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For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "No Primary Care Doc? Covered California Will Get You One",
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"content": "\u003cp>Health insurers are gearing up to comply with a new Covered California rule that will require them next year to ensure that all enrollees have a primary care provider.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You need a captain of the ship.'\u003ccite> Lance Lang, chief medical officer of Covered California \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>The policy change for 2017 is part of a broader push by the exchange to improve the quality of care, even as it faces double-digit premium increases.\u003c/p>\n\u003cp>Health insurers selling through Covered California will designate a family doctor — or in some cases a nurse practitioner or physician’s assistant — for every plan holder who doesn’t already have one within 60 days of the coverage start date. The role of the assigned provider will be to help enrollees “navigate the system,” the exchange said last week.\u003c/p>\n\u003cp>The new policy applies to all enrollees, including those in Preferred Provider Organizations (PPOs), in which patients choose the physicians they want, and in HMOs, where the doctor networks are narrower and patients need a referral from their primary care doctor to see other providers.\u003c/p>\n\u003cp>“You need a captain of the ship,” Lance Lang, chief medical officer of Covered California, said of the role primary care providers play in coordinating patient health. These clinicians “[know] the patient, not just their statistics and lab values.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lang said the new policy is meant to improve both the quality and cost efficiency of care.\u003c/p>\n\u003cp>As the agency \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">unveiled its 2017 health plans and premium rates\u003c/a> last week, Executive Director Peter Lee said officials wanted to make sure that “having coverage means [policyholders] also have access to care.”\u003c/p>\n\u003cp>PPO enrollees will still have the freedom to choose their own providers and will not require referrals from their primary care doctors to see other providers.\u003c/p>\n\u003cp>For them, “this isn’t a ‘mother may I’ doctor,” said Lee.\u003c/p>\n\u003cp>Consumers Union, a nonprofit advocacy group with a seat on a Covered California advisory committee, supported the change but wants the exchange to make sure it’s easy for consumers to change doctors if they need to and to find providers in their network who are accepting new patients.\u003c/p>\n\u003cp>The move to more coordinated care did not surprise health policy experts.\u003c/p>\n\u003cp>“California has definitely, relative to the nation as a whole, been far more aggressive in moving into managed care,” said Dr. Geoffrey Joyce, director of health policy at the University of Southern California’s Schaeffer Center.\u003c/p>\n\u003cp>However, Joyce said the Covered California policy change is not a full shift to managed care because the primary care assignments would not be as binding or restrictive as in traditional HMOs, in which patients have to pay more if they see doctors to whom they are not referred.\u003c/p>\n\u003cp>But the new policy could have clinical and financial benefits, he said.\u003c/p>\n\u003cp>“Everyone’s moving towards better integrated care, better coordinated care. And so having one primary care provider be your sort of gatekeeper and your focal point makes sense,” Joyce said.\u003c/p>\n\u003cp>Lang said that Covered California is moving away from a “fragmented, disorganized, wild west” kind of care but is not trying to steer consumers away from PPOs and into HMOs.\u003c/p>\n\u003cp>Primary care relationships can simply help avoid unnecessary medical costs, Lang said, because a family doctor can prevent duplication of tests and other services and make it less likely a patient will be readmitted to a hospital.\u003c/p>\n\u003cp>The new primary care requirement is part of a series of new measures meant to improve the quality of care in Covered California health plans. The exchange’s board of directors recently approved rules that include penalizing hospitals financially for underperforming and even removing them — or doctors — from health insurance networks if they perform too poorly or charge too much.\u003c/p>\n\u003cp>Health plans will also be required to share data about chronic diseases among their patients and work to reduce health disparities.\u003c/p>\n\u003cp>Covered California’s health plan premiums will increase by an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">average of 13.2 percent statewide\u003c/a> next year, but Lang said rising costs are not the impetus for the policy change on primary care. A body of research shows the benefits of coordinated care, he said.\u003c/p>\n\u003cp>How many of the 1.4 million Covered California enrollees who currently have primary care doctors is unknown, but about half of the patients in the marketplace are in HMOs, where primary care physicians are the first point of contact.\u003c/p>\n\u003cp>The California Academy of Family Physicians applauded the Covered California decision, saying primary care can help reduce costs in the current health care system, where “patients sometimes think the emergency room is their only option for urgent care.”\u003c/p>\n\u003cp>The success of Covered California’s effort depends on how it’s carried out, and the implementation should be monitored to make sure there is an adequate number of providers for patients, the family doctors group said.\u003c/p>\n\u003cp>California laws and insurance exchange rules require health plans to ensure that patients can see providers within a certain timeframe. But in some areas where there is a shortage of primary care providers, patients already have to wait to see a clinician, Joyce said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It’s possible patients will still have to wait to see a provider under the new Covered California policy, but being assigned to a primary care provider might help expedite a patient’s search for an in-network doctor, Joyce said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health insurers are gearing up to comply with a new Covered California rule that will require them next year to ensure that all enrollees have a primary care provider.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You need a captain of the ship.'\u003ccite> Lance Lang, chief medical officer of Covered California \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>The policy change for 2017 is part of a broader push by the exchange to improve the quality of care, even as it faces double-digit premium increases.\u003c/p>\n\u003cp>Health insurers selling through Covered California will designate a family doctor — or in some cases a nurse practitioner or physician’s assistant — for every plan holder who doesn’t already have one within 60 days of the coverage start date. The role of the assigned provider will be to help enrollees “navigate the system,” the exchange said last week.\u003c/p>\n\u003cp>The new policy applies to all enrollees, including those in Preferred Provider Organizations (PPOs), in which patients choose the physicians they want, and in HMOs, where the doctor networks are narrower and patients need a referral from their primary care doctor to see other providers.\u003c/p>\n\u003cp>“You need a captain of the ship,” Lance Lang, chief medical officer of Covered California, said of the role primary care providers play in coordinating patient health. These clinicians “[know] the patient, not just their statistics and lab values.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lang said the new policy is meant to improve both the quality and cost efficiency of care.\u003c/p>\n\u003cp>As the agency \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">unveiled its 2017 health plans and premium rates\u003c/a> last week, Executive Director Peter Lee said officials wanted to make sure that “having coverage means [policyholders] also have access to care.”\u003c/p>\n\u003cp>PPO enrollees will still have the freedom to choose their own providers and will not require referrals from their primary care doctors to see other providers.\u003c/p>\n\u003cp>For them, “this isn’t a ‘mother may I’ doctor,” said Lee.\u003c/p>\n\u003cp>Consumers Union, a nonprofit advocacy group with a seat on a Covered California advisory committee, supported the change but wants the exchange to make sure it’s easy for consumers to change doctors if they need to and to find providers in their network who are accepting new patients.\u003c/p>\n\u003cp>The move to more coordinated care did not surprise health policy experts.\u003c/p>\n\u003cp>“California has definitely, relative to the nation as a whole, been far more aggressive in moving into managed care,” said Dr. Geoffrey Joyce, director of health policy at the University of Southern California’s Schaeffer Center.\u003c/p>\n\u003cp>However, Joyce said the Covered California policy change is not a full shift to managed care because the primary care assignments would not be as binding or restrictive as in traditional HMOs, in which patients have to pay more if they see doctors to whom they are not referred.\u003c/p>\n\u003cp>But the new policy could have clinical and financial benefits, he said.\u003c/p>\n\u003cp>“Everyone’s moving towards better integrated care, better coordinated care. And so having one primary care provider be your sort of gatekeeper and your focal point makes sense,” Joyce said.\u003c/p>\n\u003cp>Lang said that Covered California is moving away from a “fragmented, disorganized, wild west” kind of care but is not trying to steer consumers away from PPOs and into HMOs.\u003c/p>\n\u003cp>Primary care relationships can simply help avoid unnecessary medical costs, Lang said, because a family doctor can prevent duplication of tests and other services and make it less likely a patient will be readmitted to a hospital.\u003c/p>\n\u003cp>The new primary care requirement is part of a series of new measures meant to improve the quality of care in Covered California health plans. The exchange’s board of directors recently approved rules that include penalizing hospitals financially for underperforming and even removing them — or doctors — from health insurance networks if they perform too poorly or charge too much.\u003c/p>\n\u003cp>Health plans will also be required to share data about chronic diseases among their patients and work to reduce health disparities.\u003c/p>\n\u003cp>Covered California’s health plan premiums will increase by an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">average of 13.2 percent statewide\u003c/a> next year, but Lang said rising costs are not the impetus for the policy change on primary care. A body of research shows the benefits of coordinated care, he said.\u003c/p>\n\u003cp>How many of the 1.4 million Covered California enrollees who currently have primary care doctors is unknown, but about half of the patients in the marketplace are in HMOs, where primary care physicians are the first point of contact.\u003c/p>\n\u003cp>The California Academy of Family Physicians applauded the Covered California decision, saying primary care can help reduce costs in the current health care system, where “patients sometimes think the emergency room is their only option for urgent care.”\u003c/p>\n\u003cp>The success of Covered California’s effort depends on how it’s carried out, and the implementation should be monitored to make sure there is an adequate number of providers for patients, the family doctors group said.\u003c/p>\n\u003cp>California laws and insurance exchange rules require health plans to ensure that patients can see providers within a certain timeframe. But in some areas where there is a shortage of primary care providers, patients already have to wait to see a clinician, Joyce said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It’s possible patients will still have to wait to see a provider under the new Covered California policy, but being assigned to a primary care provider might help expedite a patient’s search for an in-network doctor, Joyce said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Attorney General Joins Federal Suit to Block Anthem-Cigna Merger",
"title": "California Attorney General Joins Federal Suit to Block Anthem-Cigna Merger",
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"content": "\u003cp>California Attorney General Kamala Harris is joining a federal Justice Department antitrust lawsuit to block the proposed health insurance mega-merger between Anthem and Cigna, a consolidation that would create the country's largest health insurer.\u003c/p>\n\u003caside class=\"pullquote align right\">'The proposed merger would drive up costs for consumers and reduce access to quality healthcare for millions of Californians.'\u003ccite>Kamala Harris,\u003cbr>Attorney General of California\u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>While Harris acknowledged that mergers can create benefits for consumers, this deal \"does not strike that balance and would drive up costs for consumers and reduce access to quality healthcare for millions of Californians,\" she said in a statement.\u003c/p>\n\u003cp>The lawsuit was filed by the Justice Department and attorneys general in nine other states, in addition to California.\u003c/p>\n\u003cp>In California, Anthem Blue Cross is a \u003ca href=\"http://www.chcf.org/publications/2016/01/california-health-plans-insurers\" target=\"_blank\">huge player with about 20 percent \u003c/a>of private insurance market. Cigna has a smaller presence here, but the two companies \"compete head-to-head for customers, especially large employers,\" the attorney general's office said.\u003c/p>\n\u003cp>The Justice Department also filed a second suit, seeking to block a proposed merger between Aetna and Humana. California is not joining that suit because Humana does not have significant market share in the state, a spokeswoman for the attorney general's office said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Consumer advocates had long raised concerns about both deals and hailed today's news, saying these mergers would likely lead to \"reduced competition, increased prices, and more market power\" for the companies, said Anthony Wright, executive director of Health Access California, an advocacy group.\u003c/p>\n\u003cp>\"Bigger is not better,\" he said in a statement. \"Health care premiums are high enough without major insurers merging and reducing choice and competition further.\"\u003c/p>\n\u003cp>Aetna Inc. proposed last summer to buy Humana Inc. for $34 billion, while Anthem Inc. moved to acquire Cigna Corp. for $48 billion. The companies said Thursday they plan to fight the federal suit. Anthem called it \"an unfortunate and misguided\" step backward for access to affordable care.\u003c/p>\n\u003cp>Consumers have been dealing with rising health care costs for years, a result of several factors. Prices for prescription drugs and care have risen, and as they have, insurers — who ultimately pay most of the bill — have raised premiums and out-of-pocket expenses like deductibles to shift more costs to consumers and help protect their own bottom lines.\u003c/p>\n\u003cp>The big insurers argue that by getting larger they will be able to negotiate better prices with pharmaceutical companies, hospitals and doctor groups that also are growing. They also expect to cut expenses and add more customers, which helps them better spread the cost of investing in technology to manage and improve care.\u003c/p>\n\u003cp>In recent years insurers have invested in more elaborate technology to help customers find the most appropriate doctors and care providers and to help them take their medicines and manage their care, which can improve health and cut costs.\u003c/p>\n\u003cp>But it's unclear how much the savings from these improvements would filter down to the customer, especially if there are fewer insurers competing for business.\u003c/p>\n\u003cp>\"There's no reason to give those savings to their customers unless someone else is pushing you,\" said Gary Claxton, a vice president with the nonprofit Kaiser Family Foundation, which studies health care issues.\u003c/p>\n\u003cp>Regulators were worried about how the deals will affect competition in three areas in particular: coverage offered by large employers, insurance sold on the Affordable Care Act's public exchanges and Medicare Advantage plans, which are privately run versions of the government's Medicare program for the elderly.\u003c/p>\n\u003cp>Bill Baer, acting associate attorney general, said Thursday that major health insurers like Anthem and Aetna are thriving as independent companies.\u003c/p>\n\u003cp>\"They do not need these deals to survive, and consumers are entitled to benefit from their continued competition,\" he said.\u003c/p>\n\u003cp>Analysts who follow the industry say that when insurers grow big nationally it doesn't necessarily mean they dominate the local markets where their products are sold because there are so many regional insurers. They've also said that the insurers could sell off some of their business to ease concerns regulators might have.\u003c/p>\n\u003cp>But Baer said what the insurers offered to sell wasn't enough.\u003c/p>\n\u003cp>Industry experts say any impact from the deals on consumers would take years to materialize and could lead to savings in some areas, along with the risk of higher costs elsewhere.\u003c/p>\n\u003cp>Morningstar analyst Vishnu Lekraj said he's not sure how much stomach the insurers will have for a protracted legal battle. He thinks they eventually will walk away from these deals and hunt for smaller acquisitions that give them a presence in new markets.\u003c/p>\n\u003cp>\"In order for these firms to succeed longer term, they need to build scale,\" he said.\u003c/p>\n\u003cp>Shares of all four health insurers jumped Thursday after the Justice Department announced the lawsuit. The stocks had slumped in recent weeks as investors waited to learn what regulators would decide.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report. \u003c/em>\u003c/p>\n\n",
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"excerpt": "The deal, which would create the largest health insurance company in the U.S., would hurt competition and drive up costs, the attorney general said. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Attorney General Kamala Harris is joining a federal Justice Department antitrust lawsuit to block the proposed health insurance mega-merger between Anthem and Cigna, a consolidation that would create the country's largest health insurer.\u003c/p>\n\u003caside class=\"pullquote align right\">'The proposed merger would drive up costs for consumers and reduce access to quality healthcare for millions of Californians.'\u003ccite>Kamala Harris,\u003cbr>Attorney General of California\u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>While Harris acknowledged that mergers can create benefits for consumers, this deal \"does not strike that balance and would drive up costs for consumers and reduce access to quality healthcare for millions of Californians,\" she said in a statement.\u003c/p>\n\u003cp>The lawsuit was filed by the Justice Department and attorneys general in nine other states, in addition to California.\u003c/p>\n\u003cp>In California, Anthem Blue Cross is a \u003ca href=\"http://www.chcf.org/publications/2016/01/california-health-plans-insurers\" target=\"_blank\">huge player with about 20 percent \u003c/a>of private insurance market. Cigna has a smaller presence here, but the two companies \"compete head-to-head for customers, especially large employers,\" the attorney general's office said.\u003c/p>\n\u003cp>The Justice Department also filed a second suit, seeking to block a proposed merger between Aetna and Humana. California is not joining that suit because Humana does not have significant market share in the state, a spokeswoman for the attorney general's office said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Consumer advocates had long raised concerns about both deals and hailed today's news, saying these mergers would likely lead to \"reduced competition, increased prices, and more market power\" for the companies, said Anthony Wright, executive director of Health Access California, an advocacy group.\u003c/p>\n\u003cp>\"Bigger is not better,\" he said in a statement. \"Health care premiums are high enough without major insurers merging and reducing choice and competition further.\"\u003c/p>\n\u003cp>Aetna Inc. proposed last summer to buy Humana Inc. for $34 billion, while Anthem Inc. moved to acquire Cigna Corp. for $48 billion. The companies said Thursday they plan to fight the federal suit. Anthem called it \"an unfortunate and misguided\" step backward for access to affordable care.\u003c/p>\n\u003cp>Consumers have been dealing with rising health care costs for years, a result of several factors. Prices for prescription drugs and care have risen, and as they have, insurers — who ultimately pay most of the bill — have raised premiums and out-of-pocket expenses like deductibles to shift more costs to consumers and help protect their own bottom lines.\u003c/p>\n\u003cp>The big insurers argue that by getting larger they will be able to negotiate better prices with pharmaceutical companies, hospitals and doctor groups that also are growing. They also expect to cut expenses and add more customers, which helps them better spread the cost of investing in technology to manage and improve care.\u003c/p>\n\u003cp>In recent years insurers have invested in more elaborate technology to help customers find the most appropriate doctors and care providers and to help them take their medicines and manage their care, which can improve health and cut costs.\u003c/p>\n\u003cp>But it's unclear how much the savings from these improvements would filter down to the customer, especially if there are fewer insurers competing for business.\u003c/p>\n\u003cp>\"There's no reason to give those savings to their customers unless someone else is pushing you,\" said Gary Claxton, a vice president with the nonprofit Kaiser Family Foundation, which studies health care issues.\u003c/p>\n\u003cp>Regulators were worried about how the deals will affect competition in three areas in particular: coverage offered by large employers, insurance sold on the Affordable Care Act's public exchanges and Medicare Advantage plans, which are privately run versions of the government's Medicare program for the elderly.\u003c/p>\n\u003cp>Bill Baer, acting associate attorney general, said Thursday that major health insurers like Anthem and Aetna are thriving as independent companies.\u003c/p>\n\u003cp>\"They do not need these deals to survive, and consumers are entitled to benefit from their continued competition,\" he said.\u003c/p>\n\u003cp>Analysts who follow the industry say that when insurers grow big nationally it doesn't necessarily mean they dominate the local markets where their products are sold because there are so many regional insurers. They've also said that the insurers could sell off some of their business to ease concerns regulators might have.\u003c/p>\n\u003cp>But Baer said what the insurers offered to sell wasn't enough.\u003c/p>\n\u003cp>Industry experts say any impact from the deals on consumers would take years to materialize and could lead to savings in some areas, along with the risk of higher costs elsewhere.\u003c/p>\n\u003cp>Morningstar analyst Vishnu Lekraj said he's not sure how much stomach the insurers will have for a protracted legal battle. He thinks they eventually will walk away from these deals and hunt for smaller acquisitions that give them a presence in new markets.\u003c/p>\n\u003cp>\"In order for these firms to succeed longer term, they need to build scale,\" he said.\u003c/p>\n\u003cp>Shares of all four health insurers jumped Thursday after the Justice Department announced the lawsuit. The stocks had slumped in recent weeks as investors waited to learn what regulators would decide.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Premiums Going up 13.2% Next Year. Here's Why.",
"title": "Covered California Premiums Going up 13.2% Next Year. Here's Why.",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>Update: 2:30 p.m.\u003c/strong>\u003c/p>\n\u003cp>Covered California, the state's Obamacare marketplace, released proposed 2017 premiums Tuesday morning, and the average statewide increase will be 13.2 percent, more than triple the increase seen each of the last two years.\u003c/p>\n\u003cp>Peter Lee, the agency's executive director, cited several factors as drivers in this year's spike.\u003c/p>\n\u003cp>Most notable is an expiring federal \"reinsurance\" program, created as part of the Affordable Care Act, to spread the risk of so many newly insured people entering the risk pool. Actuarial experts estimate that alone adds 4 to 7 percent to premiums, but it's viewed as a one-time effect.\u003c/p>\n\u003cp>Rising health care costs, including specialty prescription drugs, are also a factor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lee stressed that most people could reduce their own individual increase by shopping around.\u003c/p>\n\u003cp>\"Almost 80 percent of our customers could either pay less than they are paying today or pay no more than [a] 5 percent increase,\" Lee said, if they comparison shop.\u003c/p>\n\u003cp>Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation, agreed there may be \"deals to be had.\"\u003c/p>\n\u003cp>“The market is still working much better in California than in most other states,\" he said. \"It’s quite competitive in giving consumers a large number of choices.\"\u003c/p>\n\u003cp>About 1.4 million Californians purchase their health insurance through the Covered California exchange.\u003c/p>\n\u003cp>Blue Shield and Anthem Blue Cross customers will face the steepest increases. They have about \"a quarter of the market each,\" Lee said. Anthem customers will see a statewide average increase of 16 percent, and Blue Shield is \"above 19 percent,\" Lee said.\u003c/p>\n\u003cp>In the Bay Area, those increases will be even steeper for Anthem and Blue Shield customers. Meanwhile, the average monthly premium hike for Kaiser members will be in the 5-6 percent range across much of the region.\u003c/p>\n\u003cp>\"We are committed to offering stable rates over the long term,\" said Bill Wehrle, a vice president at Kaiser Permanente, \"and are uniquely positioned to deliver more affordable health care coverage.\" He cited investments in technology and Kaiser's \"emphasis on wellness\" as factors keeping premium increases lower.\u003c/p>\n\u003cp>Here are some of the proposed rate increases for major plans in several Bay Area counties:\u003c/p>\n\u003cp>\u003cstrong>San Francisco\u003c/strong>\u003cbr>\nAverage increase: 14.8 percent\u003c/p>\n\u003cp>Kaiser: 5.3 percent\u003cbr>\nAnthem Blue Cross: 16.7 percent\u003cbr>\nBlue Shield: 24.2 percent\u003c/p>\n\u003cp>\u003cstrong>Contra Costa County\u003c/strong>\u003cbr>\nAverage increase: 13.6 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross: 22.6 percent\u003cbr>\nBlue Shield: 24.4 percent\u003c/p>\n\u003cp>\u003cstrong>Alameda County\u003c/strong>\u003cbr>\nAverage increase: 12.3 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross: 23.7 percent\u003cbr>\nBlue Shield: 18.9 percent\u003c/p>\n\u003cp>\u003cstrong>Santa Clara\u003c/strong>\u003cbr>\nAverage increase: 9.2 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross (EPO): 8.4 percent\u003cbr>\nBlue Shield: 22.3 percent\u003c/p>\n\u003cp>You can look up the proposed rate for your plan in your specific area by checking Covered California's \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA-2017-rate-booklet.pdf\" target=\"_blank\">rate booklet.\u003c/a>\u003c/p>\n\u003cp>The rates are not yet final. State regulators will review them in the coming weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>California's Obamacare customers can expect a hefty increase in their monthly health insurance premiums next year. Covered California will announce new 2017 rates Tuesday morning for people who buy their plan through the state marketplace, and experts are predicting that increases will be double or even triple what they were last year.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/274403157\" 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>“2017 is going to be a transition year,” said Peter Lee, executive director of Covered California, testifying before Congress last week. “We expect our rates to be higher than we saw in our first two years.”\u003c/p>\n\u003cp>In \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/07/31/californias-2015-obamacare-premiums-will-increase-modestly/\" target=\"_blank\">2015\u003c/a> and \u003ca href=\"https://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\" target=\"_blank\">2016\u003c/a>, marketplace premiums increased an average of 4 percent -- a rate celebrated by consumer advocates as “modest,” even “\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\">terrific\u003c/a>.”\u003c/p>\n\u003cp>Covered California’s proposed budget for 2017, released in May, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/05/11/californias-obamacare-premiums-may-rise-8-percent-next-year/\" target=\"_blank\">projected average rate increases of 8 percent\u003c/a>. Industry insiders are suggesting the average jump could be even higher.\u003c/p>\n\u003cp>There are three key reasons why.\u003c/p>\n\u003cp>\u003cstrong>One: Medical Costs are Up\u003c/strong>\u003c/p>\n\u003cp>Insurance companies say premium prices are going up because medical costs are going up. Doctors, hospitals, labs and pharmaceutical companies are all raising their prices.\u003c/p>\n\u003cp>“Unquestionably, runaway drug prices remain a serious problem,” said Charles Bacchi, president and CEO of the California Association of Health Plans, a trade group for insurers. “We’re seeing new drugs coming out with blockbuster prices, and we’ve seen drugs that have been around for 30 years double and triple in price for no reason.”\u003c/p>\n\u003cp>Northern Californians have felt the burden of higher medical costs more so than people in Southern California because the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">hospital market is more consolidated\u003c/a>, giving hospitals more bargaining power with insurers.\u003c/p>\n\u003cp>Early rate filings from other states indicate rising medical costs could contribute to premium increases anywhere from 3 to 9 percent.\u003c/p>\n\u003cp>California regulators will have a chance to review the proposed rate increases, and consumer advocacy groups say they look forward to participating in the process by challenging some of the assumptions health plans have made about costs.\u003c/p>\n\u003cp>\"To the extent insurers are booking a certain amount of medical inflation to prescription drugs, are they overestimating those costs?\" said Anthony Wright, executive director of Health Access. \"Is that a scapegoat or a true driver?*\u003c/p>\n\u003cp>\u003cstrong>Two: Federal Protections are Expiring\u003c/strong>\u003c/p>\n\u003cp>The Affordable Care Act established a “reinsurance” program that was designed to help insurance companies cover losses if they had a high proportion of really sick, expensive patients. Insurers didn’t know who was going to sign up for their plans, and basically had to guess how sick they would be and how much care they would need, then factor that into their premium rates.\u003c/p>\n\u003cp>Through the reinsurance program, all health plans paid into a shared pool, then those funds were distributed to companies that ended up with more high-cost patients. This meant plans didn’t have to make up losses by increasing premiums the following year. But that protection expires this year, adding a 4 to 7 percent increase to consumers’ monthly premiums in 2017, according to\u003ca href=\"http://www.actuary.org/content/drivers-2017-health-insurance-premium-changes-0\" target=\"_blank\"> an analysis\u003c/a> of the American Academy of Actuaries.\u003c/p>\n\u003cp>Another program, \"risk corridors,\" which is designed to protect consumers against excessive premium increases, also expires this year.\u003c/p>\n\u003cp>\u003cstrong>Three: People May Be Gaming the System\u003c/strong>\u003c/p>\n\u003cp>Most people buy their insurance during the set enrollment period starting in the fall. But people who lose their coverage during the year because they lose a job, get divorced or move (among other eligibility criteria) are able to buy a plan through Covered California outside normal enrollment periods.\u003c/p>\n\u003cp>But insurers are noticing that these customers have medical costs that are 25 to 40 percent higher than the rest of the health care population, said Bacchi.\u003c/p>\n\u003cp>Are people taking advantage of the system, signing up for coverage not because they had a qualifying change in life circumstances, but because they got sick? Or is it that sicker people are more motivated to look for ways to stay insured after they lose coverage through work or a divorce?\u003c/p>\n\u003cp>\u003cstrong>Californians May Be Better Off\u003c/strong>\u003c/p>\n\u003cp>Despite all these factors, state officials and the insurance industry say Californians are still better off than consumers in most other states. Peter Lee emphasized that Covered California is an “active purchaser,” meaning it negotiates with plans when they set their prices.\u003c/p>\n\u003cp>“Covered California does not negotiate by table-pounding, but rather by providing good data on the risk mix of who is enrolled and working the health plans to garner maximum enrollment,” Lee said in his remarks before Congress. “In 2015, we provided data that proved Covered California enrollees were healthier and presented less risk to insurance companies than anticipated, which helped drive down the cost of health premiums.”\u003c/p>\n\u003cp>Bacchi said consumers here also have more choice.\u003c/p>\n\u003cp>“We have a highly competitive health care market, with 11 health plans in Covered California duking it out over price and quality and in most of the regions of the state,” said Bacchi.\u003c/p>\n\u003cp>Health advocates say consumers should take advantage of that by shopping around for a better deal. So even if the average premium increases 8 to 12 percent, that doesn't mean every single plan jumped that much.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If you’re in a Blue Shield plan in your region, it may be that there’s another health plan that’s the best deal for you for 2017,” said Wright of Health Access. \"The good thing about the Affordable Care Act is customers are not locked out because of a pre-existing condition. But they’re not locked in either. They can shop around for price.”\u003c/p>\n\n",
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"excerpt": "Officials with Covered California released proposed 2017 rates Tuesday, and the average increase was much higher than last year's. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update: 2:30 p.m.\u003c/strong>\u003c/p>\n\u003cp>Covered California, the state's Obamacare marketplace, released proposed 2017 premiums Tuesday morning, and the average statewide increase will be 13.2 percent, more than triple the increase seen each of the last two years.\u003c/p>\n\u003cp>Peter Lee, the agency's executive director, cited several factors as drivers in this year's spike.\u003c/p>\n\u003cp>Most notable is an expiring federal \"reinsurance\" program, created as part of the Affordable Care Act, to spread the risk of so many newly insured people entering the risk pool. Actuarial experts estimate that alone adds 4 to 7 percent to premiums, but it's viewed as a one-time effect.\u003c/p>\n\u003cp>Rising health care costs, including specialty prescription drugs, are also a factor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lee stressed that most people could reduce their own individual increase by shopping around.\u003c/p>\n\u003cp>\"Almost 80 percent of our customers could either pay less than they are paying today or pay no more than [a] 5 percent increase,\" Lee said, if they comparison shop.\u003c/p>\n\u003cp>Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation, agreed there may be \"deals to be had.\"\u003c/p>\n\u003cp>“The market is still working much better in California than in most other states,\" he said. \"It’s quite competitive in giving consumers a large number of choices.\"\u003c/p>\n\u003cp>About 1.4 million Californians purchase their health insurance through the Covered California exchange.\u003c/p>\n\u003cp>Blue Shield and Anthem Blue Cross customers will face the steepest increases. They have about \"a quarter of the market each,\" Lee said. Anthem customers will see a statewide average increase of 16 percent, and Blue Shield is \"above 19 percent,\" Lee said.\u003c/p>\n\u003cp>In the Bay Area, those increases will be even steeper for Anthem and Blue Shield customers. Meanwhile, the average monthly premium hike for Kaiser members will be in the 5-6 percent range across much of the region.\u003c/p>\n\u003cp>\"We are committed to offering stable rates over the long term,\" said Bill Wehrle, a vice president at Kaiser Permanente, \"and are uniquely positioned to deliver more affordable health care coverage.\" He cited investments in technology and Kaiser's \"emphasis on wellness\" as factors keeping premium increases lower.\u003c/p>\n\u003cp>Here are some of the proposed rate increases for major plans in several Bay Area counties:\u003c/p>\n\u003cp>\u003cstrong>San Francisco\u003c/strong>\u003cbr>\nAverage increase: 14.8 percent\u003c/p>\n\u003cp>Kaiser: 5.3 percent\u003cbr>\nAnthem Blue Cross: 16.7 percent\u003cbr>\nBlue Shield: 24.2 percent\u003c/p>\n\u003cp>\u003cstrong>Contra Costa County\u003c/strong>\u003cbr>\nAverage increase: 13.6 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross: 22.6 percent\u003cbr>\nBlue Shield: 24.4 percent\u003c/p>\n\u003cp>\u003cstrong>Alameda County\u003c/strong>\u003cbr>\nAverage increase: 12.3 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross: 23.7 percent\u003cbr>\nBlue Shield: 18.9 percent\u003c/p>\n\u003cp>\u003cstrong>Santa Clara\u003c/strong>\u003cbr>\nAverage increase: 9.2 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross (EPO): 8.4 percent\u003cbr>\nBlue Shield: 22.3 percent\u003c/p>\n\u003cp>You can look up the proposed rate for your plan in your specific area by checking Covered California's \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA-2017-rate-booklet.pdf\" target=\"_blank\">rate booklet.\u003c/a>\u003c/p>\n\u003cp>The rates are not yet final. State regulators will review them in the coming weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>California's Obamacare customers can expect a hefty increase in their monthly health insurance premiums next year. Covered California will announce new 2017 rates Tuesday morning for people who buy their plan through the state marketplace, and experts are predicting that increases will be double or even triple what they were last year.\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/274403157&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/274403157'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“2017 is going to be a transition year,” said Peter Lee, executive director of Covered California, testifying before Congress last week. “We expect our rates to be higher than we saw in our first two years.”\u003c/p>\n\u003cp>In \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/07/31/californias-2015-obamacare-premiums-will-increase-modestly/\" target=\"_blank\">2015\u003c/a> and \u003ca href=\"https://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\" target=\"_blank\">2016\u003c/a>, marketplace premiums increased an average of 4 percent -- a rate celebrated by consumer advocates as “modest,” even “\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\">terrific\u003c/a>.”\u003c/p>\n\u003cp>Covered California’s proposed budget for 2017, released in May, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/05/11/californias-obamacare-premiums-may-rise-8-percent-next-year/\" target=\"_blank\">projected average rate increases of 8 percent\u003c/a>. Industry insiders are suggesting the average jump could be even higher.\u003c/p>\n\u003cp>There are three key reasons why.\u003c/p>\n\u003cp>\u003cstrong>One: Medical Costs are Up\u003c/strong>\u003c/p>\n\u003cp>Insurance companies say premium prices are going up because medical costs are going up. Doctors, hospitals, labs and pharmaceutical companies are all raising their prices.\u003c/p>\n\u003cp>“Unquestionably, runaway drug prices remain a serious problem,” said Charles Bacchi, president and CEO of the California Association of Health Plans, a trade group for insurers. “We’re seeing new drugs coming out with blockbuster prices, and we’ve seen drugs that have been around for 30 years double and triple in price for no reason.”\u003c/p>\n\u003cp>Northern Californians have felt the burden of higher medical costs more so than people in Southern California because the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">hospital market is more consolidated\u003c/a>, giving hospitals more bargaining power with insurers.\u003c/p>\n\u003cp>Early rate filings from other states indicate rising medical costs could contribute to premium increases anywhere from 3 to 9 percent.\u003c/p>\n\u003cp>California regulators will have a chance to review the proposed rate increases, and consumer advocacy groups say they look forward to participating in the process by challenging some of the assumptions health plans have made about costs.\u003c/p>\n\u003cp>\"To the extent insurers are booking a certain amount of medical inflation to prescription drugs, are they overestimating those costs?\" said Anthony Wright, executive director of Health Access. \"Is that a scapegoat or a true driver?*\u003c/p>\n\u003cp>\u003cstrong>Two: Federal Protections are Expiring\u003c/strong>\u003c/p>\n\u003cp>The Affordable Care Act established a “reinsurance” program that was designed to help insurance companies cover losses if they had a high proportion of really sick, expensive patients. Insurers didn’t know who was going to sign up for their plans, and basically had to guess how sick they would be and how much care they would need, then factor that into their premium rates.\u003c/p>\n\u003cp>Through the reinsurance program, all health plans paid into a shared pool, then those funds were distributed to companies that ended up with more high-cost patients. This meant plans didn’t have to make up losses by increasing premiums the following year. But that protection expires this year, adding a 4 to 7 percent increase to consumers’ monthly premiums in 2017, according to\u003ca href=\"http://www.actuary.org/content/drivers-2017-health-insurance-premium-changes-0\" target=\"_blank\"> an analysis\u003c/a> of the American Academy of Actuaries.\u003c/p>\n\u003cp>Another program, \"risk corridors,\" which is designed to protect consumers against excessive premium increases, also expires this year.\u003c/p>\n\u003cp>\u003cstrong>Three: People May Be Gaming the System\u003c/strong>\u003c/p>\n\u003cp>Most people buy their insurance during the set enrollment period starting in the fall. But people who lose their coverage during the year because they lose a job, get divorced or move (among other eligibility criteria) are able to buy a plan through Covered California outside normal enrollment periods.\u003c/p>\n\u003cp>But insurers are noticing that these customers have medical costs that are 25 to 40 percent higher than the rest of the health care population, said Bacchi.\u003c/p>\n\u003cp>Are people taking advantage of the system, signing up for coverage not because they had a qualifying change in life circumstances, but because they got sick? Or is it that sicker people are more motivated to look for ways to stay insured after they lose coverage through work or a divorce?\u003c/p>\n\u003cp>\u003cstrong>Californians May Be Better Off\u003c/strong>\u003c/p>\n\u003cp>Despite all these factors, state officials and the insurance industry say Californians are still better off than consumers in most other states. Peter Lee emphasized that Covered California is an “active purchaser,” meaning it negotiates with plans when they set their prices.\u003c/p>\n\u003cp>“Covered California does not negotiate by table-pounding, but rather by providing good data on the risk mix of who is enrolled and working the health plans to garner maximum enrollment,” Lee said in his remarks before Congress. “In 2015, we provided data that proved Covered California enrollees were healthier and presented less risk to insurance companies than anticipated, which helped drive down the cost of health premiums.”\u003c/p>\n\u003cp>Bacchi said consumers here also have more choice.\u003c/p>\n\u003cp>“We have a highly competitive health care market, with 11 health plans in Covered California duking it out over price and quality and in most of the regions of the state,” said Bacchi.\u003c/p>\n\u003cp>Health advocates say consumers should take advantage of that by shopping around for a better deal. So even if the average premium increases 8 to 12 percent, that doesn't mean every single plan jumped that much.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If you’re in a Blue Shield plan in your region, it may be that there’s another health plan that’s the best deal for you for 2017,” said Wright of Health Access. \"The good thing about the Affordable Care Act is customers are not locked out because of a pre-existing condition. But they’re not locked in either. They can shop around for price.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Single Mom's Search for Therapist Foiled by Insurance Companies",
"title": "Single Mom's Search for Therapist Foiled by Insurance Companies",
"headTitle": "State of Mind | State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span> 12-year-old boy named Strazh hangs from the monkey bars, staring at the ground. The other kids in the park aren’t interested in him. And he’s not interested in them.\u003c/p>\n\u003cp>“I just like to play by myself,” he says.\u003c/p>\n\u003cp>Strazh has autism. Today is a good day. But on most others, Strazh has meltdowns. Something frustrates him and he can’t control his emotions.\u003c/p>\n\u003cp>“I sometimes end up screaming,” he says. “And I end up yelling and screaming.”\u003c/p>\n\u003cp>And hitting and banging things, throwing things, adds Strazh’s mom, Natalie Dunnege. As a single parent, she says she bears the brunt of it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“He told me that I disgusted him,” she says softly. “He tells me he hates me.”\u003c/p>\n\u003cp>Dunnege puts all her spare money into therapy for Strazh. She says it helps a lot. But Dunnege herself is struggling, feeling depressed and overwhelmed. She decided to look for her own therapist.\u003c/p>\n\u003cp>“One of the things that I’ve really had to wrap my head around is that I can’t change him. I can only change how I handle the situation,” she explains. “And not that I would want to change who he is. He’s a really good kid, but it’s a lot to handle, especially as a single parent.”\u003c/p>\n\u003cp>But when she logged onto her insurance website to find a therapist, she realized her copay for a mental health visit was going to be upwards of $75 – more than double her copay for other doctors’ appointments. Under a 2008 federal mental health law, those copays are supposed to be the same.\u003c/p>\n\u003cp>“There’s no way,” Dunnege says. “It’s out of my budget right now.”\u003c/p>\n\u003cfigure id=\"attachment_186111\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-186111\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/1010622-e1463762466497.jpg\" alt=\"Natalie Dunnege and her son, Strazh.\" width=\"1920\" height=\"1280\">\u003cfigcaption class=\"wp-caption-text\">Natalie Dunnege and her son, Strazh. \u003ccite>(Sheraz Sadiq/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dunnege lives in a one-bedroom apartment with her son and her father in San Francisco's Haight district. Grandfather and grandson sleep in twin beds side by side. It’s an awkward walk past those beds to the only bathroom. Dunnege says $75 a week for therapy is impossible.\u003c/p>\n\u003cp>“My income, I just made lower middle income. Just by the skin of my teeth,” she says. “So I just have to hold off until I’m actually middle class.”\u003c/p>\n\u003cp>More than 43 million Americans suffer from depression, anxiety and other mental health conditions, according to the most recent \u003ca href=\"http://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm\" target=\"_blank\" rel=\"noopener noreferrer\">federal data\u003c/a>. But more than half the people who felt like they needed help last year, never got it. Even people who had insurance complained of barriers to care. Some said they still couldn't afford it; some were embarrassed to ask for help. Others just couldn't get through \u003ca href=\"http://www.nap.edu/catalog/23442/ending-discrimination-against-people-with-mental-and-substance-use-disorders\" target=\"_blank\" rel=\"noopener noreferrer\">the red tape\u003c/a>.\u003c/p>\n\u003cp>Recent health laws, the 2008 Mental Health Parity Act and the Affordable Care Act, were supposed to fix this. They require health plans to provide benefits for mental health conditions on par with physical health conditions. Under the law, insurance companies can’t charge higher copays or set up separate deductibles for mental health care compared to other medical or surgical care. They can’t limit hospital stays or require preauthorization for mental health treatment if the same limits are not applied to treatment for physical health conditions.\u003c/p>\n\u003cp>But advocates say insurance companies are still finding ways to keep people who need care from getting it. Some are still not complying with the law. And some have found subtle, technically legally, ways to limit treatment.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/265497893\" 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>\u003cstrong>Problems with Mental Health Provider Directories\u003c/strong>\u003c/p>\n\u003cp>Natalie Dunnege encountered some of these barriers when she tried again to find a therapist. In the last year, she got a promotion at work and moved into a larger apartment. Her employer switched to a better health plan, too. Now she has Blue Shield coverage, and her copay for mental health appointments is only $20.\u003c/p>\n\u003cp>\"Which I was really excited about,\" Dunnege says.\u003c/p>\n\u003cp>But when she looked for a therapist who took her insurance, she struck out.\u003c/p>\n\u003cp>“I contacted six or seven,” she says.\u003c/p>\n\u003cp>Only three called her back.\u003c/p>\n\u003cp>“One of them, they were completely booked,” she says. “And then the other two just didn’t accept the insurance anymore.”\u003c/p>\n\u003cp>Zero hits out of seven. Had to be a bad draw, right?\u003c/p>\n\u003cp>To find out, we decided to conduct our own survey and called all the psychologists -- 100 in total -- that were listed on the Blue Shield website for Natalie’s plan in San Francisco.\u003c/p>\n\u003cp>Here's what happened:\u003c/p>\n\u003cfigure id=\"attachment_186898\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg\">\u003cimg class=\"wp-image-186898 size-full\" title=\"Blue Shield In-Network Psychologists\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg\" alt=\"mentalHealthTreatmentPost\" width=\"1920\" height=\"2055\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-400x428.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-800x856.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-768x822.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-1440x1541.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-1180x1263.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-960x1028.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lisa Pickoff-White/KQED \u003ccite>(Lisa Pickoff-White/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The end result: 28 psychologists actually had appointments. And only eight of them had slots available outside regular work hours. Eight out of 100.\u003c/p>\n\u003cp>“Sorry, I wish you the best of luck,” was a common refrain in therapists’ voicemail messages.\u003c/p>\n\u003cp>For Natalie Dunnege, after seven rejections, she gave up looking.\u003c/p>\n\u003cp>\"It's hard when you're feeling sad and you feel like you can barely keep things together,” she says. “It just seemed like way too much at the time.”\u003c/p>\n\u003cp>Mental health advocates say this is exactly what insurance companies are hoping.\u003c/p>\n\u003cp>“It’s a way to control cost,” says Keith Humphreys, a Stanford psychiatry professor who served as an advisor to Congress when it was developing the 2008 Mental Health Parity Act. He says while insurers are now required to keep an adequate number of clinicians listed in their directories, they still find ways to sidestep the rules.\u003c/p>\n\u003cp>[contextly_sidebar id=\"KbISjuBjk7yP8P3jc2UosQlAqr1b85dD\"]“You know the law doesn't say you can't put people on there who are dead, or you can't put people on there who are not taking new patients,” he says. “What that translates into, then, is people have to wait longer for care, which then cuts expenditures for the insurer and reduces access.”\u003c/p>\n\u003cp>California passed a law last year, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137\" target=\"_blank\" rel=\"noopener noreferrer\">SB 137\u003c/a>, raising the standards for physician directories. Insurers will have to police their lists for providers who are booked or retired. But a lot of questions remain about how the law will be enforced, especially when it comes to mental health providers, who are largely self-employed, solo practitioners.\u003c/p>\n\u003cp>The insurance industry says it will be a challenge.\u003c/p>\n\u003cp>“When you have networks as large as ours and you have as many enrollees as we have here in California, you're not going to be able to just have everything accurate every single second of every single day,” says Charles Bacchi, CEO of the California Association of Health Plans.\u003c/p>\n\u003cp>He said the industry is working to make it better.\u003c/p>\n\u003cp>“But we also need to be realistic,” he says. “We don't run a mental health provider's office. They do. And how they handle people calling their offices is their job.”\u003c/p>\n\u003cp>In a statement, Blue Shield said it tries to make it easy for providers to update changes in their contact information and schedule.\u003c/p>\n\u003cp>“We understand that there are a number of issues that impact a provider's availability to take new patients, such as administrative limitations and fluctuating numbers of patients based on their individual needs. When those instances arise, the provider is required to notify us so that patients have access to the most up-to-date information about who is available in their area.\"\u003c/p>\n\u003cp>The industry also says it’s facing another challenge: a nationwide shortage of mental health providers, further exacerbated by the millions of people who signed up for insurance under the Affordable Care Act.\u003c/p>\n\u003cp>In California, there are \"around 4 to 5 million more people with coverage, just in the last two years,” Bacchi says. “And that’s creating a strain for everybody, plans and mental health providers.”\u003c/p>\n\u003cp>But is it really just a supply and demand problem? Is it that there aren’t enough therapists, or is it that there aren’t enough therapists who are willing to work under the terms and rates set by the insurance companies?\u003c/p>\n\u003cp>\u003cem>This story was originally published on May 23, 2016. The video will be broadcast on KQED Newsroom July 15, 2016. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span> 12-year-old boy named Strazh hangs from the monkey bars, staring at the ground. The other kids in the park aren’t interested in him. And he’s not interested in them.\u003c/p>\n\u003cp>“I just like to play by myself,” he says.\u003c/p>\n\u003cp>Strazh has autism. Today is a good day. But on most others, Strazh has meltdowns. Something frustrates him and he can’t control his emotions.\u003c/p>\n\u003cp>“I sometimes end up screaming,” he says. “And I end up yelling and screaming.”\u003c/p>\n\u003cp>And hitting and banging things, throwing things, adds Strazh’s mom, Natalie Dunnege. As a single parent, she says she bears the brunt of it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“He told me that I disgusted him,” she says softly. “He tells me he hates me.”\u003c/p>\n\u003cp>Dunnege puts all her spare money into therapy for Strazh. She says it helps a lot. But Dunnege herself is struggling, feeling depressed and overwhelmed. She decided to look for her own therapist.\u003c/p>\n\u003cp>“One of the things that I’ve really had to wrap my head around is that I can’t change him. I can only change how I handle the situation,” she explains. “And not that I would want to change who he is. He’s a really good kid, but it’s a lot to handle, especially as a single parent.”\u003c/p>\n\u003cp>But when she logged onto her insurance website to find a therapist, she realized her copay for a mental health visit was going to be upwards of $75 – more than double her copay for other doctors’ appointments. Under a 2008 federal mental health law, those copays are supposed to be the same.\u003c/p>\n\u003cp>“There’s no way,” Dunnege says. “It’s out of my budget right now.”\u003c/p>\n\u003cfigure id=\"attachment_186111\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-186111\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/1010622-e1463762466497.jpg\" alt=\"Natalie Dunnege and her son, Strazh.\" width=\"1920\" height=\"1280\">\u003cfigcaption class=\"wp-caption-text\">Natalie Dunnege and her son, Strazh. \u003ccite>(Sheraz Sadiq/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dunnege lives in a one-bedroom apartment with her son and her father in San Francisco's Haight district. Grandfather and grandson sleep in twin beds side by side. It’s an awkward walk past those beds to the only bathroom. Dunnege says $75 a week for therapy is impossible.\u003c/p>\n\u003cp>“My income, I just made lower middle income. Just by the skin of my teeth,” she says. “So I just have to hold off until I’m actually middle class.”\u003c/p>\n\u003cp>More than 43 million Americans suffer from depression, anxiety and other mental health conditions, according to the most recent \u003ca href=\"http://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm\" target=\"_blank\" rel=\"noopener noreferrer\">federal data\u003c/a>. But more than half the people who felt like they needed help last year, never got it. Even people who had insurance complained of barriers to care. Some said they still couldn't afford it; some were embarrassed to ask for help. Others just couldn't get through \u003ca href=\"http://www.nap.edu/catalog/23442/ending-discrimination-against-people-with-mental-and-substance-use-disorders\" target=\"_blank\" rel=\"noopener noreferrer\">the red tape\u003c/a>.\u003c/p>\n\u003cp>Recent health laws, the 2008 Mental Health Parity Act and the Affordable Care Act, were supposed to fix this. They require health plans to provide benefits for mental health conditions on par with physical health conditions. Under the law, insurance companies can’t charge higher copays or set up separate deductibles for mental health care compared to other medical or surgical care. They can’t limit hospital stays or require preauthorization for mental health treatment if the same limits are not applied to treatment for physical health conditions.\u003c/p>\n\u003cp>But advocates say insurance companies are still finding ways to keep people who need care from getting it. Some are still not complying with the law. And some have found subtle, technically legally, ways to limit treatment.\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/265497893&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/265497893'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Problems with Mental Health Provider Directories\u003c/strong>\u003c/p>\n\u003cp>Natalie Dunnege encountered some of these barriers when she tried again to find a therapist. In the last year, she got a promotion at work and moved into a larger apartment. Her employer switched to a better health plan, too. Now she has Blue Shield coverage, and her copay for mental health appointments is only $20.\u003c/p>\n\u003cp>\"Which I was really excited about,\" Dunnege says.\u003c/p>\n\u003cp>But when she looked for a therapist who took her insurance, she struck out.\u003c/p>\n\u003cp>“I contacted six or seven,” she says.\u003c/p>\n\u003cp>Only three called her back.\u003c/p>\n\u003cp>“One of them, they were completely booked,” she says. “And then the other two just didn’t accept the insurance anymore.”\u003c/p>\n\u003cp>Zero hits out of seven. Had to be a bad draw, right?\u003c/p>\n\u003cp>To find out, we decided to conduct our own survey and called all the psychologists -- 100 in total -- that were listed on the Blue Shield website for Natalie’s plan in San Francisco.\u003c/p>\n\u003cp>Here's what happened:\u003c/p>\n\u003cfigure id=\"attachment_186898\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg\">\u003cimg class=\"wp-image-186898 size-full\" title=\"Blue Shield In-Network Psychologists\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg\" alt=\"mentalHealthTreatmentPost\" width=\"1920\" height=\"2055\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-400x428.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-800x856.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-768x822.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-1440x1541.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-1180x1263.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-960x1028.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lisa Pickoff-White/KQED \u003ccite>(Lisa Pickoff-White/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The end result: 28 psychologists actually had appointments. And only eight of them had slots available outside regular work hours. Eight out of 100.\u003c/p>\n\u003cp>“Sorry, I wish you the best of luck,” was a common refrain in therapists’ voicemail messages.\u003c/p>\n\u003cp>For Natalie Dunnege, after seven rejections, she gave up looking.\u003c/p>\n\u003cp>\"It's hard when you're feeling sad and you feel like you can barely keep things together,” she says. “It just seemed like way too much at the time.”\u003c/p>\n\u003cp>Mental health advocates say this is exactly what insurance companies are hoping.\u003c/p>\n\u003cp>“It’s a way to control cost,” says Keith Humphreys, a Stanford psychiatry professor who served as an advisor to Congress when it was developing the 2008 Mental Health Parity Act. He says while insurers are now required to keep an adequate number of clinicians listed in their directories, they still find ways to sidestep the rules.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“You know the law doesn't say you can't put people on there who are dead, or you can't put people on there who are not taking new patients,” he says. “What that translates into, then, is people have to wait longer for care, which then cuts expenditures for the insurer and reduces access.”\u003c/p>\n\u003cp>California passed a law last year, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137\" target=\"_blank\" rel=\"noopener noreferrer\">SB 137\u003c/a>, raising the standards for physician directories. Insurers will have to police their lists for providers who are booked or retired. But a lot of questions remain about how the law will be enforced, especially when it comes to mental health providers, who are largely self-employed, solo practitioners.\u003c/p>\n\u003cp>The insurance industry says it will be a challenge.\u003c/p>\n\u003cp>“When you have networks as large as ours and you have as many enrollees as we have here in California, you're not going to be able to just have everything accurate every single second of every single day,” says Charles Bacchi, CEO of the California Association of Health Plans.\u003c/p>\n\u003cp>He said the industry is working to make it better.\u003c/p>\n\u003cp>“But we also need to be realistic,” he says. “We don't run a mental health provider's office. They do. And how they handle people calling their offices is their job.”\u003c/p>\n\u003cp>In a statement, Blue Shield said it tries to make it easy for providers to update changes in their contact information and schedule.\u003c/p>\n\u003cp>“We understand that there are a number of issues that impact a provider's availability to take new patients, such as administrative limitations and fluctuating numbers of patients based on their individual needs. When those instances arise, the provider is required to notify us so that patients have access to the most up-to-date information about who is available in their area.\"\u003c/p>\n\u003cp>The industry also says it’s facing another challenge: a nationwide shortage of mental health providers, further exacerbated by the millions of people who signed up for insurance under the Affordable Care Act.\u003c/p>\n\u003cp>In California, there are \"around 4 to 5 million more people with coverage, just in the last two years,” Bacchi says. “And that’s creating a strain for everybody, plans and mental health providers.”\u003c/p>\n\u003cp>But is it really just a supply and demand problem? Is it that there aren’t enough therapists, or is it that there aren’t enough therapists who are willing to work under the terms and rates set by the insurance companies?\u003c/p>\n\u003cp>\u003cem>This story was originally published on May 23, 2016. The video will be broadcast on KQED Newsroom July 15, 2016. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "In Conversation with the Head of California's Physician Lobby",
"title": "In Conversation with the Head of California's Physician Lobby",
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"content": "\u003cp>The \u003ca href=\"http://www.cmanet.org/\" target=\"_blank\">\u003cu>California Medical Association\u003c/u>\u003c/a>, which represents about 41,000 doctors, has been at the heart of health care deliberations in Sacramento for decades. This year, it has staked out strong and sometimes surprising positions on the legalization of marijuana, Medi-Cal provider rates and the role it believes nurse practitioners should play in patient care.\u003c/p>\n\u003caside class=\"pullquote alignright\">One in three Californians is now on Medi-Cal. That is the public option. It needs to be funded. Right now, they’re funding it through discounts to physicians.\u003ccite>Steven Larson, California Medical Association president \u003c/cite>\u003c/aside>\n\u003cp>\u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">\u003cu>California Healthline\u003c/u>\u003c/a> discussed these positions with current CMA president, \u003ca href=\"http://www.cmanet.org/about/cma-governance/cma-executive-committee/steven-larson-md/\" target=\"_blank\">\u003cu>Steven Larson\u003c/u>\u003c/a>, a primary care and infectious disease physician who practices in Riverside. Larson is also CEO of Riverside Medical Clinic, a multispecialty medical group.\u003c/p>\n\u003cp>Among Larson’s points is that his organization — which has long battled the state over low Medi-Cal reimbursement rates for doctors — is now taking its fight to the people. Medi-Cal is the state’s Medicaid program for low-income residents. It provides coverage to more than 13 million people, and the rates California pays to participating physicians are among the lowest in the country.\u003c/p>\n\u003cp>Larson said the CMA is looking to the state’s initiative process for relief. Proposition 56, a proposed cigarette tax, and Proposition 55, an extension of the Proposition 30 income tax increases that voters approved in 2012, \u003ca href=\"http://www.sos.ca.gov/administration/news-releases-and-advisories/2016-news-releases-and-advisories/proposition-numbers-november-ballot-measures/\" target=\"_blank\">\u003cu>are both on the November ballot\u003c/u>\u003c/a>. If they pass, they’re expected to provide some money for Medi-Cal services.\u003c/p>\n\u003cp>“We have to do it on our own because the state government is not very sympathetic,” Larson said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Q: With roughly 80 percent of Medi-Cal enrollees now in managed care and that number rising, shouldn’t your argument that payments to doctors are too low be addressed to private insurance companies instead of the stat\u003c/strong>e?\u003c/p>\n\u003cp>The managed care reimbursement to Medi-Cal providers is much lower than commercial rates. Just being in managed care doesn’t mean the rates are competitive with commercial rates. Not only are they not competitive, they are not sustainable for most practices.\u003c/p>\n\u003cp>Right now these patients are disadvantaged. If you have cancer in Medi-Cal, you do no better than if you have no insurance at all. That was \u003ca href=\"http://www.latimes.com/local/california/la-me-cancer-disparities-20151119-story.html\" target=\"_blank\">\u003cu>in the Los Angeles Times recently\u003c/u>\u003c/a>. I think that’s true. They have no access.\u003c/p>\n\u003cp>\u003ca href=\"http://www.bayareaeconomy.org/files/pdf/MainstreamingMedi-Cal.pdf\" target=\"_blank\">\u003cu>California is 47th out of 50 states\u003c/u>\u003c/a> in Medicaid payments to physicians. That includes managed care.\u003c/p>\n\u003cp>What we’re doing now is hoping to create revenue through taxation that’s directed to Medi-Cal rates. The cigarette tax initiative and perhaps some of the Proposition 30 extension monies might go toward propping up Medi-Cal rates.\u003c/p>\n\u003cp>\u003cstrong>Q: You’re saying that the CMA is using the ballot process to try to increase payments to doctors because its efforts through the Legislature have failed?\u003c/strong>\u003c/p>\n\u003cp>Absolutely. We have decided we have to do it on our own because the state government is not very sympathetic. We’ve gone to them many times and it doesn’t seem to matter.\u003c/p>\n\u003cp>The idea is that the citizens of California with Medi-Cal have no access because of low reimbursement rates to doctors.\u003c/p>\n\u003cp>One in three Californians is now on Medi-Cal. That is the public option. It needs to be funded. Right now, they’re funding it through discounts to physicians. And now they have added undocumented children to full Medi-Cal coverage.\u003c/p>\n\u003cp>\u003cstrong>Q: If these ballot initiatives pass and there’s more funding for Medi-Cal, how should it be distributed?\u003c/strong>\u003c/p>\n\u003cp>We hope the money flows through the system, both in managed care and fee-for-service.\u003c/p>\n\u003cp>You have to understand the managed care plans pay primary care physicians a capitated, per member, per month rate. They pay specialists the Medi-Cal fee-for-service rates.\u003c/p>\n\u003cp>An office visit for Medi-Cal is about $16. That’s for a primary care visit and a follow-up visit for a specialist. That’s what I pay for a haircut. There’s something wrong about that.\u003c/p>\n\u003cp>\u003cstrong>Q: You mentioned that immigrant children without papers can now get full Medi-Cal. Should adult immigrants who are here without proper documentation also get it?\u003c/strong>\u003c/p>\n\u003cp>We don’t have an official CMA policy on that. We do have a policy that states that all people who reside in the state should have insurance coverage. I certainly think we should expand Medi-Cal to all individuals that can’t afford health insurance through other means. That’s my personal belief, not the CMA position.\u003c/p>\n\u003cp>\u003cstrong>Q: The CMA says it \u003ca href=\"http://www.cmanet.org/news/press-detail/?article=ca-medical-association-announces-support-for\" target=\"_blank\">\u003cu>does not “encourage the use of marijuana and discourages smoking\u003c/u>\u003c/a>.” Yet it supports an initiative on the November ballot to \u003ca href=\"https://ballotpedia.org/California_Marijuana_Legalization_Initiative,_Proposition_64_(2016)\" target=\"_blank\">\u003cu>legalize marijuana\u003c/u>\u003c/a>. Why?\u003c/strong>\u003c/p>\n\u003cp>It sounds like a high-wire act. In reality, we suspect that marijuana may have some beneficial medical effects and it’s difficult to research those in the current climate.\u003c/p>\n\u003cp>We also know that marijuana is harmful to developing brains. We want to avoid it getting into the hands of adolescents. Our understanding is that it’s easier for high school kids to get marijuana than tobacco or alcohol. It shouldn’t be… If we could regulate marijuana, then we would hope it would be less available to adolescents. The black market will dry up.\u003c/p>\n\u003cp>\u003cstrong>Q: Isn’t there a risk that making it legal will create an industry with marketing clout similar to tobacco or unhealthy foods, thus increasing consumption?\u003c/strong>\u003c/p>\n\u003cp>We’re very concerned about that. We oppose smoking marijuana or ingesting marijuana for nonmedicinal reasons. But we’re not so naïve to think it’s not going to happen.\u003c/p>\n\u003cp>Right now, medicinal marijuana is terribly abused and misused and puts physicians in the middle. I’m a practicing physician and some patients inappropriately want a diagnosis to obtain marijuana.\u003c/p>\n\u003cp>The harm reduction in adolescents outweighs the risk. Some adults who smoke it already will continue to smoke it. I don’t think a lot of adults will go out and start smoking.\u003c/p>\n\u003cp>\u003cstrong>Q: A proposed law to allow nurse practitioners more independence in treating patients \u003ca href=\"http://californiahealthline.org/news/california-nurse-practitioners-lose-battle-for-independent-practice-again/\" target=\"_blank\">\u003cu>failed in the Legislature again this year\u003c/u>\u003c/a>. You opposed it. Why not allow it, particularly in the Medi-Cal population, thus making care more available?\u003c/strong>\u003c/p>\n\u003cp>Many of our practices, including my own, have nurse practitioners. We do not feel they should practice independently. If we allow them to practice medicine, they should have the same standards that physicians have. They should be licensed by the Medical Board. They should have the same liability and educational requirements.\u003c/p>\n\u003cp>Yes, nurse practitioners could help us treat diabetes, hypertension, obesity and many common diseases. It’s the uncommon diseases they haven’t been trained to treat, or even identify. When a person is going to a practice for a diagnosis, they need to go to a diagnostician, which would be a physician, not a nurse practitioner.\u003c/p>\n\u003cp>There’s no reason why we can’t expand access just because they require supervision. They can help with telehealth. Let’s say they’re in a remote location and through telehealth they communicate with a physician who oversees the patient’s history and lab studies. We think the supervision safeguards the public.\u003c/p>\n\u003cp>\u003cstrong>Q: Some other states already have given nurse practitioners more authority. Have there been problems there?\u003c/strong>\u003c/p>\n\u003cp>In other states that have allowed it, there are very few nurse practitioners that are practicing independently. For the most part, they recognize their liabilities and deficiencies. They want to practice in the same desirable locations that physicians do. So they frequently don’t go to areas of shortages and treat Medicaid patients, which is the rationale they’re giving for their scope-of-practice expansion [in California].\u003c/p>\n\u003cp>\u003cstrong>Q: How would you respond to people who say doctors oppose expanding scope of practice for nurse practitioners because they don’t want to see prices for their services suppressed by an influx of new providers?\u003c/strong>\u003c/p>\n\u003cp>That’s simply not true. Show me a state where they have had an influx of unsupervised nurse practitioners where the prices have dropped.\u003c/p>\n\u003cp>Having additional providers does not decrease the cost of care. It increases the cost of care. Tests cost money. The less trained an individual is, the more ancillary tests they’ll order.\u003c/p>\n\u003cp>\u003cstrong>Q: On the cost of prescription drugs, why support Sen. Ed Hernandez’s \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB1010\" target=\"_blank\">\u003cu>drug transparency bill\u003c/u>\u003c/a> yet fight \u003ca href=\"https://ballotpedia.org/California_Proposition_61,_Drug_Price_Standards_Initiative_(2016)\" target=\"_blank\">\u003cu>the initiative that will be on the November ballot\u003c/u>\u003c/a> to regulate the price that state agencies pay for drugs?\u003c/strong>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The reason we oppose the [ballot] initiative is we believe it is poorly written. We think it’s cumbersome to tie drug costs to [Department of Veterans Affairs] drug pricing. It will probably result in drug shortages for California and it will inhibit innovation.\u003c/p>\n\n",
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"excerpt": "For starters, Steven Larson explains why it's time to go straight to voters with ballot measures aimed at increasing how much Medi-Cal pays physicians.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The \u003ca href=\"http://www.cmanet.org/\" target=\"_blank\">\u003cu>California Medical Association\u003c/u>\u003c/a>, which represents about 41,000 doctors, has been at the heart of health care deliberations in Sacramento for decades. This year, it has staked out strong and sometimes surprising positions on the legalization of marijuana, Medi-Cal provider rates and the role it believes nurse practitioners should play in patient care.\u003c/p>\n\u003caside class=\"pullquote alignright\">One in three Californians is now on Medi-Cal. That is the public option. It needs to be funded. Right now, they’re funding it through discounts to physicians.\u003ccite>Steven Larson, California Medical Association president \u003c/cite>\u003c/aside>\n\u003cp>\u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">\u003cu>California Healthline\u003c/u>\u003c/a> discussed these positions with current CMA president, \u003ca href=\"http://www.cmanet.org/about/cma-governance/cma-executive-committee/steven-larson-md/\" target=\"_blank\">\u003cu>Steven Larson\u003c/u>\u003c/a>, a primary care and infectious disease physician who practices in Riverside. Larson is also CEO of Riverside Medical Clinic, a multispecialty medical group.\u003c/p>\n\u003cp>Among Larson’s points is that his organization — which has long battled the state over low Medi-Cal reimbursement rates for doctors — is now taking its fight to the people. Medi-Cal is the state’s Medicaid program for low-income residents. It provides coverage to more than 13 million people, and the rates California pays to participating physicians are among the lowest in the country.\u003c/p>\n\u003cp>Larson said the CMA is looking to the state’s initiative process for relief. Proposition 56, a proposed cigarette tax, and Proposition 55, an extension of the Proposition 30 income tax increases that voters approved in 2012, \u003ca href=\"http://www.sos.ca.gov/administration/news-releases-and-advisories/2016-news-releases-and-advisories/proposition-numbers-november-ballot-measures/\" target=\"_blank\">\u003cu>are both on the November ballot\u003c/u>\u003c/a>. If they pass, they’re expected to provide some money for Medi-Cal services.\u003c/p>\n\u003cp>“We have to do it on our own because the state government is not very sympathetic,” Larson said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Q: With roughly 80 percent of Medi-Cal enrollees now in managed care and that number rising, shouldn’t your argument that payments to doctors are too low be addressed to private insurance companies instead of the stat\u003c/strong>e?\u003c/p>\n\u003cp>The managed care reimbursement to Medi-Cal providers is much lower than commercial rates. Just being in managed care doesn’t mean the rates are competitive with commercial rates. Not only are they not competitive, they are not sustainable for most practices.\u003c/p>\n\u003cp>Right now these patients are disadvantaged. If you have cancer in Medi-Cal, you do no better than if you have no insurance at all. That was \u003ca href=\"http://www.latimes.com/local/california/la-me-cancer-disparities-20151119-story.html\" target=\"_blank\">\u003cu>in the Los Angeles Times recently\u003c/u>\u003c/a>. I think that’s true. They have no access.\u003c/p>\n\u003cp>\u003ca href=\"http://www.bayareaeconomy.org/files/pdf/MainstreamingMedi-Cal.pdf\" target=\"_blank\">\u003cu>California is 47th out of 50 states\u003c/u>\u003c/a> in Medicaid payments to physicians. That includes managed care.\u003c/p>\n\u003cp>What we’re doing now is hoping to create revenue through taxation that’s directed to Medi-Cal rates. The cigarette tax initiative and perhaps some of the Proposition 30 extension monies might go toward propping up Medi-Cal rates.\u003c/p>\n\u003cp>\u003cstrong>Q: You’re saying that the CMA is using the ballot process to try to increase payments to doctors because its efforts through the Legislature have failed?\u003c/strong>\u003c/p>\n\u003cp>Absolutely. We have decided we have to do it on our own because the state government is not very sympathetic. We’ve gone to them many times and it doesn’t seem to matter.\u003c/p>\n\u003cp>The idea is that the citizens of California with Medi-Cal have no access because of low reimbursement rates to doctors.\u003c/p>\n\u003cp>One in three Californians is now on Medi-Cal. That is the public option. It needs to be funded. Right now, they’re funding it through discounts to physicians. And now they have added undocumented children to full Medi-Cal coverage.\u003c/p>\n\u003cp>\u003cstrong>Q: If these ballot initiatives pass and there’s more funding for Medi-Cal, how should it be distributed?\u003c/strong>\u003c/p>\n\u003cp>We hope the money flows through the system, both in managed care and fee-for-service.\u003c/p>\n\u003cp>You have to understand the managed care plans pay primary care physicians a capitated, per member, per month rate. They pay specialists the Medi-Cal fee-for-service rates.\u003c/p>\n\u003cp>An office visit for Medi-Cal is about $16. That’s for a primary care visit and a follow-up visit for a specialist. That’s what I pay for a haircut. There’s something wrong about that.\u003c/p>\n\u003cp>\u003cstrong>Q: You mentioned that immigrant children without papers can now get full Medi-Cal. Should adult immigrants who are here without proper documentation also get it?\u003c/strong>\u003c/p>\n\u003cp>We don’t have an official CMA policy on that. We do have a policy that states that all people who reside in the state should have insurance coverage. I certainly think we should expand Medi-Cal to all individuals that can’t afford health insurance through other means. That’s my personal belief, not the CMA position.\u003c/p>\n\u003cp>\u003cstrong>Q: The CMA says it \u003ca href=\"http://www.cmanet.org/news/press-detail/?article=ca-medical-association-announces-support-for\" target=\"_blank\">\u003cu>does not “encourage the use of marijuana and discourages smoking\u003c/u>\u003c/a>.” Yet it supports an initiative on the November ballot to \u003ca href=\"https://ballotpedia.org/California_Marijuana_Legalization_Initiative,_Proposition_64_(2016)\" target=\"_blank\">\u003cu>legalize marijuana\u003c/u>\u003c/a>. Why?\u003c/strong>\u003c/p>\n\u003cp>It sounds like a high-wire act. In reality, we suspect that marijuana may have some beneficial medical effects and it’s difficult to research those in the current climate.\u003c/p>\n\u003cp>We also know that marijuana is harmful to developing brains. We want to avoid it getting into the hands of adolescents. Our understanding is that it’s easier for high school kids to get marijuana than tobacco or alcohol. It shouldn’t be… If we could regulate marijuana, then we would hope it would be less available to adolescents. The black market will dry up.\u003c/p>\n\u003cp>\u003cstrong>Q: Isn’t there a risk that making it legal will create an industry with marketing clout similar to tobacco or unhealthy foods, thus increasing consumption?\u003c/strong>\u003c/p>\n\u003cp>We’re very concerned about that. We oppose smoking marijuana or ingesting marijuana for nonmedicinal reasons. But we’re not so naïve to think it’s not going to happen.\u003c/p>\n\u003cp>Right now, medicinal marijuana is terribly abused and misused and puts physicians in the middle. I’m a practicing physician and some patients inappropriately want a diagnosis to obtain marijuana.\u003c/p>\n\u003cp>The harm reduction in adolescents outweighs the risk. Some adults who smoke it already will continue to smoke it. I don’t think a lot of adults will go out and start smoking.\u003c/p>\n\u003cp>\u003cstrong>Q: A proposed law to allow nurse practitioners more independence in treating patients \u003ca href=\"http://californiahealthline.org/news/california-nurse-practitioners-lose-battle-for-independent-practice-again/\" target=\"_blank\">\u003cu>failed in the Legislature again this year\u003c/u>\u003c/a>. You opposed it. Why not allow it, particularly in the Medi-Cal population, thus making care more available?\u003c/strong>\u003c/p>\n\u003cp>Many of our practices, including my own, have nurse practitioners. We do not feel they should practice independently. If we allow them to practice medicine, they should have the same standards that physicians have. They should be licensed by the Medical Board. They should have the same liability and educational requirements.\u003c/p>\n\u003cp>Yes, nurse practitioners could help us treat diabetes, hypertension, obesity and many common diseases. It’s the uncommon diseases they haven’t been trained to treat, or even identify. When a person is going to a practice for a diagnosis, they need to go to a diagnostician, which would be a physician, not a nurse practitioner.\u003c/p>\n\u003cp>There’s no reason why we can’t expand access just because they require supervision. They can help with telehealth. Let’s say they’re in a remote location and through telehealth they communicate with a physician who oversees the patient’s history and lab studies. We think the supervision safeguards the public.\u003c/p>\n\u003cp>\u003cstrong>Q: Some other states already have given nurse practitioners more authority. Have there been problems there?\u003c/strong>\u003c/p>\n\u003cp>In other states that have allowed it, there are very few nurse practitioners that are practicing independently. For the most part, they recognize their liabilities and deficiencies. They want to practice in the same desirable locations that physicians do. So they frequently don’t go to areas of shortages and treat Medicaid patients, which is the rationale they’re giving for their scope-of-practice expansion [in California].\u003c/p>\n\u003cp>\u003cstrong>Q: How would you respond to people who say doctors oppose expanding scope of practice for nurse practitioners because they don’t want to see prices for their services suppressed by an influx of new providers?\u003c/strong>\u003c/p>\n\u003cp>That’s simply not true. Show me a state where they have had an influx of unsupervised nurse practitioners where the prices have dropped.\u003c/p>\n\u003cp>Having additional providers does not decrease the cost of care. It increases the cost of care. Tests cost money. The less trained an individual is, the more ancillary tests they’ll order.\u003c/p>\n\u003cp>\u003cstrong>Q: On the cost of prescription drugs, why support Sen. Ed Hernandez’s \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB1010\" target=\"_blank\">\u003cu>drug transparency bill\u003c/u>\u003c/a> yet fight \u003ca href=\"https://ballotpedia.org/California_Proposition_61,_Drug_Price_Standards_Initiative_(2016)\" target=\"_blank\">\u003cu>the initiative that will be on the November ballot\u003c/u>\u003c/a> to regulate the price that state agencies pay for drugs?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The reason we oppose the [ballot] initiative is we believe it is poorly written. We think it’s cumbersome to tie drug costs to [Department of Veterans Affairs] drug pricing. It will probably result in drug shortages for California and it will inhibit innovation.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Northern California Has Highest Costs in the U.S. to Deliver a Baby",
"title": "Northern California Has Highest Costs in the U.S. to Deliver a Baby",
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"content": "\u003cp>Sacramento and the San Francisco Bay Area ranked as the most expensive places to have a baby of 30 major metropolitan regions in the U.S. according to \u003ca href=\"http://www.castlighthealth.com/press-releases/new-study-shows-huge-cost-differences-for-having-a-baby-often-in-the-same-city/\" target=\"_blank\">an analysis\u003c/a> released Thursday.\u003c/p>\n\u003cp>Sacramento came in first (congrats to you) where a vaginal birth cost $15,420 on average. The San Francisco Bay Area was a close second at $15,204. Minneapolis trailed in third place by almost $4,000, coming in at $11,527, and the least expensive of the 30 largest metropolitan areas surveyed was Kansas City, Missouri, where a vaginal delivery costs an avery $6,075.\u003c/p>\n\u003cp>These are \"routine vaginal deliveries,\" folks. Again, those are \"average\" costs. We'll get to the variation within regions further down.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206296\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/VaginalRoutine-e1467324299747.jpg\" alt=\"VaginalRoutine\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>The numbers were crunched by San Francisco-based Castlight, a health care information company. They looked at medical claims data as well as other information. Since Castlight primarily works with self-insured large companies, it says the costs it crunched include both the employee's out-of-pocket costs and what the employer paid for the delivery.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Birth by Cesarean section typically cost more than vaginal deliveries and did in this survey as well. Sacramento was first at $27,067; the Bay Area was second at $21,799. Portland, Oregon trailed in third at $18,066. The least expensive of the metropolitan areas was Pittsburgh, Penn. at $6,891.\u003c/p>\n\u003cp>Here's the national C-section map:\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206320\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/top_30_cities_delivery_maps_csection-e1467325171879.jpg\" alt=\"top_30_cities_delivery_maps_csection\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>But Castlight didn't actually stop at the 30 biggest metropolitan areas. They surveyed 190 areas across the country, including 13 in California.\u003c/p>\n\u003cp>While Sacramento and the Bay Area are the most expensive major regions to have a baby, other, smaller, California cities rank even higher.\u003c/p>\n\u003cp>Here's the list for routine vaginal deliveries in California:\u003c/p>\n\u003cp>Merced $19,191\u003cbr>\nSalinas $17,772\u003cbr>\nSacramento-Yolo $15,420\u003cbr>\nSF-Oakland-San Jose $15,204\u003cbr>\nStockton-Lodi $13,972\u003cbr>\nSan Luis Obispo-Atascadero-Paso Robles $13,926\u003cbr>\nSanta Barbara-Santa Maria-Lompoc $12,219\u003cbr>\nBakersfield $11,055\u003cbr>\nLos Angeles-Riverside-Orange $10,285\u003cbr>\nModesto $9,903\u003cbr>\nSan Diego $9,709\u003cbr>\nChico-Paradise $7,839\u003cbr>\nFresno $7,278\u003c/p>\n\u003cp>In addition to the cost difference between areas, there's tremendous cost variation within regions, too. In the Bay Area, the range for a vaginal delivery is $7,700 to $28,000, a four-fold difference. In Sacramento, it's $4,560 to $24,549, a five-fold difference.\u003c/p>\n\u003cp>Feeling ill yet?\u003c/p>\n\u003cp>If you're wondering why this happens, Kristin Torres Mowat, senior vice president at Castlight, chalked it up to the \"obscure, dysfunctional and inefficient health care market.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"smGr7FZlFDM9IcWYJVq0A3jdEsPJrPIH\"]In Northern California, consolidation on the provider side -- both doctors and hospitals -- helps them to wield market power and drive up costs.\u003c/p>\n\u003cp>The most recent evidence came earlier this month \u003ca href=\"http://inq.sagepub.com/content/53/0046958016651555.full\" target=\"_blank\">in a study\u003c/a> from USC health economists who pointed, again, to the market power of Sutter Health and Dignity Health.\u003c/p>\n\u003cp>\"Over time, they have acquired physician practices, outpatient clinics, hospitals and have a disproportionate share in the market,\" Mowat said.\u003c/p>\n\u003cp>(Disclaimer that data from Kaiser Permanente was not included in the USC study.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mowat advised that consumers ask for an estimate of costs early in their pregnancy, but that estimate is not always easy to get.\u003c/p>\n\n",
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"excerpt": "A new analysis finds that the Bay Area and Sacramento are the two most expensive places in 30 major metropolitan areas nationwide to give birth.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sacramento and the San Francisco Bay Area ranked as the most expensive places to have a baby of 30 major metropolitan regions in the U.S. according to \u003ca href=\"http://www.castlighthealth.com/press-releases/new-study-shows-huge-cost-differences-for-having-a-baby-often-in-the-same-city/\" target=\"_blank\">an analysis\u003c/a> released Thursday.\u003c/p>\n\u003cp>Sacramento came in first (congrats to you) where a vaginal birth cost $15,420 on average. The San Francisco Bay Area was a close second at $15,204. Minneapolis trailed in third place by almost $4,000, coming in at $11,527, and the least expensive of the 30 largest metropolitan areas surveyed was Kansas City, Missouri, where a vaginal delivery costs an avery $6,075.\u003c/p>\n\u003cp>These are \"routine vaginal deliveries,\" folks. Again, those are \"average\" costs. We'll get to the variation within regions further down.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206296\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/VaginalRoutine-e1467324299747.jpg\" alt=\"VaginalRoutine\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>The numbers were crunched by San Francisco-based Castlight, a health care information company. They looked at medical claims data as well as other information. Since Castlight primarily works with self-insured large companies, it says the costs it crunched include both the employee's out-of-pocket costs and what the employer paid for the delivery.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Birth by Cesarean section typically cost more than vaginal deliveries and did in this survey as well. Sacramento was first at $27,067; the Bay Area was second at $21,799. Portland, Oregon trailed in third at $18,066. The least expensive of the metropolitan areas was Pittsburgh, Penn. at $6,891.\u003c/p>\n\u003cp>Here's the national C-section map:\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206320\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/top_30_cities_delivery_maps_csection-e1467325171879.jpg\" alt=\"top_30_cities_delivery_maps_csection\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>But Castlight didn't actually stop at the 30 biggest metropolitan areas. They surveyed 190 areas across the country, including 13 in California.\u003c/p>\n\u003cp>While Sacramento and the Bay Area are the most expensive major regions to have a baby, other, smaller, California cities rank even higher.\u003c/p>\n\u003cp>Here's the list for routine vaginal deliveries in California:\u003c/p>\n\u003cp>Merced $19,191\u003cbr>\nSalinas $17,772\u003cbr>\nSacramento-Yolo $15,420\u003cbr>\nSF-Oakland-San Jose $15,204\u003cbr>\nStockton-Lodi $13,972\u003cbr>\nSan Luis Obispo-Atascadero-Paso Robles $13,926\u003cbr>\nSanta Barbara-Santa Maria-Lompoc $12,219\u003cbr>\nBakersfield $11,055\u003cbr>\nLos Angeles-Riverside-Orange $10,285\u003cbr>\nModesto $9,903\u003cbr>\nSan Diego $9,709\u003cbr>\nChico-Paradise $7,839\u003cbr>\nFresno $7,278\u003c/p>\n\u003cp>In addition to the cost difference between areas, there's tremendous cost variation within regions, too. In the Bay Area, the range for a vaginal delivery is $7,700 to $28,000, a four-fold difference. In Sacramento, it's $4,560 to $24,549, a five-fold difference.\u003c/p>\n\u003cp>Feeling ill yet?\u003c/p>\n\u003cp>If you're wondering why this happens, Kristin Torres Mowat, senior vice president at Castlight, chalked it up to the \"obscure, dysfunctional and inefficient health care market.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In Northern California, consolidation on the provider side -- both doctors and hospitals -- helps them to wield market power and drive up costs.\u003c/p>\n\u003cp>The most recent evidence came earlier this month \u003ca href=\"http://inq.sagepub.com/content/53/0046958016651555.full\" target=\"_blank\">in a study\u003c/a> from USC health economists who pointed, again, to the market power of Sutter Health and Dignity Health.\u003c/p>\n\u003cp>\"Over time, they have acquired physician practices, outpatient clinics, hospitals and have a disproportionate share in the market,\" Mowat said.\u003c/p>\n\u003cp>(Disclaimer that data from Kaiser Permanente was not included in the USC study.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mowat advised that consumers ask for an estimate of costs early in their pregnancy, but that estimate is not always easy to get.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.\u003c/p>\n\u003cp>\u003ca href=\"http://www.asanet.org/journals/JHSB/Jun16JHSBFeature.pdf\" target=\"_blank\">A new study \u003c/a>found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.\u003c/p>\n\u003cp>“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the \u003cem>Journal of Health and Social Behavior\u003c/em>.\u003c/p>\n\u003cp>In the study, she had voice actors call 320 psychotherapists in New York City.\u003c/p>\n\u003cp>All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.\u003c/p>\n\u003cp>“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”\u003c/p>\n\u003cp>For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”\u003c/p>\n\u003cp>While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”\u003c/p>\n\u003cp>Kugelmass said the overall response rate was low, which is similar to findings of a recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey\u003c/a> of San Francisco psychologists.\u003c/p>\n\u003cp>But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22121963\" target=\"_blank\">Previous research\u003c/a> has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. \u003ca href=\"http://psycnet.apa.org/psycinfo/1988-97772-005\" target=\"_blank\">Another study\u003c/a> found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.\u003c/p>\n\u003cp>Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.\u003c/p>\n\u003cp>“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can't relate to,” Kugelmass said.\u003c/p>\n\u003cp>The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.\u003c/p>\n\u003cp>Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.\u003c/p>\n\u003cp>“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”\u003c/p>\n\u003cp>She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>To read more about barriers to mental health care in California, check out KQED's series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/state-of-mind/\">State of Mind\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.\u003c/p>\n\u003cp>\u003ca href=\"http://www.asanet.org/journals/JHSB/Jun16JHSBFeature.pdf\" target=\"_blank\">A new study \u003c/a>found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.\u003c/p>\n\u003cp>“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the \u003cem>Journal of Health and Social Behavior\u003c/em>.\u003c/p>\n\u003cp>In the study, she had voice actors call 320 psychotherapists in New York City.\u003c/p>\n\u003cp>All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.\u003c/p>\n\u003cp>“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”\u003c/p>\n\u003cp>For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”\u003c/p>\n\u003cp>While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”\u003c/p>\n\u003cp>Kugelmass said the overall response rate was low, which is similar to findings of a recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey\u003c/a> of San Francisco psychologists.\u003c/p>\n\u003cp>But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22121963\" target=\"_blank\">Previous research\u003c/a> has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. \u003ca href=\"http://psycnet.apa.org/psycinfo/1988-97772-005\" target=\"_blank\">Another study\u003c/a> found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.\u003c/p>\n\u003cp>Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.\u003c/p>\n\u003cp>“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can't relate to,” Kugelmass said.\u003c/p>\n\u003cp>The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.\u003c/p>\n\u003cp>Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.\u003c/p>\n\u003cp>“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”\u003c/p>\n\u003cp>She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>To read more about barriers to mental health care in California, check out KQED's series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/state-of-mind/\">State of Mind\u003c/a>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Depressed Teen's Struggle to Find Mental Health Care in Rural California",
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"content": "\u003cp>There’s a hot pink suitcase on the floor of Shariah Vroman-Nagy’s bedroom. The 18-year-old is packing for a trip to Disneyland, one of several she takes with her family every year.\u003c/p>\n\u003cp>“Let’s see, I need a hairbrush,” she says, moving past the collection of Mickey Mouse ears on her dresser, glancing at the inspirational quotes from Marilyn Monroe on the wall.\u003c/p>\n\u003cp>The lyrics to a song called “\u003cem>Smile\u003c/em>” hang in a frame over her bed.\u003c/p>\n\u003cp>“My mom made me that when I was struggling,” says Vroman-Nagy, “because that’s the song that I would listen to. Michael Jackson did a version of it, which I love.”\u003c/p>\n\u003cp>When she feels her depression creeping in, she sings it to herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cem>Smile, though your heart is aching\u003c/em>\u003cbr>\n\u003cem>Smile, even though it’s breaking \u003c/em>\u003cbr>\n\u003cem>If you smile through your tears and sorrow\u003c/em>\u003cbr>\n\u003cem>Smile and maybe tomorrow \u003c/em>\u003cbr>\n\u003cem>You’ll see the sun come shining through, for you. \u003c/em>\u003c/p>\n\u003cp>Three years ago, it was in this room, lined with porcelain dolls and stuffed animals, where Vroman-Nagy tried to kill herself. She was 15, a freshman in high school.\u003c/p>\n\u003cp>“Everything piled up, piled up, piled up until I just couldn’t handle it anymore,” she says. “So I had my anti-depressants and I took a handful of those. But then I thought better of it, and I told my mom. She took me to the emergency room.”\u003c/p>\n\u003cfigure id=\"attachment_191785\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191785\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg\" alt=\"Shariah Vroman-Nagy in her bedroom in Redding, Calif. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy in her bedroom in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s no adolescent psychiatric hospital in Redding, the small city in far northern California where Vroman-Nagy lives. So she was taken from the local ER to a hospital in Sacramento, an hour and a half drive to the south. She was there for eight days.\u003c/p>\n\u003cp>The doctors diagnosed her with bipolar disorder. They wanted to keep her longer, but they told her the insurance company wouldn’t cover it.\u003c/p>\n\u003cp>“I didn’t feel like I was ready because I had just been put on new medications,” she says. “In the past I’ve had reactions to medications, and some have not worked. So I wanted to wait and stay for observation a little bit longer.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/266972349\" 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>Vroman-Nagy wasn’t alone with feeling that she was sent home too soon. Since 2010, the state received almost 900 appeals from patients saying their insurer unfairly denied inpatient mental health treatment, according to data from the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V04DLPkrKUl\">Department of Managed Health Care\u003c/a>, the main health insurance regulator in the state. The department overturned 47 percent of those decisions.\u003c/p>\n\u003cp>Insurers are allowed to deny coverage for certain treatments, if they determine that the care is not “medically necessary.” This determination is based on evidence-based clinical standards in both mental and medical care, but it has become a key battleground for mental health advocates.\u003c/p>\n\u003cp>They say insurers are able to \u003ca href=\"https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">deny mental health treatments\u003c/a> more often than other medical treatments, because it’s harder to prove when mental health care is medically necessary.\u003c/p>\n\u003cp>Determining the best treatment for depression, bipolar disorder, or anxiety disorders relies heavily on the subjective report of the patient, so it can be difficult to demonstrate how ill a person is.\u003c/p>\n\u003cp>“There aren’t blood tests in mental health, there aren’t X-rays in mental health,” says Keith Humphreys, Stanford psychiatrist and former White House advisor on mental health policy. “So, it’s easier to deny care for mental health than it is for things we've got physical evidence for.”\u003c/p>\n\u003cp>\u003cstrong>Outside the Hospital, Care Still Difficult to Find\u003c/strong>\u003c/p>\n\u003cp>After Vroman-Nagy went home, the hospital helped her find a therapist to continue the work she had begun on the inpatient unit. But the insurance company, Anthem Blue Cross, said no to that, too. They said the therapist wasn’t part of its network.\u003c/p>\n\u003cp>“We spent quite a long time with the insurance company battling them trying to get them to cover visits,” Vroman-Nagy says.\u003c/p>\n\u003cp>Anthem wanted her to see someone on its list of approved in-network providers, Vroman-Nagy says. At the time, that list was just six people, a common scarcity in \u003ca href=\"http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsacriteria.html\" target=\"_blank\">rural parts\u003c/a> of the country. When Vroman-Nagy started calling them, they either told her their schedules were full or they were retired. So Vroman-Nagy decided to stick with the out-of-network therapist.\u003c/p>\n\u003cfigure id=\"attachment_191782\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191782\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg\" alt=\"Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her father, Tom Nagy, supported the decision. “Because at that point, I’m mean you’re talking possible life and death issues,” he says. “That was my approach, to pay for it. Run up the charge cards.”\u003c/p>\n\u003cp>He ended up paying thousands of dollars out of pocket. Nagy is a teacher, and his wife is a nurse. They couldn’t afford to keep doing that.\u003c/p>\n\u003cp>By law in California, insurers are required to make special arrangements for patients to see an outside therapist if there are none in the plan, and they have to provide the care at the same copay or coinsurance as an in-network clinician. They can’t charge extra.\u003c/p>\n\u003cp>It’s unclear why Tom Nagy didn’t get that help. He had to fight and fight with the insurance company until he was finally reimbursed.\u003c/p>\n\u003cp>He went through \"two or three denials,\" then filed an appeal with Anthem. That was denied. So he filed a second appeal.\u003c/p>\n\u003cp>“It was literally a year-long process,” he says. \"As a parent, it’s hard enough to deal with these situations and be supportive, but then you get the whole financial thing, it just adds a whole other layer. It’s frustrating.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"X2OS9UvvrWrgYd3y51AcrwAvhclm8opt\"]Psychiatrist Keith Humphreys says it’s rare to see someone keep up a fight with an insurance company as long as Nagy did.\u003c/p>\n\u003cp>“It's the easiest fight in the world to win for an insurer,” Humphreys says.\u003c/p>\n\u003cp>Most people would have given up long before, he says. Take someone with depression who has trouble concentrating or can’t get out of bed.\u003c/p>\n\u003cp>“Now you're demanding that I fill out eight pages of forms?” Humphreys says. “It's canted heavily against the people wanting the services, by the nature of the condition.”\u003c/p>\n\u003cp>In a statement, Anthem Blue Cross said it is “committed to providing access to high quality and affordable health care, including mental healthcare.” It has a variety of resources to help people find the best provider for them, the statement continues, including an online listing of available mental health providers, and customer service staff who can help with a search.\u003c/p>\n\u003cp>The company also launched a new online psychology service earlier this year, called LiveHealth Online Psychology, so patients who live in rural areas where it can sometimes be hard to find a clinician, can “talk face-to-face with a licensed therapist or psychologist through high-definition video on your smartphone, tablet or computer with a webcam.\"\u003c/p>\n\u003cp>\u003cstrong>Looking Toward the Future\u003c/strong>\u003c/p>\n\u003cp>It’s Shariah Vroman-Nagy’s spring break from college, and the preparations for the family trip to Disneyland continue. She says she really needs the vacation.\u003c/p>\n\u003cp>“They call it the happiest place on earth, and I really do feel that it makes me happy when I go,” Vroman-Nagy says. “I’m glad we get to go this week because I have been having a little depression going on.”\u003c/p>\n\u003cp>She and her parents run some errands before they leave town, including a stop at Walmart to stock up on snacks for the nine-hour drive.\u003c/p>\n\u003cp>“I have a question,” Vroman-Nagy says to the cashier. “You used to have Mickey Mouse shaped cheese. Do you not carry it anymore?”\u003c/p>\n\u003cp>Instead, she got \u003cem>Frozen\u003c/em>-themed cheese sticks, with characters from the hit Disney film on the package. The radio in her car is primed with a series of Disney soundtracks, from \u003cem>Tarzan\u003c/em> to \u003cem>Beauty and the Beast\u003c/em>, songs which Vroman-Nagy knows well from her days singing with a show choir in high school.\u003c/p>\n\u003cp>Overall, Vroman-Nagy is doing much better. She works part time at the local In-N-Out Burger, and she’s training to volunteer for a suicide hotline. She’s also studying psychology and music at the local junior college.\u003c/p>\n\u003cp>She plans to become an adolescent therapist one day. But first, she’d like to be a character singer at Disneyland.\u003c/p>\n\u003cp>“I would love to be in their entertainment,” she says, and imagines herself in a princess costume singing and dancing in the park’s stage shows or parades. “That would be my dream.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Have a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There’s a hot pink suitcase on the floor of Shariah Vroman-Nagy’s bedroom. The 18-year-old is packing for a trip to Disneyland, one of several she takes with her family every year.\u003c/p>\n\u003cp>“Let’s see, I need a hairbrush,” she says, moving past the collection of Mickey Mouse ears on her dresser, glancing at the inspirational quotes from Marilyn Monroe on the wall.\u003c/p>\n\u003cp>The lyrics to a song called “\u003cem>Smile\u003c/em>” hang in a frame over her bed.\u003c/p>\n\u003cp>“My mom made me that when I was struggling,” says Vroman-Nagy, “because that’s the song that I would listen to. Michael Jackson did a version of it, which I love.”\u003c/p>\n\u003cp>When she feels her depression creeping in, she sings it to herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Smile, though your heart is aching\u003c/em>\u003cbr>\n\u003cem>Smile, even though it’s breaking \u003c/em>\u003cbr>\n\u003cem>If you smile through your tears and sorrow\u003c/em>\u003cbr>\n\u003cem>Smile and maybe tomorrow \u003c/em>\u003cbr>\n\u003cem>You’ll see the sun come shining through, for you. \u003c/em>\u003c/p>\n\u003cp>Three years ago, it was in this room, lined with porcelain dolls and stuffed animals, where Vroman-Nagy tried to kill herself. She was 15, a freshman in high school.\u003c/p>\n\u003cp>“Everything piled up, piled up, piled up until I just couldn’t handle it anymore,” she says. “So I had my anti-depressants and I took a handful of those. But then I thought better of it, and I told my mom. She took me to the emergency room.”\u003c/p>\n\u003cfigure id=\"attachment_191785\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191785\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg\" alt=\"Shariah Vroman-Nagy in her bedroom in Redding, Calif. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy in her bedroom in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s no adolescent psychiatric hospital in Redding, the small city in far northern California where Vroman-Nagy lives. So she was taken from the local ER to a hospital in Sacramento, an hour and a half drive to the south. She was there for eight days.\u003c/p>\n\u003cp>The doctors diagnosed her with bipolar disorder. They wanted to keep her longer, but they told her the insurance company wouldn’t cover it.\u003c/p>\n\u003cp>“I didn’t feel like I was ready because I had just been put on new medications,” she says. “In the past I’ve had reactions to medications, and some have not worked. So I wanted to wait and stay for observation a little bit longer.”\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/266972349&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/266972349'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Vroman-Nagy wasn’t alone with feeling that she was sent home too soon. Since 2010, the state received almost 900 appeals from patients saying their insurer unfairly denied inpatient mental health treatment, according to data from the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V04DLPkrKUl\">Department of Managed Health Care\u003c/a>, the main health insurance regulator in the state. The department overturned 47 percent of those decisions.\u003c/p>\n\u003cp>Insurers are allowed to deny coverage for certain treatments, if they determine that the care is not “medically necessary.” This determination is based on evidence-based clinical standards in both mental and medical care, but it has become a key battleground for mental health advocates.\u003c/p>\n\u003cp>They say insurers are able to \u003ca href=\"https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">deny mental health treatments\u003c/a> more often than other medical treatments, because it’s harder to prove when mental health care is medically necessary.\u003c/p>\n\u003cp>Determining the best treatment for depression, bipolar disorder, or anxiety disorders relies heavily on the subjective report of the patient, so it can be difficult to demonstrate how ill a person is.\u003c/p>\n\u003cp>“There aren’t blood tests in mental health, there aren’t X-rays in mental health,” says Keith Humphreys, Stanford psychiatrist and former White House advisor on mental health policy. “So, it’s easier to deny care for mental health than it is for things we've got physical evidence for.”\u003c/p>\n\u003cp>\u003cstrong>Outside the Hospital, Care Still Difficult to Find\u003c/strong>\u003c/p>\n\u003cp>After Vroman-Nagy went home, the hospital helped her find a therapist to continue the work she had begun on the inpatient unit. But the insurance company, Anthem Blue Cross, said no to that, too. They said the therapist wasn’t part of its network.\u003c/p>\n\u003cp>“We spent quite a long time with the insurance company battling them trying to get them to cover visits,” Vroman-Nagy says.\u003c/p>\n\u003cp>Anthem wanted her to see someone on its list of approved in-network providers, Vroman-Nagy says. At the time, that list was just six people, a common scarcity in \u003ca href=\"http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsacriteria.html\" target=\"_blank\">rural parts\u003c/a> of the country. When Vroman-Nagy started calling them, they either told her their schedules were full or they were retired. So Vroman-Nagy decided to stick with the out-of-network therapist.\u003c/p>\n\u003cfigure id=\"attachment_191782\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191782\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg\" alt=\"Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her father, Tom Nagy, supported the decision. “Because at that point, I’m mean you’re talking possible life and death issues,” he says. “That was my approach, to pay for it. Run up the charge cards.”\u003c/p>\n\u003cp>He ended up paying thousands of dollars out of pocket. Nagy is a teacher, and his wife is a nurse. They couldn’t afford to keep doing that.\u003c/p>\n\u003cp>By law in California, insurers are required to make special arrangements for patients to see an outside therapist if there are none in the plan, and they have to provide the care at the same copay or coinsurance as an in-network clinician. They can’t charge extra.\u003c/p>\n\u003cp>It’s unclear why Tom Nagy didn’t get that help. He had to fight and fight with the insurance company until he was finally reimbursed.\u003c/p>\n\u003cp>He went through \"two or three denials,\" then filed an appeal with Anthem. That was denied. So he filed a second appeal.\u003c/p>\n\u003cp>“It was literally a year-long process,” he says. \"As a parent, it’s hard enough to deal with these situations and be supportive, but then you get the whole financial thing, it just adds a whole other layer. It’s frustrating.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Psychiatrist Keith Humphreys says it’s rare to see someone keep up a fight with an insurance company as long as Nagy did.\u003c/p>\n\u003cp>“It's the easiest fight in the world to win for an insurer,” Humphreys says.\u003c/p>\n\u003cp>Most people would have given up long before, he says. Take someone with depression who has trouble concentrating or can’t get out of bed.\u003c/p>\n\u003cp>“Now you're demanding that I fill out eight pages of forms?” Humphreys says. “It's canted heavily against the people wanting the services, by the nature of the condition.”\u003c/p>\n\u003cp>In a statement, Anthem Blue Cross said it is “committed to providing access to high quality and affordable health care, including mental healthcare.” It has a variety of resources to help people find the best provider for them, the statement continues, including an online listing of available mental health providers, and customer service staff who can help with a search.\u003c/p>\n\u003cp>The company also launched a new online psychology service earlier this year, called LiveHealth Online Psychology, so patients who live in rural areas where it can sometimes be hard to find a clinician, can “talk face-to-face with a licensed therapist or psychologist through high-definition video on your smartphone, tablet or computer with a webcam.\"\u003c/p>\n\u003cp>\u003cstrong>Looking Toward the Future\u003c/strong>\u003c/p>\n\u003cp>It’s Shariah Vroman-Nagy’s spring break from college, and the preparations for the family trip to Disneyland continue. She says she really needs the vacation.\u003c/p>\n\u003cp>“They call it the happiest place on earth, and I really do feel that it makes me happy when I go,” Vroman-Nagy says. “I’m glad we get to go this week because I have been having a little depression going on.”\u003c/p>\n\u003cp>She and her parents run some errands before they leave town, including a stop at Walmart to stock up on snacks for the nine-hour drive.\u003c/p>\n\u003cp>“I have a question,” Vroman-Nagy says to the cashier. “You used to have Mickey Mouse shaped cheese. Do you not carry it anymore?”\u003c/p>\n\u003cp>Instead, she got \u003cem>Frozen\u003c/em>-themed cheese sticks, with characters from the hit Disney film on the package. The radio in her car is primed with a series of Disney soundtracks, from \u003cem>Tarzan\u003c/em> to \u003cem>Beauty and the Beast\u003c/em>, songs which Vroman-Nagy knows well from her days singing with a show choir in high school.\u003c/p>\n\u003cp>Overall, Vroman-Nagy is doing much better. She works part time at the local In-N-Out Burger, and she’s training to volunteer for a suicide hotline. She’s also studying psychology and music at the local junior college.\u003c/p>\n\u003cp>She plans to become an adolescent therapist one day. But first, she’d like to be a character singer at Disneyland.\u003c/p>\n\u003cp>“I would love to be in their entertainment,” she says, and imagines herself in a princess costume singing and dancing in the park’s stage shows or parades. “That would be my dream.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Have a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Assembly OKs Asking Feds to Allow Undocumented Immigrants Access to Covered California",
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"content": "\u003cp>The California Assembly approved a bill on Tuesday that would permit undocumented immigrants access to Covered California, the state's health insurance marketplace.\u003c/p>\n\u003cp>Under federal law undocumented immigrants are barred from any of the benefits of the Affordable Care Act.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">Senate Bill 10\u003c/a> would direct California to ask the federal government for a waiver that would permit undocumented immigrants the option to buy insurance on Covered California -- with their own money. It passed by a vote of 54-19.\u003c/p>\n\u003cp>California would be the first state to make such a request.\u003c/p>\n\u003cp>“This waiver will allow an estimated 390,000 immigrants who earn an income too high to qualify for Medi-Cal to purchase healthcare through the exchange under the Affordable Care Act,\" said Sen. Ricardo Lara, D-Bell Gardens, author of the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Undocumented immigrants would not be eligible for subsidies. If such a waiver were ultimately approved, families with mixed status -- where some family members are undocumented and some are lawfully present -- could all be on the same health insurance plan, potentially simplifying access to finding care.\u003c/p>\n\u003cp>Robin Hvidston, executive director of the Claremont-based group We the People Rising, a group which advocates for strict enforcement of immigration laws, criticized the measure last month in \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-undocumented-immigrant-health-insurance-20160414-story.html\" target=\"_blank\">an interview with the Los Angeles Times\u003c/a>.\u003c/p>\n\u003cp>“We oppose that [bill] because that encourages illegal immigration,” Hvidston said. “It sends a message to the world that if you come to our country you will be rewarded.”\u003c/p>\n\u003cp>A law permitting Medi-Cal coverage for undocumented children \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/13/undocumented-kids-soon-eligible-for-medi-cal/\" target=\"_blank\">went into effect earlier this month\u003c/a>. An estimated 170,000 children are expected to benefit at a cost to the state of $40 million this year and $132 million annually after that.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill goes back to the Senate this week for final approval before it can head to the governor's desk.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The California Assembly approved a bill on Tuesday that would permit undocumented immigrants access to Covered California, the state's health insurance marketplace.\u003c/p>\n\u003cp>Under federal law undocumented immigrants are barred from any of the benefits of the Affordable Care Act.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">Senate Bill 10\u003c/a> would direct California to ask the federal government for a waiver that would permit undocumented immigrants the option to buy insurance on Covered California -- with their own money. It passed by a vote of 54-19.\u003c/p>\n\u003cp>California would be the first state to make such a request.\u003c/p>\n\u003cp>“This waiver will allow an estimated 390,000 immigrants who earn an income too high to qualify for Medi-Cal to purchase healthcare through the exchange under the Affordable Care Act,\" said Sen. Ricardo Lara, D-Bell Gardens, author of the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Undocumented immigrants would not be eligible for subsidies. If such a waiver were ultimately approved, families with mixed status -- where some family members are undocumented and some are lawfully present -- could all be on the same health insurance plan, potentially simplifying access to finding care.\u003c/p>\n\u003cp>Robin Hvidston, executive director of the Claremont-based group We the People Rising, a group which advocates for strict enforcement of immigration laws, criticized the measure last month in \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-undocumented-immigrant-health-insurance-20160414-story.html\" target=\"_blank\">an interview with the Los Angeles Times\u003c/a>.\u003c/p>\n\u003cp>“We oppose that [bill] because that encourages illegal immigration,” Hvidston said. “It sends a message to the world that if you come to our country you will be rewarded.”\u003c/p>\n\u003cp>A law permitting Medi-Cal coverage for undocumented children \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/13/undocumented-kids-soon-eligible-for-medi-cal/\" target=\"_blank\">went into effect earlier this month\u003c/a>. An estimated 170,000 children are expected to benefit at a cost to the state of $40 million this year and $132 million annually after that.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill goes back to the Senate this week for final approval before it can head to the governor's desk.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "How Therapy Became A Hobby of the Wealthy – Rather Than A Necessity for the Mentally Ill",
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"content": "\u003cp>There’s something that really bothers Stanford psychiatry professor Keith Humphreys. When he thinks of all the years he spends training the next generation of psychiatrists, the enormous investment in medical school and residency, he wants them to devote that education to taking care of people with serious mental illness.\u003c/p>\n\u003cp>But many of them instead set up a private practice, where they can charge $400 an hour in cash to help people who Humphreys calls “the worried well” –- people who enjoy the self-exploration of therapy but do not necessarily have a mental health problem.\u003c/p>\n\u003cp>\"A minute I spend training that person is a minute of my life wasted,” Humphreys says. “That very well-trained person should be taking care of very, very troubled people. When they don’t, everyone who needs that care loses out.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'They’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.'\u003ccite>Keith Humphreys, Stanford Psychiatry Professor \u003c/cite>\u003c/aside>\n\u003cp>Humphreys says this trend of mental health clinicians shunning the health insurance industry and decamping to the cash market dates back 70 years, to the end of World War II.\u003c/p>\n\u003cp>In 1946, the majority of veterans cared for by what was then called the Veterans Administration were mental health patients, Humphreys says. But there weren’t enough mental health providers to take care of them. So the VA partnered with several medical schools, including Stanford where Humphreys teaches, to train mental health professionals.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Those schools started turning out hundreds and hundreds of psychologists a year. The expansion dovetailed with soaring American affluence -- and soaring American interest in self-exploration.\u003c/p>\n\u003cp>Having a psychoanalyst became \"a sort of status symbol,\" Humphreys says.\u003c/p>\n\u003cp>A lot of psychologists who were trained to work in the public sector saw a better financial opportunity and jumped ship. They hung shingles and started their own private practices where they could charge wealthy people much higher rates.\u003c/p>\n\u003cp>“When you put in a free market in a society where people were very interested in self-exploration, a lot of them went out and did their own thing,” Humphreys says.\u003c/p>\n\u003cfigure id=\"attachment_187932\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-187932\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/keithatDavos-400x225.jpg\" alt=\"Stanford psychiatry professor Keith Humphreys\" width=\"400\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-960x540.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Stanford psychiatry professor Keith Humphreys \u003ccite>(Courtesy: Keith Humphreys)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The reason this was possible is because of how the overall U.S. health care system was established, Humphreys says. Most people got their health insurance through work. Employers competed with each other for the best employees by offering better benefits.\u003c/p>\n\u003cp>So the standards for coverage developed over time in a piecemeal, haphazard way.\u003c/p>\n\u003cp>As health policy evolved, mental health benefits continuously lagged, Humphreys says. Coverage for mental health treatments or hospitalizations was meager or nonexistent.\u003c/p>\n\u003cp>“We don’t seem to have this problem with cardiology or oncology,” Humphreys says. “You don’t see people lining up to pay cash for those services because the benefits are so low.\"\u003c/p>\n\u003cp>This wouldn’t happen in places that have single-payer health systems, like Canada, Humphreys says, because all the health care payments are controlled by the government. Mental health care was baked into that system earlier on.\u003c/p>\n\u003cp>As a result, people in Canada with more severe mental illness are more likely to get services, according to \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199702203360806\" target=\"_blank\">a study\u003c/a> published in the New England Journal of Medicine.\u003c/p>\n\u003cp>That’s not the case in the U.S. People with less serious mental health conditions get more services here. Humphreys says it's mainly wealthy people who fall into the worried well category, who are consuming psychotherapy.\u003c/p>\n\u003cp>“If it’s a market where you pretty much have to pay for yourself, the rich are always going to win,” he says.\u003c/p>\n\u003cp>The growing workforce of psychiatrists, psychologists, marriage and family therapists, and licensed social workers has responded to that market demand.\u003c/p>\n\u003cp>And not just because it’s better money. Treating high-functioning professionals in a private office is a lot less stressful than doing rounds on a psychiatric ward of a public hospital.\u003c/p>\n\u003cp>“It’s understandable why someone would say this is really demanding,” Humphreys says. “For my own well-being or professional satisfaction, I’m going to stop doing this and move into doing outpatient psychotherapy with executives from Google who have angst. My salary goes up dramatically and my work is much, much easier.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"tU61AbaxNL1XAbjFbyvdGvgJyPnAKYCV\"]Especially in affluent places like the Bay Area, this creates a divide, a culture of mental health haves and have-nots. Mental health clinicians don’t need to participate in the health care system or take insurance to keep their schedules full -- making it harder and harder for people of lower income to find a therapist.\u003c/p>\n\u003cp>“That’s why you can have a lot of mental health professionals in an area, but still have a shortage of care for people in need,” Humphreys adds. “The person who’s hurt is the person who’s suicidal, maybe they’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.”\u003c/p>\n\u003cp>Mental health advocates have worked to shift this balance, passing the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act in 2010. Together, those laws require health plans to offer mental health coverage on par with other medical coverage.\u003c/p>\n\u003cp>But so far, it hasn’t put a dent in the cash market for mental health. Humphreys says given the nature of mental health care and the American obsession with self-improvement, the cash market will be here to stay.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Accessing mental health care is often pleasurable and enjoyable, and accessing a lot of other health care isn’t,” Humphreys says. “I mean, who goes to the dentist for fun?”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There’s something that really bothers Stanford psychiatry professor Keith Humphreys. When he thinks of all the years he spends training the next generation of psychiatrists, the enormous investment in medical school and residency, he wants them to devote that education to taking care of people with serious mental illness.\u003c/p>\n\u003cp>But many of them instead set up a private practice, where they can charge $400 an hour in cash to help people who Humphreys calls “the worried well” –- people who enjoy the self-exploration of therapy but do not necessarily have a mental health problem.\u003c/p>\n\u003cp>\"A minute I spend training that person is a minute of my life wasted,” Humphreys says. “That very well-trained person should be taking care of very, very troubled people. When they don’t, everyone who needs that care loses out.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'They’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.'\u003ccite>Keith Humphreys, Stanford Psychiatry Professor \u003c/cite>\u003c/aside>\n\u003cp>Humphreys says this trend of mental health clinicians shunning the health insurance industry and decamping to the cash market dates back 70 years, to the end of World War II.\u003c/p>\n\u003cp>In 1946, the majority of veterans cared for by what was then called the Veterans Administration were mental health patients, Humphreys says. But there weren’t enough mental health providers to take care of them. So the VA partnered with several medical schools, including Stanford where Humphreys teaches, to train mental health professionals.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Those schools started turning out hundreds and hundreds of psychologists a year. The expansion dovetailed with soaring American affluence -- and soaring American interest in self-exploration.\u003c/p>\n\u003cp>Having a psychoanalyst became \"a sort of status symbol,\" Humphreys says.\u003c/p>\n\u003cp>A lot of psychologists who were trained to work in the public sector saw a better financial opportunity and jumped ship. They hung shingles and started their own private practices where they could charge wealthy people much higher rates.\u003c/p>\n\u003cp>“When you put in a free market in a society where people were very interested in self-exploration, a lot of them went out and did their own thing,” Humphreys says.\u003c/p>\n\u003cfigure id=\"attachment_187932\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-187932\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/keithatDavos-400x225.jpg\" alt=\"Stanford psychiatry professor Keith Humphreys\" width=\"400\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-960x540.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Stanford psychiatry professor Keith Humphreys \u003ccite>(Courtesy: Keith Humphreys)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The reason this was possible is because of how the overall U.S. health care system was established, Humphreys says. Most people got their health insurance through work. Employers competed with each other for the best employees by offering better benefits.\u003c/p>\n\u003cp>So the standards for coverage developed over time in a piecemeal, haphazard way.\u003c/p>\n\u003cp>As health policy evolved, mental health benefits continuously lagged, Humphreys says. Coverage for mental health treatments or hospitalizations was meager or nonexistent.\u003c/p>\n\u003cp>“We don’t seem to have this problem with cardiology or oncology,” Humphreys says. “You don’t see people lining up to pay cash for those services because the benefits are so low.\"\u003c/p>\n\u003cp>This wouldn’t happen in places that have single-payer health systems, like Canada, Humphreys says, because all the health care payments are controlled by the government. Mental health care was baked into that system earlier on.\u003c/p>\n\u003cp>As a result, people in Canada with more severe mental illness are more likely to get services, according to \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199702203360806\" target=\"_blank\">a study\u003c/a> published in the New England Journal of Medicine.\u003c/p>\n\u003cp>That’s not the case in the U.S. People with less serious mental health conditions get more services here. Humphreys says it's mainly wealthy people who fall into the worried well category, who are consuming psychotherapy.\u003c/p>\n\u003cp>“If it’s a market where you pretty much have to pay for yourself, the rich are always going to win,” he says.\u003c/p>\n\u003cp>The growing workforce of psychiatrists, psychologists, marriage and family therapists, and licensed social workers has responded to that market demand.\u003c/p>\n\u003cp>And not just because it’s better money. Treating high-functioning professionals in a private office is a lot less stressful than doing rounds on a psychiatric ward of a public hospital.\u003c/p>\n\u003cp>“It’s understandable why someone would say this is really demanding,” Humphreys says. “For my own well-being or professional satisfaction, I’m going to stop doing this and move into doing outpatient psychotherapy with executives from Google who have angst. My salary goes up dramatically and my work is much, much easier.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Especially in affluent places like the Bay Area, this creates a divide, a culture of mental health haves and have-nots. Mental health clinicians don’t need to participate in the health care system or take insurance to keep their schedules full -- making it harder and harder for people of lower income to find a therapist.\u003c/p>\n\u003cp>“That’s why you can have a lot of mental health professionals in an area, but still have a shortage of care for people in need,” Humphreys adds. “The person who’s hurt is the person who’s suicidal, maybe they’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.”\u003c/p>\n\u003cp>Mental health advocates have worked to shift this balance, passing the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act in 2010. Together, those laws require health plans to offer mental health coverage on par with other medical coverage.\u003c/p>\n\u003cp>But so far, it hasn’t put a dent in the cash market for mental health. 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"content": "\u003cp>When San Francisco resident Natalie Dunnege needed a therapist, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">she couldn’t find one\u003c/a> who took her insurance.\u003c/p>\n\u003cp>“When I would call them they wouldn’t return my phone calls or they wouldn’t be accepting patients,” she says.\u003c/p>\n\u003cp>Insurance companies say there’s a shortage of therapists.\u003c/p>\n\u003cp>But it’s not that simple. Especially in urban areas, there are lots of therapists. They just don’t want to work with the insurance companies.\u003c/p>\n\u003cp>Take Michael Klein, a psychologist practicing in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“With the right kind of support, they blossom,” he says.\u003c/p>\n\u003cp>Klein doesn’t accept insurance -- and he’s far from alone. Nearly half of therapists in California don’t take insurance, according to a \u003ca href=\"http://www.camft.org/ias/images/PDFs/articles/mariam/2015_demographic_survey.pdf\" target=\"_blank\">recent survey\u003c/a> from the California Association of Marriage and Family Therapists. The same is true of \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967759/\">psychiatrists\u003c/a>. There are two reasons why, Klein says.\u003c/p>\n\u003caside class=\"pullquote alignright\">Insurance companies say there's a shortage of therapists, but therapists struggle to be accepted into a network.\u003c/aside>\n\u003cp>“One, because the reimbursement rates don’t provide a living wage,” Klein says. “You can’t own a home and drive a car and survive on what in-network providers pay you.”\u003c/p>\n\u003cp>Most insurance companies pay therapists in their networks between $60 and $80 per session. In the Bay Area and Los Angeles, therapists say the market rate for therapy is more like $150 or $200 a session.\u003c/p>\n\u003cp>“The second thing is the paperwork. For an hour of psychotherapy you spend a half hour of paperwork. So, I got into this field because I don’t like paper work,” Klein says with a laugh.\u003c/p>\n\u003cp>On that first point -- money -- insurance companies acknowledge that they may have to raise their rates to attract more therapists, particularly in rural areas. But they also say it’s on therapists to compromise.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/265685067\" 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>“I think it’s unrealistic to expect either the state of California taxpayers or for health plans to just pay providers whatever they ask to be paid,” says Charles Bacchi, CEO of the California Association of Health Plans, a trade group for the insurance industry.\u003c/p>\n\u003cp>“That's not sustainable,” he continues. “So you're either in the system, and you want to be part of our health care system. Or you want to do concierge service outside of it and just pretend our health care system doesn't exist. That's your choice as a provider. Our job is to find providers that are willing to be part of the solution and willing to provide coverage to those of low and moderate income.\"\u003c/p>\n\u003cp>That’s exactly how San Francisco psychologist Jonathan Horowitz feels. He wants to take insurance. But he’s hit roadblock after roadblock. He sent out 10 applications to insurance companies and got nowhere.\u003c/p>\n\u003cp>“I might knock on Cigna’s door and say, 'Hey are you guys accepting any new therapists in 94105?'” he says. “And they might say, 'No we’re not doing that. We’re totally full.'”\u003c/p>\n\u003cp>[contextly_sidebar id=\"eS6QVmoo2kjciQQ0tu4JO43ybZNtSzAw\"]\u003c/p>\n\u003cp>Six different companies told Horowitz their networks were full.\u003c/p>\n\u003cp>So even though a patient like Natalie Dunnege might call seven therapists in her insurance network and not be able to get an appointment, insurance companies are telling new and willing therapists that there’s no demand for them.\u003c/p>\n\u003cp>“I definitely think it’s to control costs,” Horowitz says. “That’s very clear.”\u003c/p>\n\u003cp>He tried for a year, and one company finally said yes. Sort of. Horowitz never got a formal notice saying his clinic was admitted to the network.\u003c/p>\n\u003cp>“It was just like, 'Oh wait, it looks like we’re suddenly getting a couple referrals from them. I wonder if we’re in their directory,'” he explains.\u003c/p>\n\u003cp>They were. Sort of. The clinic was listed in the directory. But the therapists who work at the clinic weren’t approved yet, meaning there was no one who was allowed to see the clients calling the clinic.\u003c/p>\n\u003cp>So Horowitz tried to call the insurance company to clear things up. He tried many, many times. Here’s what happened during his latest attempt to navigate the automated phone system:\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company automated attendant:\u003c/strong> First I’ll need your provider identification number. If you need a moment, say, hold on.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Hold on.\u003c/em>\u003c/p>\n\u003cp>Sound familiar? Turns out therapists get the automated run around as much as patients do. Horowitz persevered.\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Okay, please say or enter your pin.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> My pin? Is this my pin? (He enters a few numbers).\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> I’m sorry I couldn’t find an account using the info you gave me. Do you already belong to the network?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> I think so?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry, yes or no.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Um, I don’t know ... yes?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Alright. And have you already requested a credentialing application?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Yes.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry could you repeat that.\u003c/em>\u003c/p>\n\u003cp>These experiences did not bode well from Horowitz' perspective.\u003c/p>\n\u003cp>“Honestly, I got a really bad feeling about it,” he says.\u003c/p>\n\u003cp>He figured, if this is what it’s like just finding out if he’s in the network, how’s it going to be when he has a problem with a claim and can’t get paid?\u003c/p>\n\u003cp>“I could just see that getting out of hand really quickly,” he says. “So at that point we just said, do we really even want to do this?”\u003c/p>\n\u003cp>Not just that. The reimbursement rate was even lower than he expected, and the billing was so complicated that he was going to have to hire someone to do it. He says he couldn’t afford that.\u003c/p>\n\u003cp>“We made the decision that we’re just going to cancel the contract and continue to go with cash,” he says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Easier said than done. Horowitz hasn’t been able to get through to anyone on the phone to cancel the contract. In the meantime, prospective patients are finding his name on the directory and are calling for appointments. Horowitz says he just has to say no.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When San Francisco resident Natalie Dunnege needed a therapist, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">she couldn’t find one\u003c/a> who took her insurance.\u003c/p>\n\u003cp>“When I would call them they wouldn’t return my phone calls or they wouldn’t be accepting patients,” she says.\u003c/p>\n\u003cp>Insurance companies say there’s a shortage of therapists.\u003c/p>\n\u003cp>But it’s not that simple. Especially in urban areas, there are lots of therapists. They just don’t want to work with the insurance companies.\u003c/p>\n\u003cp>Take Michael Klein, a psychologist practicing in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“With the right kind of support, they blossom,” he says.\u003c/p>\n\u003cp>Klein doesn’t accept insurance -- and he’s far from alone. Nearly half of therapists in California don’t take insurance, according to a \u003ca href=\"http://www.camft.org/ias/images/PDFs/articles/mariam/2015_demographic_survey.pdf\" target=\"_blank\">recent survey\u003c/a> from the California Association of Marriage and Family Therapists. The same is true of \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967759/\">psychiatrists\u003c/a>. There are two reasons why, Klein says.\u003c/p>\n\u003caside class=\"pullquote alignright\">Insurance companies say there's a shortage of therapists, but therapists struggle to be accepted into a network.\u003c/aside>\n\u003cp>“One, because the reimbursement rates don’t provide a living wage,” Klein says. “You can’t own a home and drive a car and survive on what in-network providers pay you.”\u003c/p>\n\u003cp>Most insurance companies pay therapists in their networks between $60 and $80 per session. In the Bay Area and Los Angeles, therapists say the market rate for therapy is more like $150 or $200 a session.\u003c/p>\n\u003cp>“The second thing is the paperwork. For an hour of psychotherapy you spend a half hour of paperwork. So, I got into this field because I don’t like paper work,” Klein says with a laugh.\u003c/p>\n\u003cp>On that first point -- money -- insurance companies acknowledge that they may have to raise their rates to attract more therapists, particularly in rural areas. But they also say it’s on therapists to compromise.\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/265685067&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/265685067'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I think it’s unrealistic to expect either the state of California taxpayers or for health plans to just pay providers whatever they ask to be paid,” says Charles Bacchi, CEO of the California Association of Health Plans, a trade group for the insurance industry.\u003c/p>\n\u003cp>“That's not sustainable,” he continues. “So you're either in the system, and you want to be part of our health care system. Or you want to do concierge service outside of it and just pretend our health care system doesn't exist. That's your choice as a provider. Our job is to find providers that are willing to be part of the solution and willing to provide coverage to those of low and moderate income.\"\u003c/p>\n\u003cp>That’s exactly how San Francisco psychologist Jonathan Horowitz feels. He wants to take insurance. But he’s hit roadblock after roadblock. He sent out 10 applications to insurance companies and got nowhere.\u003c/p>\n\u003cp>“I might knock on Cigna’s door and say, 'Hey are you guys accepting any new therapists in 94105?'” he says. “And they might say, 'No we’re not doing that. We’re totally full.'”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Six different companies told Horowitz their networks were full.\u003c/p>\n\u003cp>So even though a patient like Natalie Dunnege might call seven therapists in her insurance network and not be able to get an appointment, insurance companies are telling new and willing therapists that there’s no demand for them.\u003c/p>\n\u003cp>“I definitely think it’s to control costs,” Horowitz says. “That’s very clear.”\u003c/p>\n\u003cp>He tried for a year, and one company finally said yes. Sort of. Horowitz never got a formal notice saying his clinic was admitted to the network.\u003c/p>\n\u003cp>“It was just like, 'Oh wait, it looks like we’re suddenly getting a couple referrals from them. I wonder if we’re in their directory,'” he explains.\u003c/p>\n\u003cp>They were. Sort of. The clinic was listed in the directory. 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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
"link": "/californiareportmagazine",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"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",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
"tagline": "Your irreverent guide to the trends redefining our world",
"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/02/CAT_2_Tile-scaled.jpg",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"code-switch-life-kit": {
"id": "code-switch-life-kit",
"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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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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},
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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.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"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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}
},
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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.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"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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"meta": {
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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",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"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",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"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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"link": "/radio/program/fresh-air",
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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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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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},
"here-and-now": {
"id": "here-and-now",
"title": "Here & Now",
"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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"rss": "https://feeds.npr.org/510051/podcast.xml"
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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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"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"rss": "https://feeds.npr.org/510308/podcast.xml"
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},
"how-i-built-this": {
"id": "how-i-built-this",
"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.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
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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",
"imageAlt": "KQED Hyphenación",
"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"source": "kqed",
"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"amazon": "https://music.amazon.com/podcasts/6c3dd23c-93fb-4aab-97ba-1725fa6315f1/hyphenaci%C3%B3n",
"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"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",
"imageAlt": "KQED The Political Mind of Jerry Brown",
"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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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/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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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"
}
},
"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)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"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",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
"spotify": "https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"
}
},
"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": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"spotify": "https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x",
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"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
"site": "news",
"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
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