And, Ma said, Anthem has a history of dramatically hiking premium rates, even after state regulators have deemed them unreasonable. Add in a high number of consumer complaints, a question about whether they contract with enough doctors, low quality ratings and Anthem’s major data breach last year, and you get a volatile mixture that defies merger approval, she said. “The big concern is, if they get bigger, are these problems going to get bigger?”\u003c/p>\n\u003cp>In a prepared statement, Anthem spokesman Darrel Ng said Anthem and Cigna have limited overlap and combined will be in a better position to improve consumer choice and quality as well as preserve affordability.\u003c/p>\n\u003cp>“Expanding access to affordable health coverage is the foundation of our combination with Cigna and will remain Anthem’s top priority,” Ng said.\u003c/p>\n\u003cp>“We are continuing to work with the Department of Justice and appropriate state regulators, and are confident that our proposed merger is being reviewed based on these facts.”\u003c/p>\n\u003cp>An outright rejection could sink the deal. That could send shockwaves through the stock market and raise questions about California’s attitude toward business. Health care systems around the country are combining, claiming financial necessity. Insurers say they need to combine, too, to maintain negotiating clout.\u003c/p>\n\u003cp>Instead of blocking the deal, regulators could approve it with conditions.\u003c/p>\n\u003cp>One of Jones’ predecessors, John Garamendi, did both. In 2004, he rejected Anthem’s proposed merger with competitor Wellpoint. Anthem sued him. Garamendi later approved the deal, but got the company to pay $265 million toward various health projects in California, double those in the original agreement.\u003c/p>\n\u003cp>Approval in California isn’t Anthem’s only worry. Federal antitrust officials have yet to weigh in. It’s unclear who will render judgment on the deal first, them or Jones.\u003c/p>\n\u003cp>The hearing Tuesday is in San Francisco. The insurance department said it will soon hold hearings on another huge health industry deal, Aetna’s proposed $37 million acquisition of Humana. The Department of Managed Health Care has already held its hearings on both mergers, but has not issued a timeframe for any decision.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last week, state regulators signed off on Centene’s $7 billion purchase of fellow health insurer Health Net.\u003c/p>\n\u003cp>But that’s a dinky deal compared to Anthem’s proposed $54 billion acquisition of Cigna, which Tuesday undergoes public review by the California Department of Insurance and its politically ambitious commissioner, Dave Jones.\u003c/p>\n\u003cp>The stakes are high. A rejection by California — given the state’s huge market — could jeopardize the acquisition altogether.\u003c/p>\n\u003cp>Eyes are now on Jones, who plans to run for state attorney general in 2018. Last week he said the Centene-Health Net deal could enhance competition in California. Centene currently has almost no market share in California but does have financial stability from its out-of-state business, so it would bring an infusion of “new capital and new resources” to take over Health Net and take on market share leaders.\u003c/p>\n\u003cp>More than three-quarters of the private insurance market in California now belongs to Kaiser Permanente (42 percent), Anthem Blue Cross (20 percent) and Blue Shield of California (15 percent). Centene’s acquisition of Health Net, the fourth-largest insurer in the state (6 percent), could help it compete with the Big Three, Jones said. In the case of Anthem, though, that logic would work against it, because merger approval would mean one of the Big Three would just get more powerful, according to Shana Charles, health policy professor at California State University Fullerton.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“For the regulators, the big question is whether or not a merger would make the market more competitive,” she said. “Because Anthem is so big in California, that’s going to be a big concern.”\u003c/p>\n\u003cp>Jones has fashioned himself as a consumer advocate challenging the power of big insurers. “He has consistently played that role,” Charles said. “So really, this is a perfect opportunity for him.”\u003c/p>\n\u003cp>Several factors weigh against the Anthem/Cigna and Aetna/Humana deals, consumer advocates said.\u003c/p>\n\u003cp>“For the Anthem/Cigna deal, there is overlap in market share, and that wasn’t the case with Centene,” said Tam Ma, attorney for the Sacramento-based advocacy nonprofit Health Access California. Since Cigna and Anthem compete for subscribers, Ma said the Anthem deal would reduce health insurance competition in 31 counties in California.\u003c/p>\n\u003cp>And, Ma said, Anthem has a history of dramatically hiking premium rates, even after state regulators have deemed them unreasonable. Add in a high number of consumer complaints, a question about whether they contract with enough doctors, low quality ratings and Anthem’s major data breach last year, and you get a volatile mixture that defies merger approval, she said. “The big concern is, if they get bigger, are these problems going to get bigger?”\u003c/p>\n\u003cp>In a prepared statement, Anthem spokesman Darrel Ng said Anthem and Cigna have limited overlap and combined will be in a better position to improve consumer choice and quality as well as preserve affordability.\u003c/p>\n\u003cp>“Expanding access to affordable health coverage is the foundation of our combination with Cigna and will remain Anthem’s top priority,” Ng said.\u003c/p>\n\u003cp>“We are continuing to work with the Department of Justice and appropriate state regulators, and are confident that our proposed merger is being reviewed based on these facts.”\u003c/p>\n\u003cp>An outright rejection could sink the deal. That could send shockwaves through the stock market and raise questions about California’s attitude toward business. Health care systems around the country are combining, claiming financial necessity. Insurers say they need to combine, too, to maintain negotiating clout.\u003c/p>\n\u003cp>Instead of blocking the deal, regulators could approve it with conditions.\u003c/p>\n\u003cp>One of Jones’ predecessors, John Garamendi, did both. In 2004, he rejected Anthem’s proposed merger with competitor Wellpoint. Anthem sued him. Garamendi later approved the deal, but got the company to pay $265 million toward various health projects in California, double those in the original agreement.\u003c/p>\n\u003cp>Approval in California isn’t Anthem’s only worry. Federal antitrust officials have yet to weigh in. It’s unclear who will render judgment on the deal first, them or Jones.\u003c/p>\n\u003cp>The hearing Tuesday is in San Francisco. The insurance department said it will soon hold hearings on another huge health industry deal, Aetna’s proposed $37 million acquisition of Humana. The Department of Managed Health Care has already held its hearings on both mergers, but has not issued a timeframe for any decision.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Who's Responsible for Your Uber Driver's Health Coverage?",
"title": "Who's Responsible for Your Uber Driver's Health Coverage?",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>For six months, Eliza Kinrose worked about ten hours a week delivering anything from cupcakes to art supplies to strangers’ homes.\u003c/p>\n\u003cp>Shortly after quitting her steady job as a recruiter, Kinrose, 29, signed up to work for a new San Francisco-based mobile delivery service called \u003ca href=\"https://postmates.com/\">Postmates\u003c/a>. She made about $15 an hour for six months, which was just enough to scrape by until she launched a yoga business.\u003c/p>\n\u003cp>Postmates is just one of an explosion of “gig economy” or “on-demand economy” companies that connect people seeking services with sellers of those services in a few minutes’ time. Those who work for the gig economy do not receive health insurance, or any of the other social protections extended to employees. Unless they are employed elsewhere, they need to find and pay for these protections on their own.\u003c/p>\n\u003cp>But one evening, Kinrose received an email from Postmates about an intriguing free \"perk\" to help her find health insurance called \u003ca href=\"https://www.stridehealth.com/\">Stride Health.\u003c/a>\u003c/p>\n\u003cp>Stride Health is a startup health insurance broker service, which makes recommendations about health plans that are tailored to people's needs. The company offers web and mobile services to assist customers once they've purchased a health plan, including premium payment reminders and guidance on whether they qualify for subsidies. Stride Health also shows customers how much scenarios, like asthma or heart disease, would affect their out of pocket costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>San Francisco-based Stride Health is one of many startups taking advantage of new opportunities created by the \u003ca href=\"http://www.hhs.gov/healthcare/rights/\">Affordable Care Act\u003c/a> and the perceived failings of the federal and state marketplaces for individuals to buy health insurance. It is unique, however, in targeting gig economy workers like Kinrose. Uber, Postmates and Taskrabbit, three of the largest gig economy companies, market Stride Health's service to their workers.\u003c/p>\n\u003cfigure id=\"attachment_48816\" class=\"wp-caption alignright\" style=\"max-width: 307px\">\u003cimg class=\" wp-image-48816\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/10/uber-sidecar-400x600.jpg\" alt=\"Many workers, like Rick Warren, drive for multiple companies, including Sidecar and Lyft. \" width=\"307\" height=\"461\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar-400x600.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar-787x1180.jpg 787w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar-1180x1770.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar-960x1440.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar.jpg 1280w\" sizes=\"(max-width: 307px) 100vw, 307px\">\u003cfigcaption class=\"wp-caption-text\">Many workers, like Rick Warren, drive for multiple companies, including Sidecar and Lyft.\u003c/figcaption>\u003c/figure>\n\u003cp>Stride Health's involvement with the gig economy may signal a shift in attitudes and priorities. According to Stride Health CEO Noah Lang, Uber and the rest are starting to care about the needs of their workers. \"They want to make sure people don't end up in a tough spot by forgoing coverage,\" he said.\u003c/p>\n\u003cp>But critics of the gig economy say Stride Health is a bandaid solution, as workers are still on the hook to pay for their own health insurance.\u003c/p>\n\u003cp>“When we have a jobs-based social welfare system, some people get a combination of health care, disability and more,” said Ken Jacobs, chair of the Labor Center at UC Berkeley, who specializes in health care coverage and public policy. “In a world where people are operating separately from that, the safety net goes away.\"\u003c/p>\n\u003cp>\u003cstrong>How Big Is the Gig Economy, Really?\u003c/strong>\u003c/p>\n\u003cp>In cities across the United States, anyone with a smartphone can order a meal from Postmates, a ride to work via Lyft or Uber, groceries on Instacart or a home cleaning on Handy. These services are so pervasive, with billions in total sales as a group that it’s hard to believe they only sprung up in the past five years.\u003c/p>\n\u003caside class=\"pullquote alignright\">“These marketplaces care about growing and maintaining their labor pool. But at the same time, they have to minimize their risks by not stepping over any of the lines.”\u003cbr>\n\u003ccite>Noah Lang, Stride Health cofounder and CEO\u003c/cite>\u003c/aside>\n\u003cp>The on-demand economy has been hailed as the next big thing, but labor economists say it still hasn’t made much of a dent in the overall U.S. economy. The idea may be disruptive to the status quo, but the most recent data suggests that Americans are no less likely to be self-employed than a decade ago.\u003c/p>\n\u003cp>“The gig economy currently is not really even big enough to show up in the [national economic] data,” said Jacobs. “And unfortunately, we don’t yet have a good sense of how big it will be.”\u003c/p>\n\u003cp>One promising trend, according to Jacobs, is that the companies are starting to release more data on their workers. In 2014, Uber collaborated with Princeton University economist Alan Kreuger on a report that determined the company had 160,000 “driver partners” in the United States. By contrast, the Bureau of Labor Statistics estimated that there were some 230,000 taxi-drivers in the U.S. in 2012.\u003c/p>\n\u003cp>Uber may not show up in national data just yet, but it is having an outsized impact in politics and popular culture. Even the presidential candidates are taking a side: While Hilary Clinton says she wants to “crack down” on sharing economy abuses of workers, Jeb Bush was recently spotted hailing an Uber ride in San Francisco.\u003c/p>\n\u003cp>\u003cb>Independent\u003c/b>\u003cstrong> Contractors or Employees? \u003c/strong>\u003c/p>\n\u003cp>By targeting the gig economy, Stride Health has taken a central role in an ongoing debate between policymakers, investors, and litigators, about whether on-demand companies should be treating their workers as employees and paying their expenses, as well as providing health insurance and other benefits.\u003c/p>\n\u003cp>Uber, a San Francisco-based company that uses a smartphone app to link people needing car rides with drivers for hire who use their own vehicles, is currently facing a\u003ca href=\"http://ww2.kqed.org/futureofyou/2015/09/23/uc-riverside-professor-slams-feds-stands-by-his-health-app/\"> looming class action lawsuit\u003c/a>. In the suit, three Uber drivers are collectively challenging the company on whether they should be considered employees under the law – and not independent contractors, as the company now classifies them.\u003c/p>\n\u003cp>And in June, the California Labor Commission ruled against Uber in determining that an ex-driver was entitled to reimbursement for business expenses.\u003c/p>\n\u003cp>“Many drivers have included on their list of issues that they are on their own for health insurance,” said Shannon Liss-Riordan, of Boston, Mass. the lead plaintiff attorney in the class action lawsuit against Uber. Liss-Riordan is also taking aim against Uber’s main rival, Lyft, and has spoken to hundreds of people who drive for these companies. “These drivers are left in the cold,” she said.\u003c/p>\n\u003cp>How the Uber case ends up could have national implications. If the company loses its class-action lawsuit and has to reclassify its drivers from independent contractors to employees, that would force the company to pay for things like expenses, and provide benefits to full-time drivers. One recent estimate is that Uber would need to \u003ca href=\"http://recode.net/2015/07/14/uber-could-have-to-pay-an-additional-209-million-to-reclassify-its-drivers-in-california/\">pay $209 million a year\u003c/a> to reclassify its drivers to employees – and that’s just in California.\u003c/p>\n\u003cp>Not everyone believes that Uber and the rest have left anyone out in the cold.\u003c/p>\n\u003cfigure id=\"attachment_48815\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-48815\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/10/Uber-1-800x533.jpg\" alt=\"Lyft driver Deco Carter scanning for a fare.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1-960x640.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lyft driver Deco Carter scanning for a fare. \u003ccite>(Alan Toth/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For one thing, the Affordable Care Act has relieved the burden for many drivers, as it provides subsidies for low-income people to buy health insurance independently. Uber's CEO Travis Kalanick reportedly referred to the ACA as \"huge\" for the gig economy.\u003c/p>\n\u003cp>Some policymakers envision a middle ground, where workers have some added protections but are not full employees. One idea is a new worker category called a \"dependent contractor,\" which is legal in Germany, Canada and other countries, but not in the United States.\u003c/p>\n\u003cp>U.S. Senator Mark Warner, D-Virginia, has spent more than a year researching the on-demand economy. \u003ca href=\"http://onlabor.org/2015/06/22/a-new-category-of-worker-for-the-on-demand-economy/\">He has proposed \u003c/a>numerous paths forward to broker a peace in the legal wars, including the dependent contractor model. He has also proposed similar marketplaces to the Affordable Care Act for other key benefits, including workers' compensation.\u003c/p>\n\u003cp>But Warner doesn't agree that the ACA is a silver bullet for the gig economy, as these companies do not pay into it. Uber avoids providing health insurance to drivers, which it considers contractors, as the ACA mandates that only employers extend coverage to full-time employees. That’s a loophole that saves gig economy companies a lot of money.\u003c/p>\n\u003cp>\u003cstrong>Walking the Tightrope \u003c/strong>\u003c/p>\n\u003cp>Some \u003ca href=\"http://qz.com/299655/why-your-uber-driver-hates-uber/\">critics of Uber have painted the company’s top executives as indifferent to the plight of workers\u003c/a>. But by providing services to workers, these companies risk adding fuel to the legal argument that they should be employees and not independent contractors.\u003c/p>\n\u003cp>\u003ca href=\"http://docs.procurement.ku.edu/departmental_policies/Independent_Contractor_Excerpts.pdf\">The I.R.S. has about twenty factors\u003c/a> that it takes into account when determining a worker classification. One important distinction is how much \"control\" an employer has over the work that's being done, but it's not always clear what control means.\u003c/p>\n\u003cp>“Essentially, this [partnership with Stride Health] is about how these workers can get health care without exposing Uber and the rest to liability or responsibility,” said UC Berkeley’s Jacobs.\u003c/p>\n\u003cfigure id=\"attachment_48819\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-48819\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/10/IMG_1692-800x600.jpg\" alt=\"Stride Health's founders Noah Lang (left) and Matt Butner (right) \" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stride Health's founders Noah Lang (left) and Matt Butner (right) \u003ccite>(Christina Farr/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lang doesn’t totally disagree, but paints the partnership in a more positive light: “These marketplaces care about growing and maintaining their labor pool,” he said. “But at the same time, they have to minimize their risks by not stepping over any of the lines.”\u003c/p>\n\u003cp>If these companies do nothing, their practices may draw fire from policymakers. An uninsured and at-risk population is likely to incur major health costs in the long-term, costs that could eventually be borne by taxpayers. According to Lang, about 40 percent of gig economy workers surveyed by Stride Health said they would \"not have gotten coverage otherwise.\"\u003c/p>\n\u003cp>Stride Health seems to be a safe solution for the gig economy companies. It is unclear how many workers are using the tool, but Uber said it is helping those who are uninsured drivers find an affordable health plan. And drivers seem to like it.\u003c/p>\n\u003cp>“Finding affordable, effective health insurance is top of mind for many drivers,\" an Uber spokesperson said in a press release. A spokesperson for Taskrabbit said the company “vetted other options” but ultimately opted to partner with Stride due to the “thoughtful approach for independent contractors.”\u003c/p>\n\u003cp>Postmates declined to comment on its reasons for partnering with Stride. \u003cspan class=\"s1\">Uber and Taskrabbit emailed statements that could not be attributed to any company official. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Will On-Demand Companies Ever Provide Health Insurance to Workers?\u003c/strong>\u003c/p>\n\u003cp>Critics of the on-demand economy say that Uber and the rest are the latest in a long line of companies that use fancy wordplay and questionable tactics to avoid protecting workers. These legal battles go back decades, with FedEx most recently settling a lawsuit with drivers who claimed they had been misclassified.\u003c/p>\n\u003cp>“Uber tries to argue that it’s not in the car service industry; it’s a technology platform,” said Liss-Riordan in an interview. “The court rejected that.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“Some folks are working part-time for other jobs. Others have not had health insurance in a long time and need extra help navigating their options.\"\u003cbr>\n\u003ccite>An Uber spokesperson\u003c/cite>\u003c/aside>\n\u003cp>Some on-demand economy companies are now taking steps to reclassify their workers as employees, including \u003ca href=\"http://www.doctorondemand.com/\">Doctor on Demand\u003c/a>, a company that connects people with doctors online in a matter of minutes, as well as mobile delivery services Instacart and Shyp.\u003c/p>\n\u003cp>But Lang is doubtful that this will trigger a shift for the on-demand economy at large. As Lang points out, Uber’s labor pool is much larger than \u003ca href=\"http://www.businessinsider.com/why-instacart-is-reclassifing-some-of-its-workers-as-employees-2015-6\">an Instarcart\u003c/a> or Shyp and its workers are not specialized like Doctor on Demand’s physicians – all they need is a drivers’ license. “I give Shyp and Instacart kudos, of course,” he said, “but it’s also opportunistic for them.”\u003c/p>\n\u003cp>A change in federal law or a landmark Supreme Court ruling might force Uber, Lyft and others to treat their workers as employees. This wouldn’t mean that every driver would receive employee-sponsored health insurance overnight.\u003c/p>\n\u003cp>Dan Diamond, executive editor for the research and consulting firm \u003ca href=\"https://www.advisory.com/\">The Advisory Board\u003c/a>, has written about how Uber would handle the health care problem if its drivers were considered employees. Diamond does not believe that workers would immediately benefit from a reclassification.\u003c/p>\n\u003cp>Uber might opt to avoid providing health insurance by paying a fee under the Affordable Care Act (a requirement if businesses do not provide health insurance to employees who work more than 30 hours per week). It might also cap workers’ at 29 hours per week to keep them part-time employees.\u003c/p>\n\u003cp>Diamond expects that Uber will use every weapon in its arsenal to avoid such an outcome. “For Uber, none of these options are ideal.”\u003c/p>\n\u003cp>Deco Carter, a Bay Area-based Lyft driver, said he “knew the risks” when he joined the growing ranks of gig economy workers. He has been involved in two auto accidents, and lacked income for several weeks until he got his car fixed.\u003c/p>\n\u003cp>\"I really didn't have anything to fall back on,\" he said. \"If it wasn't for my fiancé, I don't know what I would have done.\"\u003c/p>\n\u003cp>In the years ahead, he hopes that Lyft would consider extending benefits to drivers, particularly to those who work full-time hours. Lyft is not currently working with Stride Health, but it drivers have access to an alternative service called the eHealth marketplace. A spokesperson denied requests from KQED for an interview.\u003c/p>\n\u003cp>But while executives at these companies may want to do more to protect workers, they are also under pressure to protect their bottom line. It would be highly expensive for them to reclassify workers.\u003c/p>\n\u003cp>Most experts are watching the presidential race as an indicator of what’s to come.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“My fear is that we’ll either re-classify everyone as an employee or trust the unfettered hand of capitalism,” said Warner. “Before that happens, I’m hoping those of us who are thinking about this in a bipartisan fashion can come up with some policy ideas that might be embraced by both sides.”\u003c/p>\n\n",
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"excerpt": "A startup called Stride Health is working with Uber, Taskrabbit and Postmates to help their workers find affordable health insurance. Is it enough?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For six months, Eliza Kinrose worked about ten hours a week delivering anything from cupcakes to art supplies to strangers’ homes.\u003c/p>\n\u003cp>Shortly after quitting her steady job as a recruiter, Kinrose, 29, signed up to work for a new San Francisco-based mobile delivery service called \u003ca href=\"https://postmates.com/\">Postmates\u003c/a>. She made about $15 an hour for six months, which was just enough to scrape by until she launched a yoga business.\u003c/p>\n\u003cp>Postmates is just one of an explosion of “gig economy” or “on-demand economy” companies that connect people seeking services with sellers of those services in a few minutes’ time. Those who work for the gig economy do not receive health insurance, or any of the other social protections extended to employees. Unless they are employed elsewhere, they need to find and pay for these protections on their own.\u003c/p>\n\u003cp>But one evening, Kinrose received an email from Postmates about an intriguing free \"perk\" to help her find health insurance called \u003ca href=\"https://www.stridehealth.com/\">Stride Health.\u003c/a>\u003c/p>\n\u003cp>Stride Health is a startup health insurance broker service, which makes recommendations about health plans that are tailored to people's needs. The company offers web and mobile services to assist customers once they've purchased a health plan, including premium payment reminders and guidance on whether they qualify for subsidies. Stride Health also shows customers how much scenarios, like asthma or heart disease, would affect their out of pocket costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>San Francisco-based Stride Health is one of many startups taking advantage of new opportunities created by the \u003ca href=\"http://www.hhs.gov/healthcare/rights/\">Affordable Care Act\u003c/a> and the perceived failings of the federal and state marketplaces for individuals to buy health insurance. It is unique, however, in targeting gig economy workers like Kinrose. Uber, Postmates and Taskrabbit, three of the largest gig economy companies, market Stride Health's service to their workers.\u003c/p>\n\u003cfigure id=\"attachment_48816\" class=\"wp-caption alignright\" style=\"max-width: 307px\">\u003cimg class=\" wp-image-48816\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/10/uber-sidecar-400x600.jpg\" alt=\"Many workers, like Rick Warren, drive for multiple companies, including Sidecar and Lyft. \" width=\"307\" height=\"461\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar-400x600.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar-787x1180.jpg 787w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar-1180x1770.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar-960x1440.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/uber-sidecar.jpg 1280w\" sizes=\"(max-width: 307px) 100vw, 307px\">\u003cfigcaption class=\"wp-caption-text\">Many workers, like Rick Warren, drive for multiple companies, including Sidecar and Lyft.\u003c/figcaption>\u003c/figure>\n\u003cp>Stride Health's involvement with the gig economy may signal a shift in attitudes and priorities. According to Stride Health CEO Noah Lang, Uber and the rest are starting to care about the needs of their workers. \"They want to make sure people don't end up in a tough spot by forgoing coverage,\" he said.\u003c/p>\n\u003cp>But critics of the gig economy say Stride Health is a bandaid solution, as workers are still on the hook to pay for their own health insurance.\u003c/p>\n\u003cp>“When we have a jobs-based social welfare system, some people get a combination of health care, disability and more,” said Ken Jacobs, chair of the Labor Center at UC Berkeley, who specializes in health care coverage and public policy. “In a world where people are operating separately from that, the safety net goes away.\"\u003c/p>\n\u003cp>\u003cstrong>How Big Is the Gig Economy, Really?\u003c/strong>\u003c/p>\n\u003cp>In cities across the United States, anyone with a smartphone can order a meal from Postmates, a ride to work via Lyft or Uber, groceries on Instacart or a home cleaning on Handy. These services are so pervasive, with billions in total sales as a group that it’s hard to believe they only sprung up in the past five years.\u003c/p>\n\u003caside class=\"pullquote alignright\">“These marketplaces care about growing and maintaining their labor pool. But at the same time, they have to minimize their risks by not stepping over any of the lines.”\u003cbr>\n\u003ccite>Noah Lang, Stride Health cofounder and CEO\u003c/cite>\u003c/aside>\n\u003cp>The on-demand economy has been hailed as the next big thing, but labor economists say it still hasn’t made much of a dent in the overall U.S. economy. The idea may be disruptive to the status quo, but the most recent data suggests that Americans are no less likely to be self-employed than a decade ago.\u003c/p>\n\u003cp>“The gig economy currently is not really even big enough to show up in the [national economic] data,” said Jacobs. “And unfortunately, we don’t yet have a good sense of how big it will be.”\u003c/p>\n\u003cp>One promising trend, according to Jacobs, is that the companies are starting to release more data on their workers. In 2014, Uber collaborated with Princeton University economist Alan Kreuger on a report that determined the company had 160,000 “driver partners” in the United States. By contrast, the Bureau of Labor Statistics estimated that there were some 230,000 taxi-drivers in the U.S. in 2012.\u003c/p>\n\u003cp>Uber may not show up in national data just yet, but it is having an outsized impact in politics and popular culture. Even the presidential candidates are taking a side: While Hilary Clinton says she wants to “crack down” on sharing economy abuses of workers, Jeb Bush was recently spotted hailing an Uber ride in San Francisco.\u003c/p>\n\u003cp>\u003cb>Independent\u003c/b>\u003cstrong> Contractors or Employees? \u003c/strong>\u003c/p>\n\u003cp>By targeting the gig economy, Stride Health has taken a central role in an ongoing debate between policymakers, investors, and litigators, about whether on-demand companies should be treating their workers as employees and paying their expenses, as well as providing health insurance and other benefits.\u003c/p>\n\u003cp>Uber, a San Francisco-based company that uses a smartphone app to link people needing car rides with drivers for hire who use their own vehicles, is currently facing a\u003ca href=\"http://ww2.kqed.org/futureofyou/2015/09/23/uc-riverside-professor-slams-feds-stands-by-his-health-app/\"> looming class action lawsuit\u003c/a>. In the suit, three Uber drivers are collectively challenging the company on whether they should be considered employees under the law – and not independent contractors, as the company now classifies them.\u003c/p>\n\u003cp>And in June, the California Labor Commission ruled against Uber in determining that an ex-driver was entitled to reimbursement for business expenses.\u003c/p>\n\u003cp>“Many drivers have included on their list of issues that they are on their own for health insurance,” said Shannon Liss-Riordan, of Boston, Mass. the lead plaintiff attorney in the class action lawsuit against Uber. Liss-Riordan is also taking aim against Uber’s main rival, Lyft, and has spoken to hundreds of people who drive for these companies. “These drivers are left in the cold,” she said.\u003c/p>\n\u003cp>How the Uber case ends up could have national implications. If the company loses its class-action lawsuit and has to reclassify its drivers from independent contractors to employees, that would force the company to pay for things like expenses, and provide benefits to full-time drivers. One recent estimate is that Uber would need to \u003ca href=\"http://recode.net/2015/07/14/uber-could-have-to-pay-an-additional-209-million-to-reclassify-its-drivers-in-california/\">pay $209 million a year\u003c/a> to reclassify its drivers to employees – and that’s just in California.\u003c/p>\n\u003cp>Not everyone believes that Uber and the rest have left anyone out in the cold.\u003c/p>\n\u003cfigure id=\"attachment_48815\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-48815\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/10/Uber-1-800x533.jpg\" alt=\"Lyft driver Deco Carter scanning for a fare.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/Uber-1-960x640.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lyft driver Deco Carter scanning for a fare. \u003ccite>(Alan Toth/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For one thing, the Affordable Care Act has relieved the burden for many drivers, as it provides subsidies for low-income people to buy health insurance independently. Uber's CEO Travis Kalanick reportedly referred to the ACA as \"huge\" for the gig economy.\u003c/p>\n\u003cp>Some policymakers envision a middle ground, where workers have some added protections but are not full employees. One idea is a new worker category called a \"dependent contractor,\" which is legal in Germany, Canada and other countries, but not in the United States.\u003c/p>\n\u003cp>U.S. Senator Mark Warner, D-Virginia, has spent more than a year researching the on-demand economy. \u003ca href=\"http://onlabor.org/2015/06/22/a-new-category-of-worker-for-the-on-demand-economy/\">He has proposed \u003c/a>numerous paths forward to broker a peace in the legal wars, including the dependent contractor model. He has also proposed similar marketplaces to the Affordable Care Act for other key benefits, including workers' compensation.\u003c/p>\n\u003cp>But Warner doesn't agree that the ACA is a silver bullet for the gig economy, as these companies do not pay into it. Uber avoids providing health insurance to drivers, which it considers contractors, as the ACA mandates that only employers extend coverage to full-time employees. That’s a loophole that saves gig economy companies a lot of money.\u003c/p>\n\u003cp>\u003cstrong>Walking the Tightrope \u003c/strong>\u003c/p>\n\u003cp>Some \u003ca href=\"http://qz.com/299655/why-your-uber-driver-hates-uber/\">critics of Uber have painted the company’s top executives as indifferent to the plight of workers\u003c/a>. But by providing services to workers, these companies risk adding fuel to the legal argument that they should be employees and not independent contractors.\u003c/p>\n\u003cp>\u003ca href=\"http://docs.procurement.ku.edu/departmental_policies/Independent_Contractor_Excerpts.pdf\">The I.R.S. has about twenty factors\u003c/a> that it takes into account when determining a worker classification. One important distinction is how much \"control\" an employer has over the work that's being done, but it's not always clear what control means.\u003c/p>\n\u003cp>“Essentially, this [partnership with Stride Health] is about how these workers can get health care without exposing Uber and the rest to liability or responsibility,” said UC Berkeley’s Jacobs.\u003c/p>\n\u003cfigure id=\"attachment_48819\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-48819\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/10/IMG_1692-800x600.jpg\" alt=\"Stride Health's founders Noah Lang (left) and Matt Butner (right) \" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/10/IMG_1692-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stride Health's founders Noah Lang (left) and Matt Butner (right) \u003ccite>(Christina Farr/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lang doesn’t totally disagree, but paints the partnership in a more positive light: “These marketplaces care about growing and maintaining their labor pool,” he said. “But at the same time, they have to minimize their risks by not stepping over any of the lines.”\u003c/p>\n\u003cp>If these companies do nothing, their practices may draw fire from policymakers. An uninsured and at-risk population is likely to incur major health costs in the long-term, costs that could eventually be borne by taxpayers. According to Lang, about 40 percent of gig economy workers surveyed by Stride Health said they would \"not have gotten coverage otherwise.\"\u003c/p>\n\u003cp>Stride Health seems to be a safe solution for the gig economy companies. It is unclear how many workers are using the tool, but Uber said it is helping those who are uninsured drivers find an affordable health plan. And drivers seem to like it.\u003c/p>\n\u003cp>“Finding affordable, effective health insurance is top of mind for many drivers,\" an Uber spokesperson said in a press release. A spokesperson for Taskrabbit said the company “vetted other options” but ultimately opted to partner with Stride due to the “thoughtful approach for independent contractors.”\u003c/p>\n\u003cp>Postmates declined to comment on its reasons for partnering with Stride. \u003cspan class=\"s1\">Uber and Taskrabbit emailed statements that could not be attributed to any company official. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Will On-Demand Companies Ever Provide Health Insurance to Workers?\u003c/strong>\u003c/p>\n\u003cp>Critics of the on-demand economy say that Uber and the rest are the latest in a long line of companies that use fancy wordplay and questionable tactics to avoid protecting workers. These legal battles go back decades, with FedEx most recently settling a lawsuit with drivers who claimed they had been misclassified.\u003c/p>\n\u003cp>“Uber tries to argue that it’s not in the car service industry; it’s a technology platform,” said Liss-Riordan in an interview. “The court rejected that.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“Some folks are working part-time for other jobs. Others have not had health insurance in a long time and need extra help navigating their options.\"\u003cbr>\n\u003ccite>An Uber spokesperson\u003c/cite>\u003c/aside>\n\u003cp>Some on-demand economy companies are now taking steps to reclassify their workers as employees, including \u003ca href=\"http://www.doctorondemand.com/\">Doctor on Demand\u003c/a>, a company that connects people with doctors online in a matter of minutes, as well as mobile delivery services Instacart and Shyp.\u003c/p>\n\u003cp>But Lang is doubtful that this will trigger a shift for the on-demand economy at large. As Lang points out, Uber’s labor pool is much larger than \u003ca href=\"http://www.businessinsider.com/why-instacart-is-reclassifing-some-of-its-workers-as-employees-2015-6\">an Instarcart\u003c/a> or Shyp and its workers are not specialized like Doctor on Demand’s physicians – all they need is a drivers’ license. “I give Shyp and Instacart kudos, of course,” he said, “but it’s also opportunistic for them.”\u003c/p>\n\u003cp>A change in federal law or a landmark Supreme Court ruling might force Uber, Lyft and others to treat their workers as employees. This wouldn’t mean that every driver would receive employee-sponsored health insurance overnight.\u003c/p>\n\u003cp>Dan Diamond, executive editor for the research and consulting firm \u003ca href=\"https://www.advisory.com/\">The Advisory Board\u003c/a>, has written about how Uber would handle the health care problem if its drivers were considered employees. Diamond does not believe that workers would immediately benefit from a reclassification.\u003c/p>\n\u003cp>Uber might opt to avoid providing health insurance by paying a fee under the Affordable Care Act (a requirement if businesses do not provide health insurance to employees who work more than 30 hours per week). It might also cap workers’ at 29 hours per week to keep them part-time employees.\u003c/p>\n\u003cp>Diamond expects that Uber will use every weapon in its arsenal to avoid such an outcome. “For Uber, none of these options are ideal.”\u003c/p>\n\u003cp>Deco Carter, a Bay Area-based Lyft driver, said he “knew the risks” when he joined the growing ranks of gig economy workers. He has been involved in two auto accidents, and lacked income for several weeks until he got his car fixed.\u003c/p>\n\u003cp>\"I really didn't have anything to fall back on,\" he said. \"If it wasn't for my fiancé, I don't know what I would have done.\"\u003c/p>\n\u003cp>In the years ahead, he hopes that Lyft would consider extending benefits to drivers, particularly to those who work full-time hours. Lyft is not currently working with Stride Health, but it drivers have access to an alternative service called the eHealth marketplace. A spokesperson denied requests from KQED for an interview.\u003c/p>\n\u003cp>But while executives at these companies may want to do more to protect workers, they are also under pressure to protect their bottom line. It would be highly expensive for them to reclassify workers.\u003c/p>\n\u003cp>Most experts are watching the presidential race as an indicator of what’s to come.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“My fear is that we’ll either re-classify everyone as an employee or trust the unfettered hand of capitalism,” said Warner. “Before that happens, I’m hoping those of us who are thinking about this in a bipartisan fashion can come up with some policy ideas that might be embraced by both sides.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>I’m filled with dread every time I open my mailbox to find an “\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">Explanation of Benefits\u003c/a>” from my health insurer.\u003c/p>\n\u003cp>It’s bad enough when my portion of the tab is what I expected. But I virtually lose it when my bill is more than it should be.\u003c/p>\n\u003cp>A survey \u003ca href=\"http://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\">last month\u003c/a> by Consumers Union found that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\">nearly one in four Californians\u003c/a> with private insurance faces surprise medical bills, in which the insurer paid less than expected.\u003c/p>\n\u003cp>Today, I’m going to give you some very simple advice to deploy if -- and when -- you receive a surprise bill:\u003c/p>\n\u003cp>Fight it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This advice applies to people with private insurance -- purchased either on or off the Covered California marketplace -- or employer-sponsored coverage.\u003c/p>\n\u003cp>It also applies to a broad range of surprises, whether you think you were charged too much for a procedure, wrongly penalized for going out of network or otherwise incorrectly billed.\u003c/p>\n\u003cp>“At least 50 percent of the time, you will prevail,” says Wendell Potter, a former health insurance company executive and author of “\u003ca href=\"http://wendellpotter.com/deadlyspin/\" target=\"_blank\">Deadly Spin\u003c/a>,” an exposé about the health insurance industry’s practices.\u003c/p>\n\u003cp>“It’s very much worth it” to fight, he says.\u003c/p>\n\u003cp>\u003cstrong>Q: My insurance company billed me for going to an out-of-network doctor, but the same insurer told me beforehand that the doctor is in-network. What should I do?\u003c/strong>\u003c/p>\n\u003cp>A: It’s time to make some calls.\u003c/p>\n\u003cp>Many of you don’t realize you have appeal rights. Or you give up before trying.\u003c/p>\n\u003cp>In the Consumers Union survey, 40 percent of those who received surprise bills didn’t take action.\u003c/p>\n\u003cp>More than half of those said it was because they “didn’t think it would make a difference,” and 18 percent said they didn’t know how to complain.\u003c/p>\n\u003cp>“People often are intimidated by the process of trying to get their insurance company to approve something that’s been denied,” Potter says.\u003c/p>\n\u003cp>Insurance companies know it and bank on it, he says.\u003c/p>\n\u003cp>“They know that people are not very savvy when it comes to dealing with insurance companies,” he says.\u003c/p>\n\u003cp>It’s time to get savvy.\u003c/p>\n\u003cp>Start with your insurer. The Explanation of Benefits will have instructions explaining how to contest the bill, or just call the customer service number on your health insurance card.\u003c/p>\n\u003cp>Insurance companies devote entire departments to consumer appeals and urge you to take action if there’s something amiss with your bill, says Nicole Kasabian Evans of the California Association of Health Plans.\u003c/p>\n\u003cp>“If you have a concern, or something looks or feels funny, challenge it,” she says.\u003c/p>\n\u003cp>If your appeal isn’t resolved within 30 days or you’re not satisfied with the outcome, go to your regulator, says Rodger Butler, spokesman with the state Department of Managed Health Care (DMHC).\u003c/p>\n\u003cp>I wish I could tell you there’s just one regulator for everyone, but in California, we have two state departments with authority over health plans: DMHC and the Department of Insurance.\u003c/p>\n\u003cp>(To complicate matters, for \u003ca href=\"http://www.nciom.org/wp-content/uploads/2003/01/C11.pdf\" target=\"_blank\">some people with employer-sponsored insurance\u003c/a>, the U.S. Department of Labor is the regulator.)\u003c/p>\n\u003cp>To simplify, start by calling DMHC’s Help Center at 888-466-2219. DMHC regulates the \u003ca href=\"http://stage.chcf.org/articles/2015/05/enrollment-individual-up\" target=\"_blank\">vast majority\u003c/a> of individual/family, small business and large-group health plans in the state.\u003c/p>\n\u003cp>“If you don’t know who to call, call us,” Butler says.\u003c/p>\n\u003cp>If DMHC is your regulator, you can move forward with the appeal process by phone or \u003ca href=\"http://dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForm.aspx#.VV-uBGRViko\" target=\"_blank\">file your complaint online\u003c/a> (\u003ca href=\"http://www.HealthHelp.ca.gov\" target=\"_blank\">www.HealthHelp.ca.gov\u003c/a>). If not, the Help Center can connect you to the correct regulator, Butler says.\u003c/p>\n\u003cp>If you’ve gone through that process and you’re still facing a bill, go to the doctor, hospital or other provider where you received the service and bargain, suggests Julie Silas, senior attorney at Consumers Union.\u003c/p>\n\u003cp>“It’s worth picking up the phone and seeing if you can negotiate a reduced bill or payment plan with your provider,” she says.\u003c/p>\n\u003cp>I realize that fighting your insurance company doesn’t sound pleasant, especially if you’re sick and in treatment.\u003c/p>\n\u003cp>But you have allies.\u003c/p>\n\u003cp>“We can assist in the appeal process with the insurer so that consumers don’t have to do it themselves,” says Janice Rocco, deputy commissioner at the Department of Insurance.\u003c/p>\n\u003cp>I won’t deny that fighting an insurance bill requires time, effort and probably some frustration, even if you get help. But given the complexity of the health insurance world -- and the dizzying pace of change -- you need to be active and engaged in your coverage.\u003c/p>\n\u003cp>“This is an example of the changing landscape of health care, where the consumer really needs to be their own advocate,” Kasabian Evans says.\u003c/p>\n\u003cp>Potter puts it another way: “It’s important to be a squeaky wheel.”\u003c/p>\n\u003cp>His tips:\u003c/p>\n\u003cul>\n\u003cli>Be persistent. “If you make one call and don’t make progress, call again and keep calling,” he says.\u003c/li>\n\u003cli>Be organized. Note the time and date of your calls with customer service representatives, and the name of the person you’re talking to. If you mail documents, make a copy for your files first.\u003c/li>\n\u003cli>Most insurance companies have executive teams that deal with “squeaky wheels,” Potter says. “If you send a letter to the CEO, there’s a good chance that letter will be sent to the people who are dedicated to high-profile cases,” he says.\u003c/li>\n\u003cli>If all else fails, he says, “you might hire an attorney.”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>Qu\u003c/em>\u003cem>esti\u003c/em>\u003cem>ons for Emily: \u003c/em>\u003ca href=\"mailto:AskEmily@usc.edu\">\u003cem>AskEmily@usc.edu\u003c/em>\u003c/a>\u003cbr>\n\u003cem>Click \u003c/em>\u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\">\u003cem>here\u003c/em>\u003c/a>\u003cem> to find previous Ask Emily columns. \u003c/em>\u003c/p>\n\u003cp>\u003cem> \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The \u003c/em>\u003ca href=\"http://www.centerforhealthreporting.org/\">\u003cem>CHCF Center for Health Reporting\u003c/em>\u003c/a>\u003cem> partners with news organizations to cover California health policy. Located at the \u003c/em>\u003ca href=\"http://annenberg.usc.edu/\">\u003cem>USC Annenberg School for Communication and Journalism\u003c/em>\u003c/a>\u003cem>, it is funded by the nonpartisan \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>California HealthCare Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>I’m filled with dread every time I open my mailbox to find an “\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">Explanation of Benefits\u003c/a>” from my health insurer.\u003c/p>\n\u003cp>It’s bad enough when my portion of the tab is what I expected. But I virtually lose it when my bill is more than it should be.\u003c/p>\n\u003cp>A survey \u003ca href=\"http://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\">last month\u003c/a> by Consumers Union found that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\">nearly one in four Californians\u003c/a> with private insurance faces surprise medical bills, in which the insurer paid less than expected.\u003c/p>\n\u003cp>Today, I’m going to give you some very simple advice to deploy if -- and when -- you receive a surprise bill:\u003c/p>\n\u003cp>Fight it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This advice applies to people with private insurance -- purchased either on or off the Covered California marketplace -- or employer-sponsored coverage.\u003c/p>\n\u003cp>It also applies to a broad range of surprises, whether you think you were charged too much for a procedure, wrongly penalized for going out of network or otherwise incorrectly billed.\u003c/p>\n\u003cp>“At least 50 percent of the time, you will prevail,” says Wendell Potter, a former health insurance company executive and author of “\u003ca href=\"http://wendellpotter.com/deadlyspin/\" target=\"_blank\">Deadly Spin\u003c/a>,” an exposé about the health insurance industry’s practices.\u003c/p>\n\u003cp>“It’s very much worth it” to fight, he says.\u003c/p>\n\u003cp>\u003cstrong>Q: My insurance company billed me for going to an out-of-network doctor, but the same insurer told me beforehand that the doctor is in-network. What should I do?\u003c/strong>\u003c/p>\n\u003cp>A: It’s time to make some calls.\u003c/p>\n\u003cp>Many of you don’t realize you have appeal rights. Or you give up before trying.\u003c/p>\n\u003cp>In the Consumers Union survey, 40 percent of those who received surprise bills didn’t take action.\u003c/p>\n\u003cp>More than half of those said it was because they “didn’t think it would make a difference,” and 18 percent said they didn’t know how to complain.\u003c/p>\n\u003cp>“People often are intimidated by the process of trying to get their insurance company to approve something that’s been denied,” Potter says.\u003c/p>\n\u003cp>Insurance companies know it and bank on it, he says.\u003c/p>\n\u003cp>“They know that people are not very savvy when it comes to dealing with insurance companies,” he says.\u003c/p>\n\u003cp>It’s time to get savvy.\u003c/p>\n\u003cp>Start with your insurer. The Explanation of Benefits will have instructions explaining how to contest the bill, or just call the customer service number on your health insurance card.\u003c/p>\n\u003cp>Insurance companies devote entire departments to consumer appeals and urge you to take action if there’s something amiss with your bill, says Nicole Kasabian Evans of the California Association of Health Plans.\u003c/p>\n\u003cp>“If you have a concern, or something looks or feels funny, challenge it,” she says.\u003c/p>\n\u003cp>If your appeal isn’t resolved within 30 days or you’re not satisfied with the outcome, go to your regulator, says Rodger Butler, spokesman with the state Department of Managed Health Care (DMHC).\u003c/p>\n\u003cp>I wish I could tell you there’s just one regulator for everyone, but in California, we have two state departments with authority over health plans: DMHC and the Department of Insurance.\u003c/p>\n\u003cp>(To complicate matters, for \u003ca href=\"http://www.nciom.org/wp-content/uploads/2003/01/C11.pdf\" target=\"_blank\">some people with employer-sponsored insurance\u003c/a>, the U.S. Department of Labor is the regulator.)\u003c/p>\n\u003cp>To simplify, start by calling DMHC’s Help Center at 888-466-2219. DMHC regulates the \u003ca href=\"http://stage.chcf.org/articles/2015/05/enrollment-individual-up\" target=\"_blank\">vast majority\u003c/a> of individual/family, small business and large-group health plans in the state.\u003c/p>\n\u003cp>“If you don’t know who to call, call us,” Butler says.\u003c/p>\n\u003cp>If DMHC is your regulator, you can move forward with the appeal process by phone or \u003ca href=\"http://dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForm.aspx#.VV-uBGRViko\" target=\"_blank\">file your complaint online\u003c/a> (\u003ca href=\"http://www.HealthHelp.ca.gov\" target=\"_blank\">www.HealthHelp.ca.gov\u003c/a>). If not, the Help Center can connect you to the correct regulator, Butler says.\u003c/p>\n\u003cp>If you’ve gone through that process and you’re still facing a bill, go to the doctor, hospital or other provider where you received the service and bargain, suggests Julie Silas, senior attorney at Consumers Union.\u003c/p>\n\u003cp>“It’s worth picking up the phone and seeing if you can negotiate a reduced bill or payment plan with your provider,” she says.\u003c/p>\n\u003cp>I realize that fighting your insurance company doesn’t sound pleasant, especially if you’re sick and in treatment.\u003c/p>\n\u003cp>But you have allies.\u003c/p>\n\u003cp>“We can assist in the appeal process with the insurer so that consumers don’t have to do it themselves,” says Janice Rocco, deputy commissioner at the Department of Insurance.\u003c/p>\n\u003cp>I won’t deny that fighting an insurance bill requires time, effort and probably some frustration, even if you get help. But given the complexity of the health insurance world -- and the dizzying pace of change -- you need to be active and engaged in your coverage.\u003c/p>\n\u003cp>“This is an example of the changing landscape of health care, where the consumer really needs to be their own advocate,” Kasabian Evans says.\u003c/p>\n\u003cp>Potter puts it another way: “It’s important to be a squeaky wheel.”\u003c/p>\n\u003cp>His tips:\u003c/p>\n\u003cul>\n\u003cli>Be persistent. “If you make one call and don’t make progress, call again and keep calling,” he says.\u003c/li>\n\u003cli>Be organized. Note the time and date of your calls with customer service representatives, and the name of the person you’re talking to. If you mail documents, make a copy for your files first.\u003c/li>\n\u003cli>Most insurance companies have executive teams that deal with “squeaky wheels,” Potter says. “If you send a letter to the CEO, there’s a good chance that letter will be sent to the people who are dedicated to high-profile cases,” he says.\u003c/li>\n\u003cli>If all else fails, he says, “you might hire an attorney.”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>Qu\u003c/em>\u003cem>esti\u003c/em>\u003cem>ons for Emily: \u003c/em>\u003ca href=\"mailto:AskEmily@usc.edu\">\u003cem>AskEmily@usc.edu\u003c/em>\u003c/a>\u003cbr>\n\u003cem>Click \u003c/em>\u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\">\u003cem>here\u003c/em>\u003c/a>\u003cem> to find previous Ask Emily columns. \u003c/em>\u003c/p>\n\u003cp>\u003cem> \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The \u003c/em>\u003ca href=\"http://www.centerforhealthreporting.org/\">\u003cem>CHCF Center for Health Reporting\u003c/em>\u003c/a>\u003cem> partners with news organizations to cover California health policy. Located at the \u003c/em>\u003ca href=\"http://annenberg.usc.edu/\">\u003cem>USC Annenberg School for Communication and Journalism\u003c/em>\u003c/a>\u003cem>, it is funded by the nonpartisan \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>California HealthCare Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_22350\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/5161_transform.jpg\">\u003cimg class=\"size-full wp-image-22350\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/5161_transform.jpg\" alt=\"The law would require health insurers to publicly disclose and justify their rates. (Getty Images)\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/11/5161_transform.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/5161_transform-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/5161_transform-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The law would require health insurers to publicly disclose and justify their rates. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update, 12:30 a.m.\u003c/strong>\u003cbr>\nAt first glance, Proposition 45 seemed like a no-brainer for consumers. The measure would have given the state’s insurance commissioner the authority to reject excessive rate hikes in health insurance sold on the individual and small-business markets.\u003c/p>\n\u003cp>Consumers who had seen their premiums go up by double digits year after year clung to Prop. 45 as the savior.\u003c/p>\n\u003cp>“I felt like a frog in hot water that got hotter and hotter until it was boiling,” says Josh Libresco, a market researcher who has bought health insurance for his family on the individual market for 20 years.\u003c/p>\n\u003cp>\u003c!--more-->But consumer voices like this were overwhelmed in the conversation around Prop. 45 by health insurance companies, including Kaiser and Blue Cross Blue Shield, which raised $43.6 million to defeat the measure. The proponents raised just $2.5 million.\u003c/p>\n\u003cp>“Health insurance companies have a tremendous economic stake in the outcome,” says Daniel G. Newman, president and co-founder of MapLight, a nonpartisan research organization that tracks the influence of money on politics. “There’s also billions of dollars at stake for health care consumers, but consumers don’t have millions collectively to put in favor of a ballot measure.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The No side was further bolstered by \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/02/fight-continues-over-ballot-measure-to-control-health-insurance-premiums/\" target=\"_blank\">concerns raised by Covered California\u003c/a>, the state agency tasked with implementing the Affordable Care Act in California. Board members and staff discussed various complications that could arise from Prop. 45 and complicate Covered California’s ability to carry out its mission, pitting the agency against the current commissioner, Dave Jones, in \u003ca href=\"http://ww2.kqed.org/stateofhealth/tag/proposition-45/\" target=\"_blank\">an unusual dispute between allies\u003c/a>.\u003c/p>\n\u003cp>The agency negotiates rates with insurers directly, and feared that a challenge to those rates under Prop. 45 could undo that work, delay final rates beyond federal deadlines or even cause insurers to withdraw plans from the state marketplace.\u003c/p>\n\u003cp>Insurance companies made Covered California an unlikely bedfellow, weaving its concerns into the industry’s ad campaign and urging people to vote no on Prop. 45 to \"protect the Affordable Care Act.\"\u003c/p>\n\u003cp>The influence of that campaign appears to have worked with voters. A poll from the middle of the summer showed 69 percent of likely voters favored Prop. 45 and giving the commissioner more power to control health insurance rates.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>By election night, that support slipped to just about 40 percent.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22350\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/5161_transform.jpg\">\u003cimg class=\"size-full wp-image-22350\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/5161_transform.jpg\" alt=\"The law would require health insurers to publicly disclose and justify their rates. (Getty Images)\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/11/5161_transform.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/5161_transform-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/5161_transform-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The law would require health insurers to publicly disclose and justify their rates. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update, 12:30 a.m.\u003c/strong>\u003cbr>\nAt first glance, Proposition 45 seemed like a no-brainer for consumers. The measure would have given the state’s insurance commissioner the authority to reject excessive rate hikes in health insurance sold on the individual and small-business markets.\u003c/p>\n\u003cp>Consumers who had seen their premiums go up by double digits year after year clung to Prop. 45 as the savior.\u003c/p>\n\u003cp>“I felt like a frog in hot water that got hotter and hotter until it was boiling,” says Josh Libresco, a market researcher who has bought health insurance for his family on the individual market for 20 years.\u003c/p>\n\u003cp>\u003c!--more-->But consumer voices like this were overwhelmed in the conversation around Prop. 45 by health insurance companies, including Kaiser and Blue Cross Blue Shield, which raised $43.6 million to defeat the measure. The proponents raised just $2.5 million.\u003c/p>\n\u003cp>“Health insurance companies have a tremendous economic stake in the outcome,” says Daniel G. Newman, president and co-founder of MapLight, a nonpartisan research organization that tracks the influence of money on politics. “There’s also billions of dollars at stake for health care consumers, but consumers don’t have millions collectively to put in favor of a ballot measure.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The No side was further bolstered by \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/02/fight-continues-over-ballot-measure-to-control-health-insurance-premiums/\" target=\"_blank\">concerns raised by Covered California\u003c/a>, the state agency tasked with implementing the Affordable Care Act in California. Board members and staff discussed various complications that could arise from Prop. 45 and complicate Covered California’s ability to carry out its mission, pitting the agency against the current commissioner, Dave Jones, in \u003ca href=\"http://ww2.kqed.org/stateofhealth/tag/proposition-45/\" target=\"_blank\">an unusual dispute between allies\u003c/a>.\u003c/p>\n\u003cp>The agency negotiates rates with insurers directly, and feared that a challenge to those rates under Prop. 45 could undo that work, delay final rates beyond federal deadlines or even cause insurers to withdraw plans from the state marketplace.\u003c/p>\n\u003cp>Insurance companies made Covered California an unlikely bedfellow, weaving its concerns into the industry’s ad campaign and urging people to vote no on Prop. 45 to \"protect the Affordable Care Act.\"\u003c/p>\n\u003cp>The influence of that campaign appears to have worked with voters. A poll from the middle of the summer showed 69 percent of likely voters favored Prop. 45 and giving the commissioner more power to control health insurance rates.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>By election night, that support slipped to just about 40 percent.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_2574\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/01/Gavel-20111114-e1409248436930.jpg\">\u003cimg class=\"size-large wp-image-2574\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/01/Gavel-20111114-620x411.jpg\" alt=\"(s_falkow: Flickr)\" width=\"620\" height=\"411\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(s_falkow: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca title=\"Kaiser Health News\" href=\"http://capsules.kaiserhealthnews.org/index.php/2014/09/lawsuit-accuses-calif-of-denying-care-to-medi-cal-applicants/#more-30760\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>California’s lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the health care they are entitled to receive, according to a lawsuit filed Wednesday by a coalition of health advocates and legal services groups.\u003c/p>\n\u003caside class=\"pullquote alignleft\">A Tulare County man had applied for Medi-Cal but died of a pulmonary embolism while waiting for the state to confirm his eligibility.\u003c/aside>\n\u003cp>The lawsuit, filed in Alameda County Superior Court, says the state is failing to process applications within 45 days as required by law. Some applicants have been waiting to receive their Medi-Cal cards since the end of last year, according to the suit. The applicants include children, pregnant women and adults with life-threatening health conditions, who advocates say are either postponing treatment or paying cash to see doctors.\u003c/p>\n\u003cp>Medi-Cal is the state’s version of Medicaid, the publicly funded health insurance program for low-income Americans. About 11 million people receive Medi-Cal benefits in California, including 2.2 million who applied since January. Roughly 350,000 applications are still pending.\u003c!--more-->\u003c/p>\n\u003cp>The lawsuit cites several cases, including that of Tulare County resident Robert Rivera, who applied for Medi-Cal in January but died of a pulmonary embolism while the state was determining if he was eligible for the insurance. Two months after his death, Rivera’s mother received a letter saying that the benefits had been approved.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Los Angeles County resident Mark Mullin submitted an application in February 2014, but wasn’t approved until four months later — after he sought legal help. During the time his application was stuck in the backlog, Mullin had to undergo an emergency appendectomy.\u003c/p>\n\u003cp>The suit is asking the state to process cases within 45 days and to grant people Medi-Cal benefits while officials verify applicants’ incomes. The coalition is also asking the state to send notices to Medi-Cal applicants who have been waiting for 45 days notifying them of their right to go before an administrative law judge.\u003c/p>\n\u003cp>The long wait is “unacceptable,” said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County. Murphy said she is concerned that the problems will get worse as more people apply for Medi-Cal. “If they are not fixed, more people will continue to wait and more will continue to suffer medical emergencies,” she said.\u003c/p>\n\u003cp>California Department of Health Care Services officials said they have been working closely with the counties and have reduced the backlog by 250,000 since early July. Many of the cases are still pending because of incorrect or incomplete information.\u003c/p>\n\u003cp>Department spokesman Tony Cava said people who need immediate care can get in-person assistance with their application at a county social services agency. They also can get their medical bills covered for care received while their applications were pending, he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The lawsuit was filed by several organizations throughout California, including Neighborhood Legal Services of Los Angeles County, the National Health Law Program and Bay Area Legal Aid.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Los Angeles County resident Mark Mullin submitted an application in February 2014, but wasn’t approved until four months later — after he sought legal help. During the time his application was stuck in the backlog, Mullin had to undergo an emergency appendectomy.\u003c/p>\n\u003cp>The suit is asking the state to process cases within 45 days and to grant people Medi-Cal benefits while officials verify applicants’ incomes. The coalition is also asking the state to send notices to Medi-Cal applicants who have been waiting for 45 days notifying them of their right to go before an administrative law judge.\u003c/p>\n\u003cp>The long wait is “unacceptable,” said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County. Murphy said she is concerned that the problems will get worse as more people apply for Medi-Cal. “If they are not fixed, more people will continue to wait and more will continue to suffer medical emergencies,” she said.\u003c/p>\n\u003cp>California Department of Health Care Services officials said they have been working closely with the counties and have reduced the backlog by 250,000 since early July. Many of the cases are still pending because of incorrect or incomplete information.\u003c/p>\n\u003cp>Department spokesman Tony Cava said people who need immediate care can get in-person assistance with their application at a county social services agency. They also can get their medical bills covered for care received while their applications were pending, he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The lawsuit was filed by several organizations throughout California, including Neighborhood Legal Services of Los Angeles County, the National Health Law Program and Bay Area Legal Aid.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Details of Autism Benefits -- Like Provider Rates -- Coming After Rollout",
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"content": "\u003cfigure id=\"attachment_17935\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/186380264-e1393616709383.jpg\">\u003cimg class=\"size-large wp-image-17935\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/186380264-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca title=\"California Healthline\" href=\"http://www.californiahealthline.org/capitol-desk/2014/9/autism-details-to-come-after-rollout\" target=\"_blank\">CaliforniaHealthline\u003c/a>\u003c/p>\n\u003cp>At the first stakeholder meeting last week to review California's new autism Medi-Cal coverage, state health officials said many details have yet to be worked out. Medi-Cal is California's Medicaid program.\u003c/p>\n\u003cp>\u003ca title=\"Long-Sought Autism Treatment Now Covered by Medi-Cal\" href=\"http://ww2.kqed.org/stateofhealth/2014/08/05/long-fought-autism-therapy-a-medi-cal-benefit-state-says/\" target=\"_blank\">New benefits, which include coverage of applied behavior analysis\u003c/a> -- also known as ABA therapy -- begin next week.\u003c/p>\n\u003cp>Department of Health Care Services officials said many details -- including the crucial figure of what the reimbursement rates will be -- still need to be worked out. Rates will be discussed at the next stakeholder meeting Oct. 16, officials said.\u003c!--more-->\u003c/p>\n\u003cp>The department still is on schedule to submit an autism coverage state plan amendment to the Centers for Medicare & Medicaid Services by Sept. 30, officials said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We will talk about rates later. We will have a separate session on rate setting,\" said Sarah Brooks, branch chief of the Medi-Cal managed care division at DHCS. \"We are working with different ABA providers so health plans can build their networks. We will be working with them to make sure we have proper network adequacy.\"\u003c/p>\n\u003cp>According to Laurie Weaver, chief of the benefits division at DHCS, the new benefit will cover the broad area of behavior health treatment, which includes ABA therapy as one type of treatment, but the department first will focus on ABA, since it's at the heart of the new benefit.\u003c/p>\n\u003cp>\"The state plan amendment will address ABA first, and we'll go from there,\" she said.\u003c/p>\n\u003cp>According to Abbie Totten, director of state programs for the California Association of Health Plans, it's unusual to launch a benefit before setting up the network.\u003c/p>\n\u003cp>\"You have to understand,\" Totten said to stakeholders at Thursday's meeting, \"we are implementing this benefit in a backwards manner. Usually when you implement a benefit you have time … you can develop all of those pieces, and we are not being provided that opportunity in this case.\"\u003c/p>\n\u003cp>The health plans will work with the state to implement the benefit as best they can -- but right now, she said, people will need to bear with the process, which may be rocky and a little confusing at first.\u003c/p>\n\u003cp>\"We have no rates, we have no idea what payment looks like, we have no idea what licensing or provider criteria will look like,\" Totten said.\u003c/p>\n\u003cp>\"So, just as a caution, we will work together on this. We are committed with the department to make this work, but we don't even have a [state plan amendment] that's approved yet,\" she said. \"We're going to do our best and try to make sure the providers are reimbursed properly.\"\u003c/p>\n\u003cp>\"This is day one,\" said Rene Mollow, deputy director of health care benefits and eligibility at DHCS.\u003c/p>\n\u003cp>\"You can look at this and say, 'Oh no, there's so much to do,' \" Mollow said. \"Or rather you can say, 'Wow, look at what we're doing here.' \"\u003c/p>\n\u003cp>Mollow said the department is committed to implementing the benefit with full involvement of stakeholders -- and that lengthens the process somewhat.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We are just starting down this pathway, and we know there will be improvements and there will be efforts to inform what the state of California will be doing,\" she said. \"It's a process. I would look at it as: day one. Woo-hoo!\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17935\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/186380264-e1393616709383.jpg\">\u003cimg class=\"size-large wp-image-17935\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/186380264-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca title=\"California Healthline\" href=\"http://www.californiahealthline.org/capitol-desk/2014/9/autism-details-to-come-after-rollout\" target=\"_blank\">CaliforniaHealthline\u003c/a>\u003c/p>\n\u003cp>At the first stakeholder meeting last week to review California's new autism Medi-Cal coverage, state health officials said many details have yet to be worked out. Medi-Cal is California's Medicaid program.\u003c/p>\n\u003cp>\u003ca title=\"Long-Sought Autism Treatment Now Covered by Medi-Cal\" href=\"http://ww2.kqed.org/stateofhealth/2014/08/05/long-fought-autism-therapy-a-medi-cal-benefit-state-says/\" target=\"_blank\">New benefits, which include coverage of applied behavior analysis\u003c/a> -- also known as ABA therapy -- begin next week.\u003c/p>\n\u003cp>Department of Health Care Services officials said many details -- including the crucial figure of what the reimbursement rates will be -- still need to be worked out. Rates will be discussed at the next stakeholder meeting Oct. 16, officials said.\u003c!--more-->\u003c/p>\n\u003cp>The department still is on schedule to submit an autism coverage state plan amendment to the Centers for Medicare & Medicaid Services by Sept. 30, officials said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We will talk about rates later. We will have a separate session on rate setting,\" said Sarah Brooks, branch chief of the Medi-Cal managed care division at DHCS. \"We are working with different ABA providers so health plans can build their networks. We will be working with them to make sure we have proper network adequacy.\"\u003c/p>\n\u003cp>According to Laurie Weaver, chief of the benefits division at DHCS, the new benefit will cover the broad area of behavior health treatment, which includes ABA therapy as one type of treatment, but the department first will focus on ABA, since it's at the heart of the new benefit.\u003c/p>\n\u003cp>\"The state plan amendment will address ABA first, and we'll go from there,\" she said.\u003c/p>\n\u003cp>According to Abbie Totten, director of state programs for the California Association of Health Plans, it's unusual to launch a benefit before setting up the network.\u003c/p>\n\u003cp>\"You have to understand,\" Totten said to stakeholders at Thursday's meeting, \"we are implementing this benefit in a backwards manner. Usually when you implement a benefit you have time … you can develop all of those pieces, and we are not being provided that opportunity in this case.\"\u003c/p>\n\u003cp>The health plans will work with the state to implement the benefit as best they can -- but right now, she said, people will need to bear with the process, which may be rocky and a little confusing at first.\u003c/p>\n\u003cp>\"We have no rates, we have no idea what payment looks like, we have no idea what licensing or provider criteria will look like,\" Totten said.\u003c/p>\n\u003cp>\"So, just as a caution, we will work together on this. We are committed with the department to make this work, but we don't even have a [state plan amendment] that's approved yet,\" she said. \"We're going to do our best and try to make sure the providers are reimbursed properly.\"\u003c/p>\n\u003cp>\"This is day one,\" said Rene Mollow, deputy director of health care benefits and eligibility at DHCS.\u003c/p>\n\u003cp>\"You can look at this and say, 'Oh no, there's so much to do,' \" Mollow said. \"Or rather you can say, 'Wow, look at what we're doing here.' \"\u003c/p>\n\u003cp>Mollow said the department is committed to implementing the benefit with full involvement of stakeholders -- and that lengthens the process somewhat.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We are just starting down this pathway, and we know there will be improvements and there will be efforts to inform what the state of California will be doing,\" she said. \"It's a process. I would look at it as: day one. Woo-hoo!\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"here-and-now": {
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
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"order": 18
},
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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