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"content": "\u003cp>Have you ever gone in for a medical procedure you knew was covered by your health plan, only to be hit weeks later by a large, unexpected bill from a doctor whose name you didn’t even recognize?\u003c/p>\n\u003cp>If so, you’re not alone. More than one in five Californians with private health insurance reported receiving “surprise” medical bills at least once over the previous two years, according to a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\">2015 Consumer Reports survey\u003c/a>.\u003c/p>\n\u003cp>Today in Sacramento, consumer advocates will launch a campaign they hope will eliminate such surprises. Legislation introduced last year by Assembly member Rob Bonta, D-Oakland, is back, after falling just three Assembly votes short of passage in 2015.\u003c/p>\n\u003cp>The California Medical Association is fighting Bonta’s bill, and it is busy preparing a plan of its own with a different approach to the problem — one that puts more of the financial onus on insurers and gives doctors a better deal.\u003c/p>\n\u003cp>At issue: the practice at many hospitals and outpatient surgery centers of using doctors not covered by a patient’s insurance plan — specialists such as anesthesiologists, pathologists and radiologists — for procedures that are otherwise covered.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Because health plans typically pay a small fraction of the charges by these “out of network” specialists, consumers get saddled with their bills. And what they charge is often a lot more than what the insurers pay their in-network docs.\u003c/p>\n\u003cp>Under Bonta’s proposal, health plans would pay these specialists more or less what they pay their covered physicians for similar care. The specialists would accept that level of payment and stop sending big bills to patients.\u003c/p>\n\u003cp>The CMA says this plan would put too big a squeeze on doctors’ pocketbooks. Instead, the association wants to set the payments in line with what the doctors charge.\u003c/p>\n\u003cp>Michael Dondero of Long Beach has experienced the unsettling feeling of coming home to a large, unexpected medical bill. He had hernia surgery last year that was pre-approved by his health plan, held in a hospital covered under the plan and performed by a physician who was also part of the covered network.\u003c/p>\n\u003cp>“And yes, it went fantastic,” Dondero said. “I’m feeling a lot better now.”\u003c/p>\n\u003cp>But about a month after the surgery, Dondero received something that didn’t make him feel so good: an unexpected bill for $771. It turned out the anesthesiologist on duty during his procedure was not covered by his insurance.\u003c/p>\n\u003cp>“To me it was a real eye-opener,” Dondero said. “I just assumed an in-network procedure at an in-network hospital would be covered. But you know what happens when we assume.”\u003c/p>\n\u003cp>Dondero appealed to his insurance company, and after a month of back and forth letters and phone calls, he ended up paying a much smaller amount.\u003c/p>\n\u003cp>Both the Bonta bill and the proposal being drafted by the physicians’ association share the goal of ensuring that patients won’t get the kind of unwanted surprise that landed in Dondero’s mailbox.\u003c/p>\n\u003cp>But after that, the plans diverge. Bonta’s plan is more palatable to the health plans than the one being crafted by the medical association, which would claw back the financial advantage for specialist doctors.\u003c/p>\n\u003cp>Many specialists say the benchmark established by Bonta’s bill is far too low, claiming it would cut physician compensation by two-thirds.\u003c/p>\n\u003cp>In Bonta’s plan, physicians who think they were underpaid can appeal through an independent review.\u003c/p>\n\u003cp>Still, the medical association argues that the bill essentially penalizes doctors for insurer networks that are too small to meet the needs of patients. Doctors should not be forced to pick up the slack when health plans don’t have enough specialists to perform the medical services they’ve promised to cover, the association says.\u003c/p>\n\u003cp>Janus Norman, a senior vice president of the CMA, says the Bonta bill would create a disincentive for health plans to negotiate reasonable rates with providers.\u003c/p>\n\u003cp>The crux, Norman said, is whether surprise bills are ultimately the responsibility of the health plans or the doctors who generate them.\u003c/p>\n\u003cp>Bonta said the argument is not that simple, and that he has spent a year trying to find the middle ground between insurers and physicians.\u003c/p>\n\u003cp>“The challenge has always been getting reimbursed appropriately, and that’s where the fight has been,” Bonta said. “It’s not fully within the ambit of plans to determine who’s in the network, and it’s not fully in the ambit of providers to determine that.”\u003c/p>\n\u003cp>But one thing is clear, he said: “You can’t punish the patient if they do everything right. They schedule it in advance; it’s in the network. It’s not on the patient to find out which providers that day are in the network or not.”\u003c/p>\n\u003cp>Health Access California, a consumer advocacy group based in Sacramento that is sponsoring the Bonta bill, expects to announce today that the California Labor Federation has signed on as co-sponsor. Anthony Wright, executive director of Health Access, said he hopes this expanded support will help tip the scale in favor of the bill’s passage.\u003c/p>\n\u003cp>Wright argued that physicians bear a substantial share of responsibility for the surprise bill problem, and that they have stood in the way of fixing it. So now they should be willing to work out an arrangement that suits everyone, he said.\u003c/p>\n\u003cp>“We are working to end surprise billing, yet the California Medical Association has delayed and held that process hostage for a year to demand high reimbursement rates for its members,” Wright said. “We’ve put a lot of options on the table, and CMA has rejected all of them.”\u003c/p>\n\u003cp>Norman countered that doctors do want to fix the problem, but that the cause of it is the increasingly restricted choice of providers offered by health plans.\u003c/p>\n\u003cp>The medical association’s plan to get higher rates for doctors, based on an average of what similar physicians charge, is a method already employed in other states, including New York and Connecticut.\u003c/p>\n\u003cp>Bill Barcellona, chief lobbyist at the California Association of Provider Groups, which represents physicians that negotiate with insurance companies, said the proposal could throw the payment system out of whack, with some physicians receiving rates “200 percent higher” than what they currently get.\u003c/p>\n\u003cp>Bonta said he hopes to negotiate a compromise but won’t tolerate an attempt by the medical association to push its own agenda at the risk of undermining the main objective of eliminating surprise bills for consumers.\u003c/p>\n\u003cp>He said he is prepared to counter the competing proposal from the association, if necessary, by pushing his own bill through quickly — possibly as early as April.\u003c/p>\n\u003cp>“It isn’t my preference to push this over the finish line, but we will do that if we’re pushed,” he said.\u003c/p>\n\u003cp>Dondero said his surprise bill blindsided him a little, but that in retrospect it shouldn’t have. He urged others to contest such bills, like he did.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I think usually when other people get that bill, they just pay it,” he said. “But you can fight it. The thing is, you don’t take ‘no’ for an answer the first go-round.”\u003c/p>\n\n",
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"excerpt": "Legislation fell three votes short last year. New push pits consumer advocates and health plans against major doctors' group.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Have you ever gone in for a medical procedure you knew was covered by your health plan, only to be hit weeks later by a large, unexpected bill from a doctor whose name you didn’t even recognize?\u003c/p>\n\u003cp>If so, you’re not alone. More than one in five Californians with private health insurance reported receiving “surprise” medical bills at least once over the previous two years, according to a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\">2015 Consumer Reports survey\u003c/a>.\u003c/p>\n\u003cp>Today in Sacramento, consumer advocates will launch a campaign they hope will eliminate such surprises. Legislation introduced last year by Assembly member Rob Bonta, D-Oakland, is back, after falling just three Assembly votes short of passage in 2015.\u003c/p>\n\u003cp>The California Medical Association is fighting Bonta’s bill, and it is busy preparing a plan of its own with a different approach to the problem — one that puts more of the financial onus on insurers and gives doctors a better deal.\u003c/p>\n\u003cp>At issue: the practice at many hospitals and outpatient surgery centers of using doctors not covered by a patient’s insurance plan — specialists such as anesthesiologists, pathologists and radiologists — for procedures that are otherwise covered.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Because health plans typically pay a small fraction of the charges by these “out of network” specialists, consumers get saddled with their bills. And what they charge is often a lot more than what the insurers pay their in-network docs.\u003c/p>\n\u003cp>Under Bonta’s proposal, health plans would pay these specialists more or less what they pay their covered physicians for similar care. The specialists would accept that level of payment and stop sending big bills to patients.\u003c/p>\n\u003cp>The CMA says this plan would put too big a squeeze on doctors’ pocketbooks. Instead, the association wants to set the payments in line with what the doctors charge.\u003c/p>\n\u003cp>Michael Dondero of Long Beach has experienced the unsettling feeling of coming home to a large, unexpected medical bill. He had hernia surgery last year that was pre-approved by his health plan, held in a hospital covered under the plan and performed by a physician who was also part of the covered network.\u003c/p>\n\u003cp>“And yes, it went fantastic,” Dondero said. “I’m feeling a lot better now.”\u003c/p>\n\u003cp>But about a month after the surgery, Dondero received something that didn’t make him feel so good: an unexpected bill for $771. It turned out the anesthesiologist on duty during his procedure was not covered by his insurance.\u003c/p>\n\u003cp>“To me it was a real eye-opener,” Dondero said. “I just assumed an in-network procedure at an in-network hospital would be covered. But you know what happens when we assume.”\u003c/p>\n\u003cp>Dondero appealed to his insurance company, and after a month of back and forth letters and phone calls, he ended up paying a much smaller amount.\u003c/p>\n\u003cp>Both the Bonta bill and the proposal being drafted by the physicians’ association share the goal of ensuring that patients won’t get the kind of unwanted surprise that landed in Dondero’s mailbox.\u003c/p>\n\u003cp>But after that, the plans diverge. Bonta’s plan is more palatable to the health plans than the one being crafted by the medical association, which would claw back the financial advantage for specialist doctors.\u003c/p>\n\u003cp>Many specialists say the benchmark established by Bonta’s bill is far too low, claiming it would cut physician compensation by two-thirds.\u003c/p>\n\u003cp>In Bonta’s plan, physicians who think they were underpaid can appeal through an independent review.\u003c/p>\n\u003cp>Still, the medical association argues that the bill essentially penalizes doctors for insurer networks that are too small to meet the needs of patients. Doctors should not be forced to pick up the slack when health plans don’t have enough specialists to perform the medical services they’ve promised to cover, the association says.\u003c/p>\n\u003cp>Janus Norman, a senior vice president of the CMA, says the Bonta bill would create a disincentive for health plans to negotiate reasonable rates with providers.\u003c/p>\n\u003cp>The crux, Norman said, is whether surprise bills are ultimately the responsibility of the health plans or the doctors who generate them.\u003c/p>\n\u003cp>Bonta said the argument is not that simple, and that he has spent a year trying to find the middle ground between insurers and physicians.\u003c/p>\n\u003cp>“The challenge has always been getting reimbursed appropriately, and that’s where the fight has been,” Bonta said. “It’s not fully within the ambit of plans to determine who’s in the network, and it’s not fully in the ambit of providers to determine that.”\u003c/p>\n\u003cp>But one thing is clear, he said: “You can’t punish the patient if they do everything right. They schedule it in advance; it’s in the network. It’s not on the patient to find out which providers that day are in the network or not.”\u003c/p>\n\u003cp>Health Access California, a consumer advocacy group based in Sacramento that is sponsoring the Bonta bill, expects to announce today that the California Labor Federation has signed on as co-sponsor. Anthony Wright, executive director of Health Access, said he hopes this expanded support will help tip the scale in favor of the bill’s passage.\u003c/p>\n\u003cp>Wright argued that physicians bear a substantial share of responsibility for the surprise bill problem, and that they have stood in the way of fixing it. So now they should be willing to work out an arrangement that suits everyone, he said.\u003c/p>\n\u003cp>“We are working to end surprise billing, yet the California Medical Association has delayed and held that process hostage for a year to demand high reimbursement rates for its members,” Wright said. “We’ve put a lot of options on the table, and CMA has rejected all of them.”\u003c/p>\n\u003cp>Norman countered that doctors do want to fix the problem, but that the cause of it is the increasingly restricted choice of providers offered by health plans.\u003c/p>\n\u003cp>The medical association’s plan to get higher rates for doctors, based on an average of what similar physicians charge, is a method already employed in other states, including New York and Connecticut.\u003c/p>\n\u003cp>Bill Barcellona, chief lobbyist at the California Association of Provider Groups, which represents physicians that negotiate with insurance companies, said the proposal could throw the payment system out of whack, with some physicians receiving rates “200 percent higher” than what they currently get.\u003c/p>\n\u003cp>Bonta said he hopes to negotiate a compromise but won’t tolerate an attempt by the medical association to push its own agenda at the risk of undermining the main objective of eliminating surprise bills for consumers.\u003c/p>\n\u003cp>He said he is prepared to counter the competing proposal from the association, if necessary, by pushing his own bill through quickly — possibly as early as April.\u003c/p>\n\u003cp>“It isn’t my preference to push this over the finish line, but we will do that if we’re pushed,” he said.\u003c/p>\n\u003cp>Dondero said his surprise bill blindsided him a little, but that in retrospect it shouldn’t have. He urged others to contest such bills, like he did.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think usually when other people get that bill, they just pay it,” he said. “But you can fight it. The thing is, you don’t take ‘no’ for an answer the first go-round.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California's Obamacare Marketplace Aims To Kick Out Poor-Performing Hospitals",
"title": "California's Obamacare Marketplace Aims To Kick Out Poor-Performing Hospitals",
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"content": "\u003cp>California's insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a \u003ca href=\"http://hbex.coveredca.com/stakeholders/plan-management/PDFs/2017_QHP_Issuer_Contract_Attachment_7_3_4_2016_Redline.pdf\">novel proposal\u003c/a> that is drawing heavy fire from medical providers and insurers.\u003c/p>\n\u003cp>The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.\u003c/p>\n\u003cp>\"The first few years were about getting people in the door for coverage,\" said Lee, a key figure in the rollout of the federal health law. \"We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don't want to throw anyone out, but we don't want to pay for bad quality care either.\"\u003c/p>\n\u003cp>It appears to be the first proposal of its kind in the country. The exchange's five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital \"outliers\" on cost and quality starting in 2018. Medical groups and doctors would be rated after that.\u003c/p>\n\u003cp>Providers who don't measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By 2019, health plans would be expected to expel poor performers from their exchange networks.\u003c/p>\n\u003cp>The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.\u003c/p>\n\u003cp>Health insurers, normally at odds with providers, have joined them in the fight. The insurers are balking at the prospect of disclosing their negotiated rates with providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.\u003c/p>\n\u003cp>But scrutinizing the negotiated rates would help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a surgery or imaging test.\u003c/p>\n\u003cp>Lee said it's time for the exchange to move beyond enrollment and flex its market power on behalf of its 1.5 million members. He said insurers haven't been tough enough on hospitals and doctors.\u003c/p>\n\u003cp>Other public exchanges or large employers could try to replicate the idea, putting more pressure on providers and insurers. Lee has shared his proposal with other state marketplaces, government officials and employer groups to promote similar efforts.\u003c/p>\n\u003cp>Still, there are limits to this strategy. Exceptions would be granted if excluding a hospital or doctor from a network meant an area wouldn't have a sufficient number of providers. Insurers could appeal and offer other reasons for keeping a provider in the network.\u003c/p>\n\u003cp>\"California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat,\" said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. \"There may be a dominant hospital system that's charging through the nose, but without them you don't have an adequate network. It will be interesting to see how Covered California threads that needle.\"\u003c/p>\n\u003cp>The composition of networks has typically been left up to insurers. Until now, most of the discussion has centered on the proliferation of narrow networks, with a limited range of providers, sold under the Affordable Care Act as a way to hold down rates. A \u003ca href=\"http://ldi.upenn.edu/sites/default/files/rte/state-narrow-networks.pdf\">study\u003c/a> in 2015 found that 75 percent of Covered California plans had narrow physician networks, with more restricted choices than all but three other states.\u003c/p>\n\u003cp>\"I don't know of anyone even close to trying this,\" said Dan Polsky, the study's author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. \"I applaud Covered California for being bold to improve quality and reduce costs, but I worry about the implementation.\"\u003c/p>\n\u003cp>Polsky said measuring quality can be complicated, and steps must be taken to ensure hospitals and doctors aren't penalized for treating sicker patients or serving lower-income areas. Most quality-boosting efforts use financial bonuses and penalties rather than exclusion.\u003c/p>\n\u003cp>Under the Covered California plan, hospitals would be judged on a wide range of performance and safety measures, from rates of readmission and hospital-acquired infections to adverse drug events. The exchange said it will draw on existing measures already tracked by Medicare and other groups, and it will work with hospitals, consumer advocates and other experts over the next 18 months to finalize the details.\u003c/p>\n\u003cp>The California Hospital Association said the exchange is moving too fast and acting too much like a regulator.\u003c/p>\n\u003cp>\"The devil is in the details, and the rapidity of this concerns us,\" said Dr. David Perrott, chief medical officer at the state hospital trade group. \"We understand value-based purchasing is here in some form and we do not oppose that. But Covered California is charging ahead with this assessment and trying to figure out the answers when it hasn't been worked out.\"\u003c/p>\n\u003cp>California physicians warn that the exchange's proposal could further reduce networks that are already too thin for patients.\u003c/p>\n\u003cp>\"Right now, one of the biggest problems in healthcare is limited access to specialty care. This allows more narrowing of the networks under spurious guidelines,\" said Dr. Ted Mazer, a board member of the California Medical Association and a head and neck surgeon in San Diego.\u003c/p>\n\u003cp>Charles Bacchi, chief executive of the California Association of Health Plans, predicted that Covered California's idea will backfire, discouraging hospitals and doctors from participating in the exchange and driving up premiums as a result.\u003c/p>\n\u003cp>\"It's the right goal but the wrong approach,\" Bacchi said. \"Covered California is proposing a top-down, arbitrary measurement system that carries a big stick. This can make it difficult for health plans and providers to work together constructively.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes \u003ca href=\"http://californiahealthline.org/news/california-insurance-marketplace-wants-to-kick-out-poor-performing-hospitals/\" target=\"_blank\">California Healthline\u003c/a>, a service of the California HealthCare Foundation. Follow Chad Terhune on Twitter: \u003ca href=\"https://twitter.com/chadterhune\">@chadterhune\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News.\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California's insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a \u003ca href=\"http://hbex.coveredca.com/stakeholders/plan-management/PDFs/2017_QHP_Issuer_Contract_Attachment_7_3_4_2016_Redline.pdf\">novel proposal\u003c/a> that is drawing heavy fire from medical providers and insurers.\u003c/p>\n\u003cp>The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.\u003c/p>\n\u003cp>\"The first few years were about getting people in the door for coverage,\" said Lee, a key figure in the rollout of the federal health law. \"We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don't want to throw anyone out, but we don't want to pay for bad quality care either.\"\u003c/p>\n\u003cp>It appears to be the first proposal of its kind in the country. The exchange's five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital \"outliers\" on cost and quality starting in 2018. Medical groups and doctors would be rated after that.\u003c/p>\n\u003cp>Providers who don't measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By 2019, health plans would be expected to expel poor performers from their exchange networks.\u003c/p>\n\u003cp>The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.\u003c/p>\n\u003cp>Health insurers, normally at odds with providers, have joined them in the fight. The insurers are balking at the prospect of disclosing their negotiated rates with providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.\u003c/p>\n\u003cp>But scrutinizing the negotiated rates would help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a surgery or imaging test.\u003c/p>\n\u003cp>Lee said it's time for the exchange to move beyond enrollment and flex its market power on behalf of its 1.5 million members. He said insurers haven't been tough enough on hospitals and doctors.\u003c/p>\n\u003cp>Other public exchanges or large employers could try to replicate the idea, putting more pressure on providers and insurers. Lee has shared his proposal with other state marketplaces, government officials and employer groups to promote similar efforts.\u003c/p>\n\u003cp>Still, there are limits to this strategy. Exceptions would be granted if excluding a hospital or doctor from a network meant an area wouldn't have a sufficient number of providers. Insurers could appeal and offer other reasons for keeping a provider in the network.\u003c/p>\n\u003cp>\"California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat,\" said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. \"There may be a dominant hospital system that's charging through the nose, but without them you don't have an adequate network. It will be interesting to see how Covered California threads that needle.\"\u003c/p>\n\u003cp>The composition of networks has typically been left up to insurers. Until now, most of the discussion has centered on the proliferation of narrow networks, with a limited range of providers, sold under the Affordable Care Act as a way to hold down rates. A \u003ca href=\"http://ldi.upenn.edu/sites/default/files/rte/state-narrow-networks.pdf\">study\u003c/a> in 2015 found that 75 percent of Covered California plans had narrow physician networks, with more restricted choices than all but three other states.\u003c/p>\n\u003cp>\"I don't know of anyone even close to trying this,\" said Dan Polsky, the study's author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. \"I applaud Covered California for being bold to improve quality and reduce costs, but I worry about the implementation.\"\u003c/p>\n\u003cp>Polsky said measuring quality can be complicated, and steps must be taken to ensure hospitals and doctors aren't penalized for treating sicker patients or serving lower-income areas. Most quality-boosting efforts use financial bonuses and penalties rather than exclusion.\u003c/p>\n\u003cp>Under the Covered California plan, hospitals would be judged on a wide range of performance and safety measures, from rates of readmission and hospital-acquired infections to adverse drug events. The exchange said it will draw on existing measures already tracked by Medicare and other groups, and it will work with hospitals, consumer advocates and other experts over the next 18 months to finalize the details.\u003c/p>\n\u003cp>The California Hospital Association said the exchange is moving too fast and acting too much like a regulator.\u003c/p>\n\u003cp>\"The devil is in the details, and the rapidity of this concerns us,\" said Dr. David Perrott, chief medical officer at the state hospital trade group. \"We understand value-based purchasing is here in some form and we do not oppose that. But Covered California is charging ahead with this assessment and trying to figure out the answers when it hasn't been worked out.\"\u003c/p>\n\u003cp>California physicians warn that the exchange's proposal could further reduce networks that are already too thin for patients.\u003c/p>\n\u003cp>\"Right now, one of the biggest problems in healthcare is limited access to specialty care. This allows more narrowing of the networks under spurious guidelines,\" said Dr. Ted Mazer, a board member of the California Medical Association and a head and neck surgeon in San Diego.\u003c/p>\n\u003cp>Charles Bacchi, chief executive of the California Association of Health Plans, predicted that Covered California's idea will backfire, discouraging hospitals and doctors from participating in the exchange and driving up premiums as a result.\u003c/p>\n\u003cp>\"It's the right goal but the wrong approach,\" Bacchi said. \"Covered California is proposing a top-down, arbitrary measurement system that carries a big stick. This can make it difficult for health plans and providers to work together constructively.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes \u003ca href=\"http://californiahealthline.org/news/california-insurance-marketplace-wants-to-kick-out-poor-performing-hospitals/\" target=\"_blank\">California Healthline\u003c/a>, a service of the California HealthCare Foundation. Follow Chad Terhune on Twitter: \u003ca href=\"https://twitter.com/chadterhune\">@chadterhune\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News.\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Trump Health Plan Recycles GOP Staples And Adds A Populist Wrinkle",
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"content": "\u003cp>Republican front-runner Donald Trump released a seven-point plan to change the country's health care system that includes several familiar GOP proposals and one that puts him in agreement with, believe it or not, Democratic hopeful Bernie Sanders.\u003c/p>\n\u003cp>Right off the bat, Trump calls for the elimination of the Affordable Care Act, ringing the repeal bell that has been popular among a wide swath of Republicans and that has fueled dozens of votes to overturn Obamacare in Congress, including another \u003ca href=\"http://www.npr.org/2016/01/06/462114338/lawmakers-in-the-house-will-try-again-in-2016-to-repeal-obamacare\" target=\"_blank\">failed attempt when lawmakers reconvened first thing in January\u003c/a>.\u003c/p>\n\u003cp>The prime target is the individual mandate, the requirement that almost every American have or buy health insurance — or pay a penalty. \"No person should be required to buy insurance unless he or she wants to,\" the Trump proposal declares.\u003c/p>\n\u003cp>Obamacare relies on the mandate to make sure it isn't just the sick and people at high risk of getting sick who buy coverage, driving up insurance costs.\u003c/p>\n\u003cp>While Trump decries the mandate, the \u003ca href=\"http://www.nytimes.com/2012/02/15/health/policy/health-care-mandate-was-first-backed-by-conservatives.html\" target=\"_blank\">idea has Republican roots\u003c/a>. The mandate was seen as a market-friendly alternative to a national health system or a strict requirement on employers to provide coverage.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, the mandate and its associated tax penalties for people who don't comply has become a lightning rod for people dissatisfied with the Affordable Care Act. In 2014, the first year that the fine for lack of coverage was in place, about 7.5 million Americans \u003ca href=\"http://www.nytimes.com/2012/02/15/health/policy/health-care-mandate-was-first-backed-by-conservatives.html\" target=\"_blank\">paid an average penalty of $200\u003c/a> for not having insurance according to the IRS. In 2015, \u003ca href=\"http://kff.org/health-reform/issue-brief/the-cost-of-the-individual-mandate-penalty-for-the-remaining-uninsured/\">the potential penalties rose\u003c/a> to greater of 2 percent of annual income or $325 per adult. And this year they rise again to the greater of 2.5 percent of income or $695 per adult.\u003c/p>\n\u003cp>In a second plank, Trump calls for the sale of health insurance plans across state lines to bolster competition by increasing the number of policies being sold. Health insurance is regulated largely at the state level. And critics of the multistate approach, a \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=120276553\" target=\"_blank\">favorite of the GOP\u003c/a> for years, say it would erode consumer protections.\u003c/p>\n\u003cp>Trump hedges his call for multistate plans by saying they would have to comply with regulations in each state where they are offered. It's hard to see how, if states continue to regulate insurance differently, the theoretical benefits he touts could be achieved in practice. In fact, over the years six states, including \u003ca href=\"http://www.npr.org/sections/health-shots/2012/06/25/155702326/dropping-legal-barriers-doesnt-guarantee-interstate-insurance-sales\" target=\"_blank\">Georgia\u003c/a>, enacted laws to encourage insurance sales across their borders and a Georgetown University analysis found that they \u003ca href=\"http://chirblog.org/the-return-of-proposals-for-the-across-state-lines-sale-of-insurance/\" target=\"_blank\">failed to attract new plans\u003c/a> into their markets.\u003c/p>\n\u003cp>Some Trump proposals would change the tax treatment of health coverage.\u003c/p>\n\u003cp>One would let individuals who buy insurance deduct its cost, as employers do for coverage they make available to workers. Many health economists argue that the opposite tack — \u003ca href=\"https://www.aei.org/publication/kill-the-tax-exclusion-for-health-insurance/\" target=\"_blank\">eliminating the employer deduction\u003c/a> — would be more beneficial. The employer tax break obscures the cost of health coverage and thereby contributes to health cost inflation. The benefits from the break also tends to accrue to more highly paid people. Under Obamacare, people with low-to-moderate incomes can get a tax credit to help defray the cost of insurance purchased on marketplaces.\u003c/p>\n\u003cp>The second proposal argues in favor of letting individuals take advantage of Health Savings Accounts, or HSAs. But that's something that is already possible, and the accounts are quite popular. Right now, those accounts are tied to high-deductible health plans.\u003c/p>\n\u003cp>\"Is Trump calling for every American to have access to an HSA, not just those in high-deductible health plans (HDHPs)?\" \u003ca href=\"http://www.forbes.com/sites/ryanellis/2016/03/02/donald-trumps-healthcare-plan-and-taxes/#70c0ee2a404f\" target=\"_blank\">asks a post\u003c/a> on Forbes.com by Ryan Ellis, an adviser on tax policy for the Conservative Reform Network. \"That would seem to be undermined by his statement about how young people should want to enroll in high-deductible plans–why mention them at all?\"\u003c/p>\n\u003cp>Then there's the chicken-in-every-pot plank that would require providers of health care to disclose prices. \"Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure,\" the Trump proposal says. Not many people disagree with the intent. But it's difficult to pull off in a way that helps the average person shop. Health care prices are negotiated between insurers and providers, and people's coverage and copays vary depending on their networks and insurance particulars.\u003c/p>\n\u003cp>Trump also argues for a change in financing Medicaid, the joint federal and state health insurance program for the poor and disabled. His plan calls for block grants, or lump-sum payments, to the states that they could spend as they wish. The idea has been popular with Republicans going back to President Reagan, has been \u003ca href=\"http://www.npr.org/2011/03/08/134363543/gop-governors-revive-historic-call-for-medicaid-block-grants\" target=\"_blank\">revived more recently by GOP governors\u003c/a> as a way to cut costs and has been part of Republican proposals to repeal and replace Obamacare. Critics say block grants would \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/15787953?dopt=Abstract\" target=\"_blank\">reduce the number of people covered by Medicaid\u003c/a> and by shifting responsibilities to the states would ultimately saddle them with \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1503455\" target=\"_blank\">greater financial burdens\u003c/a>.\u003c/p>\n\u003cp>Finally, Trump throws his support behind the importation of drugs to cut costs. \"Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers,\" the proposal says. This is the one where Trump and Sanders have common ground. Sanders supports the importation of drugs from Canada and \u003ca href=\"https://berniesanders.com/issues/fighting-to-lower-prescription-drug-prices/\" target=\"_blank\">his website boasts\u003c/a> about a 1999 bus trip that took a bunch of Americans up north to get better deals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Food and Drug Administration, under both Republican and Democratic presidents, has opposed drug importation on safety grounds. And drugmakers restricted supplies of medicines \u003ca href=\"http://www.wsj.com/articles/SB1042245470898700224\" target=\"_blank\">going to drug distributors in Canada\u003c/a> to combat a rise in online pharmacy sales to Americans more than a decade ago.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Trump+Health+Plan+Recycles+GOP+Staples+And+Adds+A+Populist+Wrinkle&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Republican front-runner Donald Trump released a seven-point plan to change the country's health care system that includes several familiar GOP proposals and one that puts him in agreement with, believe it or not, Democratic hopeful Bernie Sanders.\u003c/p>\n\u003cp>Right off the bat, Trump calls for the elimination of the Affordable Care Act, ringing the repeal bell that has been popular among a wide swath of Republicans and that has fueled dozens of votes to overturn Obamacare in Congress, including another \u003ca href=\"http://www.npr.org/2016/01/06/462114338/lawmakers-in-the-house-will-try-again-in-2016-to-repeal-obamacare\" target=\"_blank\">failed attempt when lawmakers reconvened first thing in January\u003c/a>.\u003c/p>\n\u003cp>The prime target is the individual mandate, the requirement that almost every American have or buy health insurance — or pay a penalty. \"No person should be required to buy insurance unless he or she wants to,\" the Trump proposal declares.\u003c/p>\n\u003cp>Obamacare relies on the mandate to make sure it isn't just the sick and people at high risk of getting sick who buy coverage, driving up insurance costs.\u003c/p>\n\u003cp>While Trump decries the mandate, the \u003ca href=\"http://www.nytimes.com/2012/02/15/health/policy/health-care-mandate-was-first-backed-by-conservatives.html\" target=\"_blank\">idea has Republican roots\u003c/a>. The mandate was seen as a market-friendly alternative to a national health system or a strict requirement on employers to provide coverage.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, the mandate and its associated tax penalties for people who don't comply has become a lightning rod for people dissatisfied with the Affordable Care Act. In 2014, the first year that the fine for lack of coverage was in place, about 7.5 million Americans \u003ca href=\"http://www.nytimes.com/2012/02/15/health/policy/health-care-mandate-was-first-backed-by-conservatives.html\" target=\"_blank\">paid an average penalty of $200\u003c/a> for not having insurance according to the IRS. In 2015, \u003ca href=\"http://kff.org/health-reform/issue-brief/the-cost-of-the-individual-mandate-penalty-for-the-remaining-uninsured/\">the potential penalties rose\u003c/a> to greater of 2 percent of annual income or $325 per adult. And this year they rise again to the greater of 2.5 percent of income or $695 per adult.\u003c/p>\n\u003cp>In a second plank, Trump calls for the sale of health insurance plans across state lines to bolster competition by increasing the number of policies being sold. Health insurance is regulated largely at the state level. And critics of the multistate approach, a \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=120276553\" target=\"_blank\">favorite of the GOP\u003c/a> for years, say it would erode consumer protections.\u003c/p>\n\u003cp>Trump hedges his call for multistate plans by saying they would have to comply with regulations in each state where they are offered. It's hard to see how, if states continue to regulate insurance differently, the theoretical benefits he touts could be achieved in practice. In fact, over the years six states, including \u003ca href=\"http://www.npr.org/sections/health-shots/2012/06/25/155702326/dropping-legal-barriers-doesnt-guarantee-interstate-insurance-sales\" target=\"_blank\">Georgia\u003c/a>, enacted laws to encourage insurance sales across their borders and a Georgetown University analysis found that they \u003ca href=\"http://chirblog.org/the-return-of-proposals-for-the-across-state-lines-sale-of-insurance/\" target=\"_blank\">failed to attract new plans\u003c/a> into their markets.\u003c/p>\n\u003cp>Some Trump proposals would change the tax treatment of health coverage.\u003c/p>\n\u003cp>One would let individuals who buy insurance deduct its cost, as employers do for coverage they make available to workers. Many health economists argue that the opposite tack — \u003ca href=\"https://www.aei.org/publication/kill-the-tax-exclusion-for-health-insurance/\" target=\"_blank\">eliminating the employer deduction\u003c/a> — would be more beneficial. The employer tax break obscures the cost of health coverage and thereby contributes to health cost inflation. The benefits from the break also tends to accrue to more highly paid people. Under Obamacare, people with low-to-moderate incomes can get a tax credit to help defray the cost of insurance purchased on marketplaces.\u003c/p>\n\u003cp>The second proposal argues in favor of letting individuals take advantage of Health Savings Accounts, or HSAs. But that's something that is already possible, and the accounts are quite popular. Right now, those accounts are tied to high-deductible health plans.\u003c/p>\n\u003cp>\"Is Trump calling for every American to have access to an HSA, not just those in high-deductible health plans (HDHPs)?\" \u003ca href=\"http://www.forbes.com/sites/ryanellis/2016/03/02/donald-trumps-healthcare-plan-and-taxes/#70c0ee2a404f\" target=\"_blank\">asks a post\u003c/a> on Forbes.com by Ryan Ellis, an adviser on tax policy for the Conservative Reform Network. \"That would seem to be undermined by his statement about how young people should want to enroll in high-deductible plans–why mention them at all?\"\u003c/p>\n\u003cp>Then there's the chicken-in-every-pot plank that would require providers of health care to disclose prices. \"Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure,\" the Trump proposal says. Not many people disagree with the intent. But it's difficult to pull off in a way that helps the average person shop. Health care prices are negotiated between insurers and providers, and people's coverage and copays vary depending on their networks and insurance particulars.\u003c/p>\n\u003cp>Trump also argues for a change in financing Medicaid, the joint federal and state health insurance program for the poor and disabled. His plan calls for block grants, or lump-sum payments, to the states that they could spend as they wish. The idea has been popular with Republicans going back to President Reagan, has been \u003ca href=\"http://www.npr.org/2011/03/08/134363543/gop-governors-revive-historic-call-for-medicaid-block-grants\" target=\"_blank\">revived more recently by GOP governors\u003c/a> as a way to cut costs and has been part of Republican proposals to repeal and replace Obamacare. Critics say block grants would \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/15787953?dopt=Abstract\" target=\"_blank\">reduce the number of people covered by Medicaid\u003c/a> and by shifting responsibilities to the states would ultimately saddle them with \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1503455\" target=\"_blank\">greater financial burdens\u003c/a>.\u003c/p>\n\u003cp>Finally, Trump throws his support behind the importation of drugs to cut costs. \"Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers,\" the proposal says. This is the one where Trump and Sanders have common ground. Sanders supports the importation of drugs from Canada and \u003ca href=\"https://berniesanders.com/issues/fighting-to-lower-prescription-drug-prices/\" target=\"_blank\">his website boasts\u003c/a> about a 1999 bus trip that took a bunch of Americans up north to get better deals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Food and Drug Administration, under both Republican and Democratic presidents, has opposed drug importation on safety grounds. And drugmakers restricted supplies of medicines \u003ca href=\"http://www.wsj.com/articles/SB1042245470898700224\" target=\"_blank\">going to drug distributors in Canada\u003c/a> to combat a rise in online pharmacy sales to Americans more than a decade ago.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Trump+Health+Plan+Recycles+GOP+Staples+And+Adds+A+Populist+Wrinkle&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Supreme Court Strikes At States' Efforts On Health Care Transparency",
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"content": "\u003cp>The U.S. Supreme Court dealt a \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/14-181_5426.pdf\" target=\"_blank\">blow Tuesday\u003c/a> to nascent efforts to track the quality and cost of health care, ruling that a 1974 law precludes states from requiring that every health care claim involving their residents be submitted to a massive database.\u003c/p>\n\u003cp>The arguments were arcane, but the effect is clear: We're a long way off from having a true picture of the country's health care spending, especially differences in the way hospitals treat patients and doctors practice medicine.\u003c/p>\n\u003cp>It also means that, for the time being at least, we'll remain heavily reliant on data being released by Medicare, the federal health insurance program for the elderly and disabled, to study variations in health care. ProPublica has used Medicare data to study differences in \u003ca href=\"https://projects.propublica.org/checkup\" target=\"_blank\">medication prescribing\u003c/a>, \u003ca href=\"https://projects.propublica.org/surgeons/\" target=\"_blank\">surgeons' complication rates\u003c/a> and \u003ca href=\"https://projects.propublica.org/treatment/\" target=\"_blank\">use of services by doctors\u003c/a>, but it's still not clear that Medicare is representative of all health care in the country.\u003c/p>\n\u003cp>The court's decision involves a case from Vermont, one of 18 states that created so-called all-payer claims databases. Vermont's law called for health insurers, health providers, medical facilities and government agencies to report data on health care costs, prices, quality and use of services to the state. That included employers who pay the costs of their workers' treatments themselves, and not through an insurance contract. (Self-insurance is common for large companies.)\u003c/p>\n\u003cp>But Liberty Mutual Insurance Co. objected, saying the Employee Retirement Income Security Act of 1974, or ERISA, prevents states from imposing such a requirement on self-funded plans. The idea is that companies that have operations across the country shouldn't be subjected to 50 different state laws, but instead should only have to abide by rules from one agency, namely the U.S. Department of Labor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The court sided with Liberty Mutual, in a 6-2 decision, ruling it didn't have to submit the data demanded by Vermont.\u003c/p>\n\u003cp>In a friend-of-the-court \u003ca href=\"http://www.scotusblog.com/wp-content/uploads/2015/09/150904-amicus-gobeille-liberty.pdf\" target=\"_blank\">brief filed last September\u003c/a>, the American Hospital Association and the Association of American Medical Colleges said that without the data from self-funded plans, all-payer claims databases will be incomplete and not as valuable as they could be.\u003c/p>\n\u003cp>\"Hospitals only have data for the patients they treat,\" the groups wrote. \"Information from across the spectrum of an individual's health care experience is needed to inform clinical, payment, and public health policy...Complete data across all payers (including self-insurers like Respondent) is required so that both health care providers and policymakers can understand the variations in the health care system, and address those that need to change.\"\u003c/p>\n\u003cp>They also noted that self-insured plans cover a \"large majority of the working population: in 2013, nearly 60 percent of workers with health insurance were enrolled in such plans, and that figure is growing.\"\u003c/p>\n\u003cp>So what now? One option is for self-insured plans like Liberty Mutual to voluntarily provide their data to state-run databases. But given the lawsuit, that appears unlikely.\u003c/p>\n\u003cp>Another possibility, raised by Justice Stephen Breyer, is for the federal government to require self-insured plans to disclose their data. \"I see no reason why the Secretary of Labor could not develop reporting requirements that satisfy the states' needs, including some state-specific requirements, as appropriate,\" he wrote.\u003c/p>\n\u003cp>For now, though, we may have to do what we have done for years: Settle for an incomplete picture of health care spending and utilization.\u003c/p>\n\u003cp>Our team at ProPublica has already found fascinating patterns in Medicare data. In \u003ca href=\"https://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits\">one example\u003c/a>, 1,800 doctors billed Medicare for the most expensive type of office visits at least 90 percent of the time, compared to just 4 percent of office visits for all doctors.\u003c/p>\n\u003cp>Another group, the \u003ca href=\"http://www.healthcostinstitute.org/\" target=\"_blank\">Health Care Cost Institute\u003c/a>, has greenlighted research using data from three of the nation's largest private insurance companies. It has found some \u003ca href=\"http://www.healthcostinstitute.org/news-and-events/hcci-releases-new-research-assessing-national-and-state-health-policies\" target=\"_blank\">interesting trends\u003c/a> too, but hasn't released data on individual doctors and hospitals.\u003c/p>\n\u003cp>Medicare could release more data, as could the Health Care Cost Institute.\u003c/p>\n\u003cp>The Supreme Court decision means transparency has a long way to go.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.propublica.org/about/pixelping\" target=\"_blank\">Charles Ornstein\u003c/a>\u003cem> is a senior reporter at \u003c/em>\u003ca href=\"https://www.propublica.org/\" target=\"_blank\">ProPublica\u003c/a>,\u003cem> an independent investigative newsroom based in New York.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Supreme+Court+Strikes+At+States%27+Efforts+On+Health+Care+Transparency&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"excerpt": "The U.S. Supreme Court ruled that states can't require many large employers to submit health care claims to a massive database. The decision means Medicare data will remain the go-to source for now.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The U.S. Supreme Court dealt a \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/14-181_5426.pdf\" target=\"_blank\">blow Tuesday\u003c/a> to nascent efforts to track the quality and cost of health care, ruling that a 1974 law precludes states from requiring that every health care claim involving their residents be submitted to a massive database.\u003c/p>\n\u003cp>The arguments were arcane, but the effect is clear: We're a long way off from having a true picture of the country's health care spending, especially differences in the way hospitals treat patients and doctors practice medicine.\u003c/p>\n\u003cp>It also means that, for the time being at least, we'll remain heavily reliant on data being released by Medicare, the federal health insurance program for the elderly and disabled, to study variations in health care. ProPublica has used Medicare data to study differences in \u003ca href=\"https://projects.propublica.org/checkup\" target=\"_blank\">medication prescribing\u003c/a>, \u003ca href=\"https://projects.propublica.org/surgeons/\" target=\"_blank\">surgeons' complication rates\u003c/a> and \u003ca href=\"https://projects.propublica.org/treatment/\" target=\"_blank\">use of services by doctors\u003c/a>, but it's still not clear that Medicare is representative of all health care in the country.\u003c/p>\n\u003cp>The court's decision involves a case from Vermont, one of 18 states that created so-called all-payer claims databases. Vermont's law called for health insurers, health providers, medical facilities and government agencies to report data on health care costs, prices, quality and use of services to the state. That included employers who pay the costs of their workers' treatments themselves, and not through an insurance contract. (Self-insurance is common for large companies.)\u003c/p>\n\u003cp>But Liberty Mutual Insurance Co. objected, saying the Employee Retirement Income Security Act of 1974, or ERISA, prevents states from imposing such a requirement on self-funded plans. The idea is that companies that have operations across the country shouldn't be subjected to 50 different state laws, but instead should only have to abide by rules from one agency, namely the U.S. Department of Labor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The court sided with Liberty Mutual, in a 6-2 decision, ruling it didn't have to submit the data demanded by Vermont.\u003c/p>\n\u003cp>In a friend-of-the-court \u003ca href=\"http://www.scotusblog.com/wp-content/uploads/2015/09/150904-amicus-gobeille-liberty.pdf\" target=\"_blank\">brief filed last September\u003c/a>, the American Hospital Association and the Association of American Medical Colleges said that without the data from self-funded plans, all-payer claims databases will be incomplete and not as valuable as they could be.\u003c/p>\n\u003cp>\"Hospitals only have data for the patients they treat,\" the groups wrote. \"Information from across the spectrum of an individual's health care experience is needed to inform clinical, payment, and public health policy...Complete data across all payers (including self-insurers like Respondent) is required so that both health care providers and policymakers can understand the variations in the health care system, and address those that need to change.\"\u003c/p>\n\u003cp>They also noted that self-insured plans cover a \"large majority of the working population: in 2013, nearly 60 percent of workers with health insurance were enrolled in such plans, and that figure is growing.\"\u003c/p>\n\u003cp>So what now? One option is for self-insured plans like Liberty Mutual to voluntarily provide their data to state-run databases. But given the lawsuit, that appears unlikely.\u003c/p>\n\u003cp>Another possibility, raised by Justice Stephen Breyer, is for the federal government to require self-insured plans to disclose their data. \"I see no reason why the Secretary of Labor could not develop reporting requirements that satisfy the states' needs, including some state-specific requirements, as appropriate,\" he wrote.\u003c/p>\n\u003cp>For now, though, we may have to do what we have done for years: Settle for an incomplete picture of health care spending and utilization.\u003c/p>\n\u003cp>Our team at ProPublica has already found fascinating patterns in Medicare data. In \u003ca href=\"https://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits\">one example\u003c/a>, 1,800 doctors billed Medicare for the most expensive type of office visits at least 90 percent of the time, compared to just 4 percent of office visits for all doctors.\u003c/p>\n\u003cp>Another group, the \u003ca href=\"http://www.healthcostinstitute.org/\" target=\"_blank\">Health Care Cost Institute\u003c/a>, has greenlighted research using data from three of the nation's largest private insurance companies. It has found some \u003ca href=\"http://www.healthcostinstitute.org/news-and-events/hcci-releases-new-research-assessing-national-and-state-health-policies\" target=\"_blank\">interesting trends\u003c/a> too, but hasn't released data on individual doctors and hospitals.\u003c/p>\n\u003cp>Medicare could release more data, as could the Health Care Cost Institute.\u003c/p>\n\u003cp>The Supreme Court decision means transparency has a long way to go.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.propublica.org/about/pixelping\" target=\"_blank\">Charles Ornstein\u003c/a>\u003cem> is a senior reporter at \u003c/em>\u003ca href=\"https://www.propublica.org/\" target=\"_blank\">ProPublica\u003c/a>,\u003cem> an independent investigative newsroom based in New York.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Supreme+Court+Strikes+At+States%27+Efforts+On+Health+Care+Transparency&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Many Dislike Health Care System But Are Pleased With Their Own Care",
"title": "Many Dislike Health Care System But Are Pleased With Their Own Care",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The United States has the most advanced health care in the world. There are gleaming medical centers across the country where doctors cure cancers, transplant organs and bring people back from near death.\u003c/p>\n\u003cp>But a \u003ca href=\"http://www.npr.org/sections/health-shots/2016/02/29/467980734/health-quality-an-issue-for-poor-2-years-into-obamacare-poll-finds\" target=\"_blank\">poll\u003c/a> conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health shows that only one-third of Americans say the health care they receive is \"excellent.\" Even fewer people are impressed with the system as a whole.\u003c/p>\n\u003cp>\"When you're talking about health care, we have this amazing kind of schizophrenia about our system,\" says \u003ca href=\"https://www.apha.org/about-apha/executive-board-and-staff/apha-executive-board/georges-c-benjamin-md-facp-fnapa-facep-hon-frsph\" target=\"_blank\">Dr. Georges Benjamin\u003c/a>, executive director of the American Public Health Association.\u003c/p>\n\u003cp>The split in thinking shows up in the poll numbers.\u003c/p>\n\u003cp>Much the way people hate Congress but love their own representatives, people like the care they receive while complaining about the system. About 80 percent say they get good or excellent care. But 42 percent rate the health care system in their state as fair or poor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We deliver the best medicine and nursing on the planet, no question about it. But it requires a lot of things,\" Benjamin says.\u003c/p>\n\u003cp>Things like an insurance card, filling out lots of forms, paying copays and deductibles, and running from doctor to lab to imaging center.\u003c/p>\n\u003cp>The system is wildly complex and hard to navigate, and can be very frustrating. Benjamin says it's this process of getting health care that people hate.\u003c/p>\n\u003cp>Just ask Cheryl Vaun, one of our poll respondents.\u003c/p>\n\u003cp>The 57-year-old from Albany, Ore., has a low opinion of the health care system after spending years trying to help her daughter who fell suddenly ill as a teenager.\u003c/p>\n\u003cp>The 16-year-old gained 30 pounds in about a month. She had migraines and her muscles would seize up in pain.\u003c/p>\n\u003cp>Vaun and her daughter went from doctor to doctor repeating the same tests and procedures. When doctors couldn't figure out what was wrong, they offered Vaun's daughter antidepressants.\u003c/p>\n\u003cp>\"We were pretty upset,\" she says. \"My daughter was devastated because obviously she's suffering all of these health issues and it was a bit terrifying.\"\u003c/p>\n\u003cp>Vaun's daughter was finally diagnosed with acute anemia.\u003c/p>\n\u003cp>If the problem had been caught earlier, Vaun believes her daughter could have recovered. Instead it has become a chronic condition that leaves her tired and weak. The treatment is iron pills or injections, which are hard on her system and leave her sick to her stomach.\u003c/p>\n\u003cp>Repeat tests, multiple doctor visits and lack of results erode people's faith in their care, says \u003ca href=\"http://www.allhealth.org/aboutus_staff.asp\" target=\"_blank\">Sarah Dash\u003c/a>, vice president for health policy at the \u003ca href=\"http://www.allhealth.org/\" target=\"_blank\">Alliance for Health Reform\u003c/a> in Washington, D.C.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-154912\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM.png\" alt=\"Screen Shot 2016-02-29 at 10.49.16 AM\" width=\"819\" height=\"355\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM.png 819w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-400x173.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-800x347.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-768x333.png 768w\" sizes=\"(max-width: 819px) 100vw, 819px\">\u003c/p>\n\u003cp>\"Health care hasn't always been designed with the needs and efficiency of the patient in mind,\" Dash says. \"It's designed for the various doctors and the health care system.\"\u003c/p>\n\u003cp>The poll, conducted from September to November, also shows that quality of care can depend heavily on a patient's income.\u003c/p>\n\u003cp>Adults with incomes below $25,000 a year are about three times as likely as higher income people — 34 percent versus 13 percent — to say the health care they personally receive is only fair or poor.\u003c/p>\n\u003cp>William Dale Coger, 52, is one of them. The carpenter from Oak Hill, W.Va., says he's been unable to get help for his back, which he injured about 15 years ago while hauling pipe out of a well on his property.\u003c/p>\n\u003cp>His pain, mild at first, has gotten worse over the years. These days, he struggles to get out of bed in the morning and finds his left leg is unstable and his left foot goes numb.\u003c/p>\n\u003cp>\"It's gotten to the point that this pain travels clear up my back into my shoulder blade into my left side of my neck and gives me migraine headaches sometimes into the left side of my head,\" Coger says.\u003c/p>\n\u003cp>He's on disability and Medicaid.\u003c/p>\n\u003cp>Coger sees doctors at a local clinic, but he says they don't take his back trouble seriously. They recommend exercise and offer ibuprofen. He thinks surgery would be able to help him but says doctors at the clinic refuse to order an MRI.\u003c/p>\n\u003cp>\"I want to be cured,\" he says. \"I don't want pills. I don't like pills.\"\u003c/p>\n\u003cp>Benjamin of the APHA says Coger and his doctors don't seem to have the same goal. They're managing his pain; he wants to get back to work.\u003c/p>\n\u003cp>\"It can be really frustrating if you don't understand the end goal of your care,\" Benjamin says.\u003c/p>\n\u003cp>Dash says the Affordable Care Act includes lots of\u003ca href=\"http://www.hlc.org/wp-content/uploads/2010/08/ACA-Pilot-Programs-and-Demonstration-Projects-Summary.pdf\" target=\"_blank\"> pilot projects\u003c/a> to improve how patients get care — and to make it cheaper. But those changes come slowly in a system that today is wildly complex.\u003c/p>\n\u003cp>And for most people, the law seems to have changed little.\u003c/p>\n\u003cp>The NPR poll shows 74 percent of people believe their health care has stayed about the same since the ACA was implemented. And for the minority who've seen a change, about 14 percent say their care is better while 9 percent say it's worse.\u003c/p>\n\u003cp>And most think the law has had no direct impact on them.\u003c/p>\n\u003cp>Even if they didn't buy a plan through the exchange, people have more insurance benefits than they did before. They get free screenings like mammograms and colonoscopies. Birth control is free. And they can still buy insurance even if they have a pre-existing medical condition.\u003c/p>\n\u003cp>Most people aren't aware of that, though. Our poll shows only 1 in 6 adults think their benefits have increased in the past two years, and 12 percent believe they've declined.\u003c/p>\n\u003cp>And many people still don't like the law.\u003c/p>\n\u003cp>Ivan Rivera, 29, from Miami, says he is opposed to Obamacare and is angry that he's required to get insurance.\u003c/p>\n\u003cp>He says he works hard, takes care of his own health and doesn't want to have to subsidize coverage for others.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We're paying for other people,\" he says. \"People that are not working. People who are not pulling their own weight.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Many+Dislike+Health+Care+System+But+Are+Pleased+With+Their+Own+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The United States has the most advanced health care in the world. There are gleaming medical centers across the country where doctors cure cancers, transplant organs and bring people back from near death.\u003c/p>\n\u003cp>But a \u003ca href=\"http://www.npr.org/sections/health-shots/2016/02/29/467980734/health-quality-an-issue-for-poor-2-years-into-obamacare-poll-finds\" target=\"_blank\">poll\u003c/a> conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health shows that only one-third of Americans say the health care they receive is \"excellent.\" Even fewer people are impressed with the system as a whole.\u003c/p>\n\u003cp>\"When you're talking about health care, we have this amazing kind of schizophrenia about our system,\" says \u003ca href=\"https://www.apha.org/about-apha/executive-board-and-staff/apha-executive-board/georges-c-benjamin-md-facp-fnapa-facep-hon-frsph\" target=\"_blank\">Dr. Georges Benjamin\u003c/a>, executive director of the American Public Health Association.\u003c/p>\n\u003cp>The split in thinking shows up in the poll numbers.\u003c/p>\n\u003cp>Much the way people hate Congress but love their own representatives, people like the care they receive while complaining about the system. About 80 percent say they get good or excellent care. But 42 percent rate the health care system in their state as fair or poor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We deliver the best medicine and nursing on the planet, no question about it. But it requires a lot of things,\" Benjamin says.\u003c/p>\n\u003cp>Things like an insurance card, filling out lots of forms, paying copays and deductibles, and running from doctor to lab to imaging center.\u003c/p>\n\u003cp>The system is wildly complex and hard to navigate, and can be very frustrating. Benjamin says it's this process of getting health care that people hate.\u003c/p>\n\u003cp>Just ask Cheryl Vaun, one of our poll respondents.\u003c/p>\n\u003cp>The 57-year-old from Albany, Ore., has a low opinion of the health care system after spending years trying to help her daughter who fell suddenly ill as a teenager.\u003c/p>\n\u003cp>The 16-year-old gained 30 pounds in about a month. She had migraines and her muscles would seize up in pain.\u003c/p>\n\u003cp>Vaun and her daughter went from doctor to doctor repeating the same tests and procedures. When doctors couldn't figure out what was wrong, they offered Vaun's daughter antidepressants.\u003c/p>\n\u003cp>\"We were pretty upset,\" she says. \"My daughter was devastated because obviously she's suffering all of these health issues and it was a bit terrifying.\"\u003c/p>\n\u003cp>Vaun's daughter was finally diagnosed with acute anemia.\u003c/p>\n\u003cp>If the problem had been caught earlier, Vaun believes her daughter could have recovered. Instead it has become a chronic condition that leaves her tired and weak. The treatment is iron pills or injections, which are hard on her system and leave her sick to her stomach.\u003c/p>\n\u003cp>Repeat tests, multiple doctor visits and lack of results erode people's faith in their care, says \u003ca href=\"http://www.allhealth.org/aboutus_staff.asp\" target=\"_blank\">Sarah Dash\u003c/a>, vice president for health policy at the \u003ca href=\"http://www.allhealth.org/\" target=\"_blank\">Alliance for Health Reform\u003c/a> in Washington, D.C.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-154912\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM.png\" alt=\"Screen Shot 2016-02-29 at 10.49.16 AM\" width=\"819\" height=\"355\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM.png 819w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-400x173.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-800x347.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-768x333.png 768w\" sizes=\"(max-width: 819px) 100vw, 819px\">\u003c/p>\n\u003cp>\"Health care hasn't always been designed with the needs and efficiency of the patient in mind,\" Dash says. \"It's designed for the various doctors and the health care system.\"\u003c/p>\n\u003cp>The poll, conducted from September to November, also shows that quality of care can depend heavily on a patient's income.\u003c/p>\n\u003cp>Adults with incomes below $25,000 a year are about three times as likely as higher income people — 34 percent versus 13 percent — to say the health care they personally receive is only fair or poor.\u003c/p>\n\u003cp>William Dale Coger, 52, is one of them. The carpenter from Oak Hill, W.Va., says he's been unable to get help for his back, which he injured about 15 years ago while hauling pipe out of a well on his property.\u003c/p>\n\u003cp>His pain, mild at first, has gotten worse over the years. These days, he struggles to get out of bed in the morning and finds his left leg is unstable and his left foot goes numb.\u003c/p>\n\u003cp>\"It's gotten to the point that this pain travels clear up my back into my shoulder blade into my left side of my neck and gives me migraine headaches sometimes into the left side of my head,\" Coger says.\u003c/p>\n\u003cp>He's on disability and Medicaid.\u003c/p>\n\u003cp>Coger sees doctors at a local clinic, but he says they don't take his back trouble seriously. They recommend exercise and offer ibuprofen. He thinks surgery would be able to help him but says doctors at the clinic refuse to order an MRI.\u003c/p>\n\u003cp>\"I want to be cured,\" he says. \"I don't want pills. I don't like pills.\"\u003c/p>\n\u003cp>Benjamin of the APHA says Coger and his doctors don't seem to have the same goal. They're managing his pain; he wants to get back to work.\u003c/p>\n\u003cp>\"It can be really frustrating if you don't understand the end goal of your care,\" Benjamin says.\u003c/p>\n\u003cp>Dash says the Affordable Care Act includes lots of\u003ca href=\"http://www.hlc.org/wp-content/uploads/2010/08/ACA-Pilot-Programs-and-Demonstration-Projects-Summary.pdf\" target=\"_blank\"> pilot projects\u003c/a> to improve how patients get care — and to make it cheaper. But those changes come slowly in a system that today is wildly complex.\u003c/p>\n\u003cp>And for most people, the law seems to have changed little.\u003c/p>\n\u003cp>The NPR poll shows 74 percent of people believe their health care has stayed about the same since the ACA was implemented. And for the minority who've seen a change, about 14 percent say their care is better while 9 percent say it's worse.\u003c/p>\n\u003cp>And most think the law has had no direct impact on them.\u003c/p>\n\u003cp>Even if they didn't buy a plan through the exchange, people have more insurance benefits than they did before. They get free screenings like mammograms and colonoscopies. Birth control is free. And they can still buy insurance even if they have a pre-existing medical condition.\u003c/p>\n\u003cp>Most people aren't aware of that, though. Our poll shows only 1 in 6 adults think their benefits have increased in the past two years, and 12 percent believe they've declined.\u003c/p>\n\u003cp>And many people still don't like the law.\u003c/p>\n\u003cp>Ivan Rivera, 29, from Miami, says he is opposed to Obamacare and is angry that he's required to get insurance.\u003c/p>\n\u003cp>He says he works hard, takes care of his own health and doesn't want to have to subsidize coverage for others.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We're paying for other people,\" he says. \"People that are not working. People who are not pulling their own weight.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Many+Dislike+Health+Care+System+But+Are+Pleased+With+Their+Own+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Your Obamacare Tax Form May Have Errors. Here's Help.",
"title": "Your Obamacare Tax Form May Have Errors. Here's Help.",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Millions of Californians will receive Obamacare-related tax forms this year for the first time — if they haven’t already — including 13 million people who had Medi-Cal coverage in 2015.\u003c/p>\n\u003cp>These forms, called 1095s will help you prove to the Tax Man you had health insurance last year and don’t owe the Obamacare tax penalty for being uninsured.\u003c/p>\n\u003cp>Or, ahem, they might not.\u003c/p>\n\u003cp>Last year, tens of thousands of Californians \u003ca href=\"http://centerforhealthreporting.org/article/obamacares-tax-time-lessons\" target=\"_blank\">received incorrect 1095s\u003c/a> from Covered California and struggled with the agency’s resolution process. Covered California pledges to do better this year.\u003c/p>\n\u003cp>But already, some Medi-Cal and Covered California enrollees are discovering errors, and they will have to wait for fixes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I received forms from both Covered California and Medi-Cal that were both completely inaccurate,” says Aimee Roolvink, 44, of Glendora.\u003c/p>\n\u003cp>“Good luck trying to file your taxes with forms that have inconsistent numbers.”\u003c/p>\n\u003cp>Today, I’ll explain who will receive the forms and what to do if they contain inaccuracies.\u003c/p>\n\u003cp>Let’s start with three points:\u003c/p>\n\u003cul>\n\u003cli>If you had a health plan through an insurance exchange such as Covered California last year, you must have a correct 1095-A form in hand to complete your taxes.\u003c/li>\n\u003cli>Most others, who had insurance from employers, the open market or government programs such as Medicare or Medi-Cal, will receive a 1095-B or 1095-C form. \u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals\" target=\"_blank\">You don’t need these in hand to do your taxes\u003c/a>.\u003c/li>\n\u003cli>If you had insurance from multiple sources last year, you may receive more than one 1095.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>1095-A\u003c/strong>\u003c/p>\n\u003cp>This form, which comes from health insurance exchanges, like Covered California, lists the amount of tax credits you received to help pay your premiums.\u003c/p>\n\u003cp>“In terms of taxes, these forms are the most critical,” says Debra Hammer of Intuit TurboTax.\u003c/p>\n\u003cp>Why?\u003c/p>\n\u003cp>When you enrolled in your plan, you were asked to estimate your 2015 income, which determined your federal tax credits. (Many people refer to these as \"subsidies.\") When you complete your taxes this year, you’ll have to report whether your actual income varied from your estimate.\u003c/p>\n\u003cp>Since most of you received your tax credits in advance, you may either owe or be owed money if there’s a difference.\u003c/p>\n\u003cp>So, if you find mistakes on your form, request corrections quickly.\u003c/p>\n\u003cp>For errors in your personal information — name, birthdate, Social Security Number or address — call Covered California at 800-300-1506.\u003c/p>\n\u003cp>If there’s a mistake in the amount of tax credits you received or which months you were covered, or if your form is missing household members, fill out a \u003ca href=\"https://forms.nintex.com/FormHost.aspx?id=FV63pH13AmOIN5ru6fPkreV5UeQCEdouFwhQpns6P1Bz2VdwzdHA8fVj71PmkluZw3PUHu7yCU4PLT5_auIlAG-pY1CcHP2O5_pxPl2dI6LAOdQvQ-9QE2dQhmCGu9RM&TZOffset=480&TZStdOffset=-480&HasDST=true\" target=\"_blank\">dispute form online\u003c/a> or call the same phone number to have the form filled out for you. You can find the dispute form via \u003ca href=\"http://www.coveredca.com/members/\" target=\"_blank\">www.CoveredCA.com/members\u003c/a>.\u003c/p>\n\u003cp>The agency says it will issue a corrected 1095-A within 60 days of submission, though it blew the deadline for many consumers last year.\u003c/p>\n\u003cp>\u003cstrong>1095-B and 1095-C\u003c/strong>\u003c/p>\n\u003cp>1095-B forms are distributed by government-sponsored health programs (like Medicare and Medi-Cal), some employers and health insurance companies for policies purchased outside exchanges.\u003c/p>\n\u003cp>1095-C forms are issued by large employers and generally follow the same rules as 1095-Bs.\u003c/p>\n\u003cp>\u003ca href=\"https://www.irs.gov/uac/Recent-Development-2015-12-29-2015-Forms-1095B-1094B-1095C-and-1094C\" target=\"_blank\">The IRS has extended to March 31\u003c/a> the deadline for sending the B and C forms to you.\u003c/p>\n\u003cp>These forms are primarily informational and show which months you had coverage.\u003c/p>\n\u003cp>If you have a B or C form and had insurance all of last year, you can just check a box on your tax return, Hammer says. If you didn’t, you may owe a tax penalty — \u003ca href=\"http://centerforhealthreporting.org/article/how-dodge-obamacare-tax-penalty-legally\" target=\"_blank\">unless you qualify for one of Obamacare’s many exemptions\u003c/a>.\u003c/p>\n\u003cp>But you still need to make sure your forms are accurate, because the information is transmitted to the IRS, she says.\u003c/p>\n\u003cp>The Department of Health Care Services (DHCS), which administers Medi-Cal, is among the agencies sending out 1095-B forms for the first time. The department has established a toll-free help line (844-253-0883) that received more than 11,000 calls in January and more than 23,000 since November.\u003c/p>\n\u003cp>Confusingly, that phone number isn’t for people who discover mistakes on their forms. For that, you must\u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx\" target=\"_blank\"> contact your county Medi-Cal office \u003c/a>to request a correction.\u003c/p>\n\u003cp>If you receive\u003ca href=\"https://www.ssa.gov/ssi/text-over-ussi.htm\" target=\"_blank\"> Supplemental Security Income \u003c/a>(SSI) or \u003ca href=\"http://www.cdss.ca.gov/agedblinddisabled/pg1422.htm\" target=\"_blank\">State Supplementary Payment \u003c/a>(SSP) benefits, you must contact the Social Security Administration to update your information before you request a corrected form from your county, the department says.\u003c/p>\n\u003cp>Some large counties have dedicated phone lines to handle changes to Medi-Cal cases, which may include 1095 form corrections, says Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California. Ask if your county is one.\u003c/p>\n\u003cp>But don’t expect quick action.\u003c/p>\n\u003cp>“In order to give the client … the revised information, the county needs to either be able to submit a request for a reprint to the state or print it out directly,” Senderling-McDonald says.\u003c/p>\n\u003cp>Counties can’t do that yet because the state computer system “has not been programmed to allow for reprints to be done,” she says.\u003c/p>\n\u003cp>That changes March 1 for information reportable to the IRS, says Tony Cava, DHCS spokesman. After that date, corrected forms will be mailed to consumers within 30 days of a request for fixes.\u003c/p>\n\u003cp>For information not reportable to the IRS, such as errors in personal information, replacement forms will be available starting April 1, he says.\u003c/p>\n\u003cp>Since that’s just two weeks before the tax filing deadline, it’s important to remember you can file your taxes while you await corrections to B and C forms.\u003c/p>\n\u003cp>“If you believe you had Medi-Cal for 10 months of the year, go ahead and fill out your tax form showing 10 months,” says Jen Flory, senior attorney at the Western Center on Law & Poverty.\u003c/p>\n\u003cp>If you’re among the Medi-Cal recipients who don’t have to file taxes because you earned less than the\u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Calculating-the-Payment\" target=\"_blank\"> tax filing threshold,\u003c/a> you still don’t have to file even if you receive a 1095-B form, Flory added. (However, you must file taxes if you receive a 1095-A, she noted.)\u003c/p>\n\u003cp>Roolvink, the Glendora resident, submitted her Covered California dispute form in January and has spent dozens of hours on the phone trying to reach someone in her county Medi-Cal office. She’s still waiting for corrections to both 1095 forms.\u003c/p>\n\u003cp>Her forms showed that her husband and two daughters were on Medi-Cal when they actually had Covered California plans, she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“To say this is a problem is really an understatement,” she says. “It’s been a nightmare.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Millions of Californians will receive Obamacare-related tax forms this year for the first time — if they haven’t already — including 13 million people who had Medi-Cal coverage in 2015.\u003c/p>\n\u003cp>These forms, called 1095s will help you prove to the Tax Man you had health insurance last year and don’t owe the Obamacare tax penalty for being uninsured.\u003c/p>\n\u003cp>Or, ahem, they might not.\u003c/p>\n\u003cp>Last year, tens of thousands of Californians \u003ca href=\"http://centerforhealthreporting.org/article/obamacares-tax-time-lessons\" target=\"_blank\">received incorrect 1095s\u003c/a> from Covered California and struggled with the agency’s resolution process. Covered California pledges to do better this year.\u003c/p>\n\u003cp>But already, some Medi-Cal and Covered California enrollees are discovering errors, and they will have to wait for fixes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I received forms from both Covered California and Medi-Cal that were both completely inaccurate,” says Aimee Roolvink, 44, of Glendora.\u003c/p>\n\u003cp>“Good luck trying to file your taxes with forms that have inconsistent numbers.”\u003c/p>\n\u003cp>Today, I’ll explain who will receive the forms and what to do if they contain inaccuracies.\u003c/p>\n\u003cp>Let’s start with three points:\u003c/p>\n\u003cul>\n\u003cli>If you had a health plan through an insurance exchange such as Covered California last year, you must have a correct 1095-A form in hand to complete your taxes.\u003c/li>\n\u003cli>Most others, who had insurance from employers, the open market or government programs such as Medicare or Medi-Cal, will receive a 1095-B or 1095-C form. \u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals\" target=\"_blank\">You don’t need these in hand to do your taxes\u003c/a>.\u003c/li>\n\u003cli>If you had insurance from multiple sources last year, you may receive more than one 1095.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>1095-A\u003c/strong>\u003c/p>\n\u003cp>This form, which comes from health insurance exchanges, like Covered California, lists the amount of tax credits you received to help pay your premiums.\u003c/p>\n\u003cp>“In terms of taxes, these forms are the most critical,” says Debra Hammer of Intuit TurboTax.\u003c/p>\n\u003cp>Why?\u003c/p>\n\u003cp>When you enrolled in your plan, you were asked to estimate your 2015 income, which determined your federal tax credits. (Many people refer to these as \"subsidies.\") When you complete your taxes this year, you’ll have to report whether your actual income varied from your estimate.\u003c/p>\n\u003cp>Since most of you received your tax credits in advance, you may either owe or be owed money if there’s a difference.\u003c/p>\n\u003cp>So, if you find mistakes on your form, request corrections quickly.\u003c/p>\n\u003cp>For errors in your personal information — name, birthdate, Social Security Number or address — call Covered California at 800-300-1506.\u003c/p>\n\u003cp>If there’s a mistake in the amount of tax credits you received or which months you were covered, or if your form is missing household members, fill out a \u003ca href=\"https://forms.nintex.com/FormHost.aspx?id=FV63pH13AmOIN5ru6fPkreV5UeQCEdouFwhQpns6P1Bz2VdwzdHA8fVj71PmkluZw3PUHu7yCU4PLT5_auIlAG-pY1CcHP2O5_pxPl2dI6LAOdQvQ-9QE2dQhmCGu9RM&TZOffset=480&TZStdOffset=-480&HasDST=true\" target=\"_blank\">dispute form online\u003c/a> or call the same phone number to have the form filled out for you. You can find the dispute form via \u003ca href=\"http://www.coveredca.com/members/\" target=\"_blank\">www.CoveredCA.com/members\u003c/a>.\u003c/p>\n\u003cp>The agency says it will issue a corrected 1095-A within 60 days of submission, though it blew the deadline for many consumers last year.\u003c/p>\n\u003cp>\u003cstrong>1095-B and 1095-C\u003c/strong>\u003c/p>\n\u003cp>1095-B forms are distributed by government-sponsored health programs (like Medicare and Medi-Cal), some employers and health insurance companies for policies purchased outside exchanges.\u003c/p>\n\u003cp>1095-C forms are issued by large employers and generally follow the same rules as 1095-Bs.\u003c/p>\n\u003cp>\u003ca href=\"https://www.irs.gov/uac/Recent-Development-2015-12-29-2015-Forms-1095B-1094B-1095C-and-1094C\" target=\"_blank\">The IRS has extended to March 31\u003c/a> the deadline for sending the B and C forms to you.\u003c/p>\n\u003cp>These forms are primarily informational and show which months you had coverage.\u003c/p>\n\u003cp>If you have a B or C form and had insurance all of last year, you can just check a box on your tax return, Hammer says. If you didn’t, you may owe a tax penalty — \u003ca href=\"http://centerforhealthreporting.org/article/how-dodge-obamacare-tax-penalty-legally\" target=\"_blank\">unless you qualify for one of Obamacare’s many exemptions\u003c/a>.\u003c/p>\n\u003cp>But you still need to make sure your forms are accurate, because the information is transmitted to the IRS, she says.\u003c/p>\n\u003cp>The Department of Health Care Services (DHCS), which administers Medi-Cal, is among the agencies sending out 1095-B forms for the first time. The department has established a toll-free help line (844-253-0883) that received more than 11,000 calls in January and more than 23,000 since November.\u003c/p>\n\u003cp>Confusingly, that phone number isn’t for people who discover mistakes on their forms. For that, you must\u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx\" target=\"_blank\"> contact your county Medi-Cal office \u003c/a>to request a correction.\u003c/p>\n\u003cp>If you receive\u003ca href=\"https://www.ssa.gov/ssi/text-over-ussi.htm\" target=\"_blank\"> Supplemental Security Income \u003c/a>(SSI) or \u003ca href=\"http://www.cdss.ca.gov/agedblinddisabled/pg1422.htm\" target=\"_blank\">State Supplementary Payment \u003c/a>(SSP) benefits, you must contact the Social Security Administration to update your information before you request a corrected form from your county, the department says.\u003c/p>\n\u003cp>Some large counties have dedicated phone lines to handle changes to Medi-Cal cases, which may include 1095 form corrections, says Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California. Ask if your county is one.\u003c/p>\n\u003cp>But don’t expect quick action.\u003c/p>\n\u003cp>“In order to give the client … the revised information, the county needs to either be able to submit a request for a reprint to the state or print it out directly,” Senderling-McDonald says.\u003c/p>\n\u003cp>Counties can’t do that yet because the state computer system “has not been programmed to allow for reprints to be done,” she says.\u003c/p>\n\u003cp>That changes March 1 for information reportable to the IRS, says Tony Cava, DHCS spokesman. After that date, corrected forms will be mailed to consumers within 30 days of a request for fixes.\u003c/p>\n\u003cp>For information not reportable to the IRS, such as errors in personal information, replacement forms will be available starting April 1, he says.\u003c/p>\n\u003cp>Since that’s just two weeks before the tax filing deadline, it’s important to remember you can file your taxes while you await corrections to B and C forms.\u003c/p>\n\u003cp>“If you believe you had Medi-Cal for 10 months of the year, go ahead and fill out your tax form showing 10 months,” says Jen Flory, senior attorney at the Western Center on Law & Poverty.\u003c/p>\n\u003cp>If you’re among the Medi-Cal recipients who don’t have to file taxes because you earned less than the\u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Calculating-the-Payment\" target=\"_blank\"> tax filing threshold,\u003c/a> you still don’t have to file even if you receive a 1095-B form, Flory added. (However, you must file taxes if you receive a 1095-A, she noted.)\u003c/p>\n\u003cp>Roolvink, the Glendora resident, submitted her Covered California dispute form in January and has spent dozens of hours on the phone trying to reach someone in her county Medi-Cal office. She’s still waiting for corrections to both 1095 forms.\u003c/p>\n\u003cp>Her forms showed that her husband and two daughters were on Medi-Cal when they actually had Covered California plans, she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Let’s say you have a son who develops a drug problem or becomes suicidal. His doctor says he needs extensive treatment at a residential mental health center. But your insurance company denies the coverage.\u003c/p>\n\u003cp>Consumers\u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForm.aspx#.Vs4EhfkrKUk\" target=\"_blank\"> can appeal those decisions \u003c/a>to California’s Department of Managed Health Care, which will review the insurance company’s decision and either uphold it or overturn it.\u003c/p>\n\u003cp>Under law, the agency has six days to complete an urgent review, upon receipt of a complete application. \u003ca href=\"http://www.psych-appeal.com/california-dmhc-sued-for-unlawful-handling-of-mental-health-appeals/\" target=\"_blank\"> A lawsuit \u003c/a>filed late Tuesday alleges that the agency routinely violates review deadlines, sometimes taking weeks or longer to render a decision.\u003c/p>\n\u003cp>“The consequences of not receiving a timely decision can be devastating,\" says Meiram Bendat, an attorney for the plaintiffs and president of Psych-Appeal, a mental health advocacy law firm. \"Patients must decide whether to pay for costly treatments out of pocket, with the very real possibility of not getting reimbursed – or simply say ‘no’ and forego the care they desperately need.\"\u003c/p>\n\u003cp>The Department of Managed Health Care regulates health insurance plans that cover 25 million Californians. The number of people affected by the urgent review process addressed in the lawsuit is relatively few. Last year, the agency reviewed 1,789 insurance denials for care; 508 were handled on a expedited basis; and 15 percent of those (78 cases) were for mental health conditions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The department would not comment on the lawsuit directly, but said its top priority is to protect the health care rights of consumers.\u003c/p>\n\u003cp>“We take our responsibility very seriously in assisting health care consumers to receive medically necessary care when they need it,\" said Rachel Arrezola, deputy director of communications.\u003c/p>\n\u003cp>The lawsuit was filed in Los Angeles Superior Court on behalf of Evolve Growth Initiatives, which operates adolescent mental health and substance abuse treatment facilities in California and New York.\u003c/p>\n\u003cp>Evolve CEO Mendi Baron says delays in rendering appeal decisions put mental health providers in an awkward position.\u003c/p>\n\u003cp>“Mental health providers often delay or terminate care instead of taking on the risks associated with these delayed appeals” Baron says. “While Evolve does not discharge patients pending appeals, we find that if they can’t pay for treatment themselves, many patients simply won’t stay in treatment.”\u003c/p>\n\u003cp>The lawsuit filed against the Department of Managed Health Care is unusual. Consumer health advocates recently applauded the agency for taking a hard line on enforcing \u003ca href=\"http://www.dol.gov/ebsa/mentalhealthparity/\" target=\"_blank\">mental health parity regulations \u003c/a>–- which require health insurers to provide mental health benefits equal to medical care. The agency fined Kaiser Permanente $4 million in 2013 for not providing patients timely access to mental health appointments and for effectively dissuading individual therapy. In 2014, Kaiser agreed to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">pay the fine\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“DMHC may tout mental health parity,” Baron said, “but its practices are making a mockery of actual mental health care.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Let’s say you have a son who develops a drug problem or becomes suicidal. His doctor says he needs extensive treatment at a residential mental health center. But your insurance company denies the coverage.\u003c/p>\n\u003cp>Consumers\u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForm.aspx#.Vs4EhfkrKUk\" target=\"_blank\"> can appeal those decisions \u003c/a>to California’s Department of Managed Health Care, which will review the insurance company’s decision and either uphold it or overturn it.\u003c/p>\n\u003cp>Under law, the agency has six days to complete an urgent review, upon receipt of a complete application. \u003ca href=\"http://www.psych-appeal.com/california-dmhc-sued-for-unlawful-handling-of-mental-health-appeals/\" target=\"_blank\"> A lawsuit \u003c/a>filed late Tuesday alleges that the agency routinely violates review deadlines, sometimes taking weeks or longer to render a decision.\u003c/p>\n\u003cp>“The consequences of not receiving a timely decision can be devastating,\" says Meiram Bendat, an attorney for the plaintiffs and president of Psych-Appeal, a mental health advocacy law firm. \"Patients must decide whether to pay for costly treatments out of pocket, with the very real possibility of not getting reimbursed – or simply say ‘no’ and forego the care they desperately need.\"\u003c/p>\n\u003cp>The Department of Managed Health Care regulates health insurance plans that cover 25 million Californians. The number of people affected by the urgent review process addressed in the lawsuit is relatively few. Last year, the agency reviewed 1,789 insurance denials for care; 508 were handled on a expedited basis; and 15 percent of those (78 cases) were for mental health conditions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The department would not comment on the lawsuit directly, but said its top priority is to protect the health care rights of consumers.\u003c/p>\n\u003cp>“We take our responsibility very seriously in assisting health care consumers to receive medically necessary care when they need it,\" said Rachel Arrezola, deputy director of communications.\u003c/p>\n\u003cp>The lawsuit was filed in Los Angeles Superior Court on behalf of Evolve Growth Initiatives, which operates adolescent mental health and substance abuse treatment facilities in California and New York.\u003c/p>\n\u003cp>Evolve CEO Mendi Baron says delays in rendering appeal decisions put mental health providers in an awkward position.\u003c/p>\n\u003cp>“Mental health providers often delay or terminate care instead of taking on the risks associated with these delayed appeals” Baron says. “While Evolve does not discharge patients pending appeals, we find that if they can’t pay for treatment themselves, many patients simply won’t stay in treatment.”\u003c/p>\n\u003cp>The lawsuit filed against the Department of Managed Health Care is unusual. Consumer health advocates recently applauded the agency for taking a hard line on enforcing \u003ca href=\"http://www.dol.gov/ebsa/mentalhealthparity/\" target=\"_blank\">mental health parity regulations \u003c/a>–- which require health insurers to provide mental health benefits equal to medical care. The agency fined Kaiser Permanente $4 million in 2013 for not providing patients timely access to mental health appointments and for effectively dissuading individual therapy. In 2014, Kaiser agreed to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">pay the fine\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“DMHC may tout mental health parity,” Baron said, “but its practices are making a mockery of actual mental health care.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How High-Cost Specialty Drugs Impact California",
"title": "How High-Cost Specialty Drugs Impact California",
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"content": "\u003cp id=\"3531\" class=\"graf--p graf-after--figure\">What’s behind the jaw-dropping cost of new “specialty drugs” like Orkambi, which has a sticker price of $259,000 per year for cystic fibrosis patients?\u003c/p>\n\u003cp id=\"4e0b\" class=\"graf--p graf-after--p\">Orkambi, which was approved by the U.S. Food and Drug Administration last July, is expected to take almost $36 million from the state’s general fund this fiscal year and next. Seventy-four Californians with health coverage under the Department of Health Care Services are estimated to receive the drug this year, and next year, 220 people will benefit, some of whom may be the same patients as this year. That does not include any discounts the state may receive from drug manufacturers.\u003c/p>\n\u003cp id=\"5b0e\" class=\"graf--p graf-after--p\">Orkambi is listed as a “specialty tier” drug in some private health plans. That category is reserved for high-cost drugs, or, in the \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/SpecialtyTierMethodology.pdf\" rel=\"nofollow\">federal government’s\u003c/a>view, for drugs that cost more than $600 a month and are used by a small proportion of patients.\u003c/p>\n\u003cp id=\"3924\" class=\"graf--p graf-after--p\">Specialty drugs are already proving to be a financial burden on one California agency, the California Public Employees’ Retirement System, which purchases health benefits for active and retired state workers. The state public pension system says that specialty drugs made up less than 1 percent of all prescriptions for its members but 30 percent of the total drugs costs in 2014.\u003c/p>\n\u003cp class=\"graf--p graf-after--p\">The health benefits from specialty drugs justify the cost, according to the pharmaceutical industry.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp id=\"ee28\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Patients are gaining access to medicines that are better treating their diseases or frankly even curing them,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA). “Patients are now healthier. They’re more productive. They’re functioning.”\u003c/p>\n\u003cp id=\"e169\" class=\"graf--p graf-after--p\">VanderVeer said companies price drugs not just on the cost of production, but on the value the industry believes the drug brings to the health care system, such as:\u003c/p>\n\u003cul class=\"postList\">\n\u003cli id=\"7b31\" class=\"graf--li graf-after--p\">Efficacy of the treatment\u003c/li>\n\u003cli id=\"b80b\" class=\"graf--li graf-after--li\">How it increases the quality or length of life\u003c/li>\n\u003cli id=\"5c88\" class=\"graf--li graf-after--li\">The “unmet need” in the drug market\u003c/li>\n\u003c/ul>\n\u003cp id=\"cc5b\" class=\"graf--p graf-after--li\">The price of the drug also accounts for the cost of developing other drugs and the high risk that a particular drug won’t make it to market, VanderVeer said. Only 12 percent of drugs that go through clinical trials get approved, according to PhRMA.\u003c/p>\n\u003cp id=\"ef58\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Because of that high rate of failures there would be no innovative incentive for companies to continue to try to invest” if they could not recoup costs and make a profit, VanderVeer said.\u003c/p>\n\u003cp id=\"93ab\" class=\"graf--p graf-after--p\">Finally, she added, the sticker price doesn’t reflect the final price paid for the drug, which can be heavily discounted through negotiations or because of mandated rebates for Medicaid programs.\u003c/p>\n\u003cp id=\"b00f\" class=\"graf--p graf-after--p\">[contextly_sidebar id=\"zzW5l7DTsYNjFFcWE84QTNvLSahLvtDx\"]Drugmakers are following the money, said Joel Hay, professor of pharmaceutical economics and policy at USC. Companies invest in specialty drugs that target a small population because their high price tags can be spread over a large insurance pool, he said.\u003c/p>\n\u003cp id=\"02e0\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">Even though specialty drugs are \"ridiculously expensive per treatment episode,\" Hay said, the cost for each member in a health plan is \"just a few cents.” Raising 10 cents on a diabetes drug, for example, would have a bigger budget impact, he said, because more people have diabetes than cystic fibrosis.\u003c/p>\n\u003cp id=\"14f9\" class=\"graf--p graf-after--p\">Hay says manufacturers are now less inclined to invest in drugs that treat millions of people, because there is more pushback on price.\u003c/p>\n\u003cp id=\"de1b\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Drug companies are for-profit companies obligated to make money for their stockholders,” Hay said. “They’re not virtuous charitable organizations.”\u003c/p>\n\u003cp id=\"708f\" class=\"graf--p graf-after--p\">Drugmakers are also investing more in treating uncommon illnesses because there is less competition and therefore more opportunity for profit, said Dr. Helene Lipton, professor of health policy at the School of Pharmacy and Institute for Health Policy Studies at UC San Francisco.\u003c/p>\n\u003cp id=\"f652\" class=\"graf--p graf-after--p\">The high price of the drugs affects patients, she noted, because health plans put controls on the drugs so that they’re used as a last resort.\u003c/p>\n\u003cp id=\"ed3c\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“That may mean going through two or more rounds of care with other medications before being able to use the specialty drug,” Lipton said.\u003c/p>\n\u003cp id=\"063c\" class=\"graf--p graf-after--p\">It’s not just specialty drugs that are straining health plans’ budgets, said Steve Miller, chief medical officer at Express Scripts, a pharmaceutical benefits manager that negotiates drug prices for 7.5 million Californians.\u003c/p>\n\u003cp id=\"0f47\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“The price of drugs is just continuing to go up,” said Miller, explaining that the trend is due to both new high-cost drugs coming on the market, and mark-ups of old drugs.\u003c/p>\n\u003cp class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">There’s been an explosion of drugs costing $100,000 a year over the last decade, for things like cystic fibrosis and cancer, Miller said. And there was a 127 percent price increase of branded drugs that had been on the market between 2008 and 2014, he says.\u003c/p>\n\u003cp id=\"0c65\" class=\"graf--p graf-after--p\">Limiting the cost of pharmaceuticals is the basis of a California ballot initiative scheduled to go before voters this November that would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp id=\"9370\" class=\"graf--p graf-after--p\">We’ll be exploring how a specialty drug’s cost affects patient access. If you are a chronic disease patient who is having difficulty getting specialty drugs, we’d like to hear from you. \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"mailto:Pauline@Calmatters.org\">email\u003c/a> us.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp id=\"f877\" class=\"graf--p graf-after--p graf--last\">\u003cem class=\"markup--em markup--p-em\">CALmatters is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">California Data\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">Fellowship,\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> a program of the \u003c/em>\u003cem class=\"markup--em markup--p-em\">\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/\" rel=\"nofollow\">Center for Health Journalism\u003c/a> \u003c/em>\u003cem class=\"markup--em markup--p-em\">at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"excerpt": "For starters, CalPERS says specialty drugs made up less than 1 percent of prescriptions for its members but 30 percent of total drugs costs in 2014.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp id=\"3531\" class=\"graf--p graf-after--figure\">What’s behind the jaw-dropping cost of new “specialty drugs” like Orkambi, which has a sticker price of $259,000 per year for cystic fibrosis patients?\u003c/p>\n\u003cp id=\"4e0b\" class=\"graf--p graf-after--p\">Orkambi, which was approved by the U.S. Food and Drug Administration last July, is expected to take almost $36 million from the state’s general fund this fiscal year and next. Seventy-four Californians with health coverage under the Department of Health Care Services are estimated to receive the drug this year, and next year, 220 people will benefit, some of whom may be the same patients as this year. That does not include any discounts the state may receive from drug manufacturers.\u003c/p>\n\u003cp id=\"5b0e\" class=\"graf--p graf-after--p\">Orkambi is listed as a “specialty tier” drug in some private health plans. That category is reserved for high-cost drugs, or, in the \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/SpecialtyTierMethodology.pdf\" rel=\"nofollow\">federal government’s\u003c/a>view, for drugs that cost more than $600 a month and are used by a small proportion of patients.\u003c/p>\n\u003cp id=\"3924\" class=\"graf--p graf-after--p\">Specialty drugs are already proving to be a financial burden on one California agency, the California Public Employees’ Retirement System, which purchases health benefits for active and retired state workers. The state public pension system says that specialty drugs made up less than 1 percent of all prescriptions for its members but 30 percent of the total drugs costs in 2014.\u003c/p>\n\u003cp class=\"graf--p graf-after--p\">The health benefits from specialty drugs justify the cost, according to the pharmaceutical industry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp id=\"ee28\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Patients are gaining access to medicines that are better treating their diseases or frankly even curing them,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA). “Patients are now healthier. They’re more productive. They’re functioning.”\u003c/p>\n\u003cp id=\"e169\" class=\"graf--p graf-after--p\">VanderVeer said companies price drugs not just on the cost of production, but on the value the industry believes the drug brings to the health care system, such as:\u003c/p>\n\u003cul class=\"postList\">\n\u003cli id=\"7b31\" class=\"graf--li graf-after--p\">Efficacy of the treatment\u003c/li>\n\u003cli id=\"b80b\" class=\"graf--li graf-after--li\">How it increases the quality or length of life\u003c/li>\n\u003cli id=\"5c88\" class=\"graf--li graf-after--li\">The “unmet need” in the drug market\u003c/li>\n\u003c/ul>\n\u003cp id=\"cc5b\" class=\"graf--p graf-after--li\">The price of the drug also accounts for the cost of developing other drugs and the high risk that a particular drug won’t make it to market, VanderVeer said. Only 12 percent of drugs that go through clinical trials get approved, according to PhRMA.\u003c/p>\n\u003cp id=\"ef58\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Because of that high rate of failures there would be no innovative incentive for companies to continue to try to invest” if they could not recoup costs and make a profit, VanderVeer said.\u003c/p>\n\u003cp id=\"93ab\" class=\"graf--p graf-after--p\">Finally, she added, the sticker price doesn’t reflect the final price paid for the drug, which can be heavily discounted through negotiations or because of mandated rebates for Medicaid programs.\u003c/p>\n\u003cp id=\"b00f\" class=\"graf--p graf-after--p\">\u003c/p>\u003cp>\u003c/p>\u003cp>Drugmakers are following the money, said Joel Hay, professor of pharmaceutical economics and policy at USC. Companies invest in specialty drugs that target a small population because their high price tags can be spread over a large insurance pool, he said.\u003c/p>\n\u003cp id=\"02e0\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">Even though specialty drugs are \"ridiculously expensive per treatment episode,\" Hay said, the cost for each member in a health plan is \"just a few cents.” Raising 10 cents on a diabetes drug, for example, would have a bigger budget impact, he said, because more people have diabetes than cystic fibrosis.\u003c/p>\n\u003cp id=\"14f9\" class=\"graf--p graf-after--p\">Hay says manufacturers are now less inclined to invest in drugs that treat millions of people, because there is more pushback on price.\u003c/p>\n\u003cp id=\"de1b\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Drug companies are for-profit companies obligated to make money for their stockholders,” Hay said. “They’re not virtuous charitable organizations.”\u003c/p>\n\u003cp id=\"708f\" class=\"graf--p graf-after--p\">Drugmakers are also investing more in treating uncommon illnesses because there is less competition and therefore more opportunity for profit, said Dr. Helene Lipton, professor of health policy at the School of Pharmacy and Institute for Health Policy Studies at UC San Francisco.\u003c/p>\n\u003cp id=\"f652\" class=\"graf--p graf-after--p\">The high price of the drugs affects patients, she noted, because health plans put controls on the drugs so that they’re used as a last resort.\u003c/p>\n\u003cp id=\"ed3c\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“That may mean going through two or more rounds of care with other medications before being able to use the specialty drug,” Lipton said.\u003c/p>\n\u003cp id=\"063c\" class=\"graf--p graf-after--p\">It’s not just specialty drugs that are straining health plans’ budgets, said Steve Miller, chief medical officer at Express Scripts, a pharmaceutical benefits manager that negotiates drug prices for 7.5 million Californians.\u003c/p>\n\u003cp id=\"0f47\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“The price of drugs is just continuing to go up,” said Miller, explaining that the trend is due to both new high-cost drugs coming on the market, and mark-ups of old drugs.\u003c/p>\n\u003cp class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">There’s been an explosion of drugs costing $100,000 a year over the last decade, for things like cystic fibrosis and cancer, Miller said. And there was a 127 percent price increase of branded drugs that had been on the market between 2008 and 2014, he says.\u003c/p>\n\u003cp id=\"0c65\" class=\"graf--p graf-after--p\">Limiting the cost of pharmaceuticals is the basis of a California ballot initiative scheduled to go before voters this November that would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp id=\"9370\" class=\"graf--p graf-after--p\">We’ll be exploring how a specialty drug’s cost affects patient access. If you are a chronic disease patient who is having difficulty getting specialty drugs, we’d like to hear from you. \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"mailto:Pauline@Calmatters.org\">email\u003c/a> us.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp id=\"f877\" class=\"graf--p graf-after--p graf--last\">\u003cem class=\"markup--em markup--p-em\">CALmatters is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">California Data\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">Fellowship,\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> a program of the \u003c/em>\u003cem class=\"markup--em markup--p-em\">\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/\" rel=\"nofollow\">Center for Health Journalism\u003c/a> \u003c/em>\u003cem class=\"markup--em markup--p-em\">at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Chief Rips UnitedHealth for Blaming Woes on Obamacare",
"title": "Covered California Chief Rips UnitedHealth for Blaming Woes on Obamacare",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Amid growing questions over the future of insurance exchanges, the head of California’s marketplace said the nation’s largest health insurer should take responsibility for nearly $1 billion in losses and stop blaming the federal health law.\u003c/p>\n\u003cp>In a blistering critique, Covered California’s executive director, Peter Lee, said UnitedHealth Group Inc. made a series of blunders on rates and networks that led to a $475 million loss last year on individual policies across the country. The company estimates a similar exchange-related loss of $500 million for this year.\u003c/p>\n\u003cp>“Instead of saying we screwed up, they said Obamacare is the problem and we may not play any more,” Lee said in an interview with California Healthline. “It was giving an excuse to Wall Street and throwing the Affordable Care Act under the bus.”\u003c/p>\n\u003cp>Lee, a staunch defender of the health law and a former official in the Obama administration, has tangled with UnitedHealth in the past. He knocked the company for sitting out the launch of Obamacare in 2014, then welcomed UnitedHealth into Covered California for 2016.\u003c/p>\n\u003cp>But now, he said, the company is “driving me bonkers” because it has “fed this political frenzy that Obamacare doesn’t work. It’s total spin and unanchored in reality.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A company spokesman declined to comment on Lee’s criticism, and referred to UnitedHealth’s previous statements on the exchange business.\u003c/p>\n\u003cp>During a Nov. 19 conference call with analysts, UnitedHealth’s CEO Stephen Hemsley said: “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself… I think that basically is an industry-wide proposition.”\u003c/p>\n\u003cp>An Urban Institute report issued last week, however, found that some of UnitedHealth’s troubles may have been self-inflicted. The company’s premiums were substantially higher than its competitors in many of the largest U.S. markets. The insurer also offered broader provider networks that tend to attract sicker customers who incur big medical bills.\u003c/p>\n\u003cp>In November, UnitedHealth surprised analysts and health-policy experts with its steep losses and said it might leave the exchanges altogether, just after expanding into new states. The sudden reversal prompted questions about the sustainability of the government-run marketplaces, the linchpin of President Obama’s signature law.\u003c/p>\n\u003cp>UnitedHealth reiterated its dour outlook for the exchange market when it announced quarterly results Jan. 19. The company said it has seen an influx of sicker patients during special enrollment, fewer healthy people signing up and costs rising as a result.\u003c/p>\n\u003cp>UnitedHealth ended last year with about 500,000 customers in the public exchanges, and it expects membership to grow to about 800,000 during the recent open enrollment. It has said it will decide by mid-year whether to continue selling in Obamacare marketplaces.\u003c/p>\n\u003cp>Other major insurers have expressed similar concerns about doing business in the public exchanges, albeit with less red ink than UnitedHealth.\u003c/p>\n\u003cp>Anthem Inc., the nation’s second-largest health insurer, said last week that its exchange enrollment in California and 13 other states was running about 30 percent below expectations, but the business was still slightly profitable. Anthem ended last year with 791,000 exchange members.\u003c/p>\n\u003cp>Monday, insurance giant Aetna Inc. said it lost up to $140 million, or a negative margin of 3 to 4 percent, on individual coverage last year. It has 1 million members with individual policies, about 75 percent of them on public exchanges. It said it expects to break even this year, however.\u003c/p>\n\u003cp>“Our individual commercial business ended the year with improved results,” Aetna’s chief executive, Mark Bertolini, said Monday during an earnings conference call. “Despite our improved finish, this business remained unprofitable in 2015 and we continue to have serious concerns about the sustainability of the public exchanges.”\u003c/p>\n\u003cp>Ana Gupte, a healthcare analyst at Leerink Partners, said UnitedHealth and other insurers have valid complaints about the exchange market. But she acknowledged that UnitedHealth’s decision to sit out the exchanges during the first year in 2014 may have hurt the company, too.\u003c/p>\n\u003cp>“United was newer to the marketplaces than other companies, and the other guys incorporated lessons learned,” she said. “But there are broader issues. There are some changes needed from a policy perspective so all of these players can remain in the market for 2017.”\u003c/p>\n\u003cp>Gupte cited the need for federal officials to tighten the rules for special enrollment and revisit a risk adjustment program that compensates insurers for taking on costlier patients.\u003c/p>\n\u003cp>In response to industry criticism, the Obama administration is taking steps to prevent the misuse of special enrollment so people can’t wait to sign up until they need care. Special enrollment is designed for people who lose coverage or need to make a change because of an event in their life, such as moving, getting married or having a child.\u003c/p>\n\u003cp>Insurance markets can’t function properly without enough healthy customers paying premiums, which are used to cover expenses incurred by sicker policyholders. The three-month open enrollment period for the federal and state exchanges just ended Jan. 31. California extended its deadline to Feb. 6 for people who already had begun the sign-up process by Sunday.\u003c/p>\n\u003cp>John Holahan, a health-policy researcher at the Urban Institute, said the Obama administration does need to impose stricter rules for special enrollment. He also said concerns over affordability have hampered enrollment since some middle-class consumers and young, healthy people are put off by high premiums and large deductibles.\u003c/p>\n\u003cp>“But I haven’t seen anything that shows the exchanges are really in trouble,” Holahan said. “That doesn’t mean every insurer is going to make it. Some companies don’t make it, and that isn’t a sign markets are unsustainable.”\u003c/p>\n\u003cp>The U.S. Department of Health and Human Services expects about 10 million people to be enrolled in federal and state exchanges at the end of 2016. That’s far below previous government forecasts.\u003c/p>\n\u003cp>UnitedHealth sat out Covered California for the first two years before joining in several rural areas. Lee said both sides will be analyzing whether the company returns for 2017. As an active purchaser, Covered California can decide whether or not to contract with certain health plans and allow them on the state exchange.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“United will be looking at what their prospects are in California,” Lee said. “We will be looking at United as a plan to see if they offer good value for Californians. It’s to be determined on both ends.”\u003c/p>\n\n",
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"excerpt": "Covered California’s executive director, Peter Lee, said UnitedHealth made its own series of blunders that led to a $475 million loss last year.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Amid growing questions over the future of insurance exchanges, the head of California’s marketplace said the nation’s largest health insurer should take responsibility for nearly $1 billion in losses and stop blaming the federal health law.\u003c/p>\n\u003cp>In a blistering critique, Covered California’s executive director, Peter Lee, said UnitedHealth Group Inc. made a series of blunders on rates and networks that led to a $475 million loss last year on individual policies across the country. The company estimates a similar exchange-related loss of $500 million for this year.\u003c/p>\n\u003cp>“Instead of saying we screwed up, they said Obamacare is the problem and we may not play any more,” Lee said in an interview with California Healthline. “It was giving an excuse to Wall Street and throwing the Affordable Care Act under the bus.”\u003c/p>\n\u003cp>Lee, a staunch defender of the health law and a former official in the Obama administration, has tangled with UnitedHealth in the past. He knocked the company for sitting out the launch of Obamacare in 2014, then welcomed UnitedHealth into Covered California for 2016.\u003c/p>\n\u003cp>But now, he said, the company is “driving me bonkers” because it has “fed this political frenzy that Obamacare doesn’t work. It’s total spin and unanchored in reality.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A company spokesman declined to comment on Lee’s criticism, and referred to UnitedHealth’s previous statements on the exchange business.\u003c/p>\n\u003cp>During a Nov. 19 conference call with analysts, UnitedHealth’s CEO Stephen Hemsley said: “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself… I think that basically is an industry-wide proposition.”\u003c/p>\n\u003cp>An Urban Institute report issued last week, however, found that some of UnitedHealth’s troubles may have been self-inflicted. The company’s premiums were substantially higher than its competitors in many of the largest U.S. markets. The insurer also offered broader provider networks that tend to attract sicker customers who incur big medical bills.\u003c/p>\n\u003cp>In November, UnitedHealth surprised analysts and health-policy experts with its steep losses and said it might leave the exchanges altogether, just after expanding into new states. The sudden reversal prompted questions about the sustainability of the government-run marketplaces, the linchpin of President Obama’s signature law.\u003c/p>\n\u003cp>UnitedHealth reiterated its dour outlook for the exchange market when it announced quarterly results Jan. 19. The company said it has seen an influx of sicker patients during special enrollment, fewer healthy people signing up and costs rising as a result.\u003c/p>\n\u003cp>UnitedHealth ended last year with about 500,000 customers in the public exchanges, and it expects membership to grow to about 800,000 during the recent open enrollment. It has said it will decide by mid-year whether to continue selling in Obamacare marketplaces.\u003c/p>\n\u003cp>Other major insurers have expressed similar concerns about doing business in the public exchanges, albeit with less red ink than UnitedHealth.\u003c/p>\n\u003cp>Anthem Inc., the nation’s second-largest health insurer, said last week that its exchange enrollment in California and 13 other states was running about 30 percent below expectations, but the business was still slightly profitable. Anthem ended last year with 791,000 exchange members.\u003c/p>\n\u003cp>Monday, insurance giant Aetna Inc. said it lost up to $140 million, or a negative margin of 3 to 4 percent, on individual coverage last year. It has 1 million members with individual policies, about 75 percent of them on public exchanges. It said it expects to break even this year, however.\u003c/p>\n\u003cp>“Our individual commercial business ended the year with improved results,” Aetna’s chief executive, Mark Bertolini, said Monday during an earnings conference call. “Despite our improved finish, this business remained unprofitable in 2015 and we continue to have serious concerns about the sustainability of the public exchanges.”\u003c/p>\n\u003cp>Ana Gupte, a healthcare analyst at Leerink Partners, said UnitedHealth and other insurers have valid complaints about the exchange market. But she acknowledged that UnitedHealth’s decision to sit out the exchanges during the first year in 2014 may have hurt the company, too.\u003c/p>\n\u003cp>“United was newer to the marketplaces than other companies, and the other guys incorporated lessons learned,” she said. “But there are broader issues. There are some changes needed from a policy perspective so all of these players can remain in the market for 2017.”\u003c/p>\n\u003cp>Gupte cited the need for federal officials to tighten the rules for special enrollment and revisit a risk adjustment program that compensates insurers for taking on costlier patients.\u003c/p>\n\u003cp>In response to industry criticism, the Obama administration is taking steps to prevent the misuse of special enrollment so people can’t wait to sign up until they need care. Special enrollment is designed for people who lose coverage or need to make a change because of an event in their life, such as moving, getting married or having a child.\u003c/p>\n\u003cp>Insurance markets can’t function properly without enough healthy customers paying premiums, which are used to cover expenses incurred by sicker policyholders. The three-month open enrollment period for the federal and state exchanges just ended Jan. 31. California extended its deadline to Feb. 6 for people who already had begun the sign-up process by Sunday.\u003c/p>\n\u003cp>John Holahan, a health-policy researcher at the Urban Institute, said the Obama administration does need to impose stricter rules for special enrollment. He also said concerns over affordability have hampered enrollment since some middle-class consumers and young, healthy people are put off by high premiums and large deductibles.\u003c/p>\n\u003cp>“But I haven’t seen anything that shows the exchanges are really in trouble,” Holahan said. “That doesn’t mean every insurer is going to make it. Some companies don’t make it, and that isn’t a sign markets are unsustainable.”\u003c/p>\n\u003cp>The U.S. Department of Health and Human Services expects about 10 million people to be enrolled in federal and state exchanges at the end of 2016. That’s far below previous government forecasts.\u003c/p>\n\u003cp>UnitedHealth sat out Covered California for the first two years before joining in several rural areas. Lee said both sides will be analyzing whether the company returns for 2017. As an active purchaser, Covered California can decide whether or not to contract with certain health plans and allow them on the state exchange.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Open enrollment for 2016 ends Sunday for those who buy health plans from Covered California or other state exchanges.\u003c/p>\n\u003cp>But if you don’t act by the deadline, are you completely out of luck?\u003c/p>\n\u003cp>Not necessarily. If you lose your job, have a new child in the family or experience another qualifying life event, you are likely eligible for a special-enrollment period during the year.\u003c/p>\n\u003cp>Another option is a short-term health plan.\u003c/p>\n\u003cp>These plans last less than a year, have lower premiums than regular ones and often come with beefier doctor and hospital networks.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For some people — especially those who are young, healthy and don’t qualify for a tax credit from Covered California or other health insurance marketplace — short-term plans might make financial sense, even though they don’t shield you from the Obamacare tax penalty.\u003c/p>\n\u003cp>“Depending on your age and income level, you could get one of these plans, pay the uninsured tax penalty and still pay less than if you had purchased” a comprehensive plan, says Kev Coleman, head of research and data for \u003ca href=\"https://www.healthpocket.com/\" target=\"_blank\">HealthPocket\u003c/a>, a health insurance comparison website based in Mountain View.\u003c/p>\n\u003cp>If this sounds too good to be true, it probably is for most people.\u003c/p>\n\u003cp>Short-term plans won’t cover your pre-existing conditions and they don’t offer coverage for certain medical services.\u003c/p>\n\u003cp>“If you get cancer or something really serious, you’re going to want really robust health insurance,” says Nate Purpura, vice president of consumer affairs for \u003ca href=\"https://www.ehealthinsurance.com/\" target=\"_blank\">eHealth.com\u003c/a>, a private online health insurance marketplace also based in Mountain View. “And you don’t want to pay the tax penalty.”\u003c/p>\n\u003cp>Before the Affordable Care Act (ACA) took effect, short-term plans -- also called “\u003ca href=\"https://www.agilehealthinsurance.com/term-health-insurance/health-insurance-learning-center/what-is-term-health-insurance\" target=\"_blank\">term health insurance\u003c/a>\" -- were purchased primarily by people between jobs, by those waiting for their new job-based insurance to kick in or by recent college graduates.\u003c/p>\n\u003cp>“They were designed to be transitional coverage, not a permanent type of insurance product,” Purpura says.\u003c/p>\n\u003cp>But since the law’s major provisions took effect in 2014, eHealth and other insurance retailers report that sales of short-term plans are picking up. Affordability is the biggest selling point, they say.\u003c/p>\n\u003cp>If your income doesn’t qualify you for a tax credit to help pay for insurance from \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> (or another health insurance exchange), premiums can be expensive. Even with a subsidy, you still may owe hundreds each month for coverage.\u003c/p>\n\u003cp>“There are several million people nationally who don’t get subsidies. That’s basically the growth engine for the term health insurance market,” Coleman says.\u003c/p>\n\u003cp>The tax penalty hasn’t deterred some people from signing up for short-term plans, especially the young and healthy: 18- to 34-year-olds accounted for more than half the buyers of short-term plans last year at both eHealth and \u003ca href=\"https://www.agilehealthinsurance.com/\" target=\"_blank\">AgileHealthInsurance.com\u003c/a>, another Mountain view-based company, which sells only short-term health insurance plans.\u003c/p>\n\u003cp>“The biggest demographic is millennials,” says Sam Gibbs, Agile’s executive director. That is, the same young and healthy people considered key to the stability and success of the ACA’s health insurance exchanges.\u003c/p>\n\u003cp>George Goldman, a 22-year-old Century City resident, dropped his regular health insurance plan early last year because he was paying $300 a month for coverage he didn’t think he needed.\u003c/p>\n\u003cp>“It was a financial decision,” he says. “I don’t care if I’m fined.”\u003c/p>\n\u003cp>Later in the year, however, Goldman became nervous without coverage and purchased a short-term plan from eHealth for the final months of 2015. It cost a little over $200 a month, and covered a visit to the emergency room.\u003c/p>\n\u003cp>This year, he enrolled in a regular health plan again because he thought he was taking on too much risk. “It’s still a financial burden, but when you need it, you need it,” he says.\u003c/p>\n\u003cp>Before you try a short-term plan, consider the pros and cons:\u003c/p>\n\u003cp>\u003cstrong>PROS\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>You can buy them any time of year.\u003c/li>\n\u003cli>Their premiums are generally lower than major medical insurance plans. The average premium for short-term plans sold by eHealth in California last year was $177 per month, Purpura says.\u003c/li>\n\u003cli>They may have broader networks of doctors and hospitals than some plans available from exchanges.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>CONS\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>They won’t accept you if you have pre-existing conditions, or if they do, they won’t cover them.\u003c/li>\n\u003cli>They may not cover benefits such as maternity care, preventive services or prescription drugs. Some may offer drug or dental discount plans, but those aren’t the same as insurance.\u003c/li>\n\u003cli>They last less than a year and you have to reapply at the end of each term. There’s no guarantee you’ll be accepted again, especially if you got seriously ill while you had coverage.\u003c/li>\n\u003c/ul>\n\u003cp>“Term health insurance isn’t good for someone who has chronic health conditions or who takes expensive medications,” Coleman says.\u003c/p>\n\u003cp>If you think it will be cheaper to buy a short-term plan and pay the ACA tax, make sure you’re using the correct equation.\u003c/p>\n\u003cp>\u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Calculating-the-Payment\" target=\"_blank\">For the 2016 tax year\u003c/a>, the tax penalty grows to $695 per adult or 2.5 percent of annual household income, \u003cem>whichever is greater\u003c/em>. “\u003ca href=\"https://californiahealthline.wordpress.com/news/more-time-to-avoid-the-obamacare-tax-penalty/\" target=\"_blank\">Whichever is greater\u003c/a>” means you could owe thousands of dollars.\u003c/p>\n\u003cp>In general, health consumer advocates warn against short-term plans and urge you to see if you qualify for a \u003ca href=\"http://www.lifescript.com/health/centers/health_care/navigating_the_system/8_ways_to_get_health_insurance_even_if_you_missed_open_enrollment.aspx\" target=\"_blank\">special-enrollment period\u003c/a> to get a full-fledged plan. Though the federal government says it will \u003ca href=\"http://khn.org/morning-breakout/after-insurer-outcry-feds-offer-rules-to-rein-in-special-enrollment-sign-ups/\" target=\"_blank\">tighten the rules\u003c/a> governing special-enrollment periods, many of you still will qualify if you have legitimate qualifying life events.\u003c/p>\n\u003cp>“If you have an alternative to get regular health insurance, certainly try that first,” urges Cheryl Fish-Parcham, private insurance program director for \u003ca href=\"http://familiesusa.org/\" target=\"_blank\">Families USA\u003c/a>.\u003c/p>\n\u003cp>Finally, if you do have short-term insurance and aren’t happy with the level of care or service, contact the plan first. If you’re still having trouble, reach out to the \u003ca href=\"http://www.insurance.ca.gov/\" target=\"_blank\">California Department of Insurance\u003c/a> (800-927-4357).\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California HealthCare Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Open enrollment for 2016 ends Sunday for those who buy health plans from Covered California or other state exchanges.\u003c/p>\n\u003cp>But if you don’t act by the deadline, are you completely out of luck?\u003c/p>\n\u003cp>Not necessarily. If you lose your job, have a new child in the family or experience another qualifying life event, you are likely eligible for a special-enrollment period during the year.\u003c/p>\n\u003cp>Another option is a short-term health plan.\u003c/p>\n\u003cp>These plans last less than a year, have lower premiums than regular ones and often come with beefier doctor and hospital networks.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For some people — especially those who are young, healthy and don’t qualify for a tax credit from Covered California or other health insurance marketplace — short-term plans might make financial sense, even though they don’t shield you from the Obamacare tax penalty.\u003c/p>\n\u003cp>“Depending on your age and income level, you could get one of these plans, pay the uninsured tax penalty and still pay less than if you had purchased” a comprehensive plan, says Kev Coleman, head of research and data for \u003ca href=\"https://www.healthpocket.com/\" target=\"_blank\">HealthPocket\u003c/a>, a health insurance comparison website based in Mountain View.\u003c/p>\n\u003cp>If this sounds too good to be true, it probably is for most people.\u003c/p>\n\u003cp>Short-term plans won’t cover your pre-existing conditions and they don’t offer coverage for certain medical services.\u003c/p>\n\u003cp>“If you get cancer or something really serious, you’re going to want really robust health insurance,” says Nate Purpura, vice president of consumer affairs for \u003ca href=\"https://www.ehealthinsurance.com/\" target=\"_blank\">eHealth.com\u003c/a>, a private online health insurance marketplace also based in Mountain View. “And you don’t want to pay the tax penalty.”\u003c/p>\n\u003cp>Before the Affordable Care Act (ACA) took effect, short-term plans -- also called “\u003ca href=\"https://www.agilehealthinsurance.com/term-health-insurance/health-insurance-learning-center/what-is-term-health-insurance\" target=\"_blank\">term health insurance\u003c/a>\" -- were purchased primarily by people between jobs, by those waiting for their new job-based insurance to kick in or by recent college graduates.\u003c/p>\n\u003cp>“They were designed to be transitional coverage, not a permanent type of insurance product,” Purpura says.\u003c/p>\n\u003cp>But since the law’s major provisions took effect in 2014, eHealth and other insurance retailers report that sales of short-term plans are picking up. Affordability is the biggest selling point, they say.\u003c/p>\n\u003cp>If your income doesn’t qualify you for a tax credit to help pay for insurance from \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> (or another health insurance exchange), premiums can be expensive. Even with a subsidy, you still may owe hundreds each month for coverage.\u003c/p>\n\u003cp>“There are several million people nationally who don’t get subsidies. That’s basically the growth engine for the term health insurance market,” Coleman says.\u003c/p>\n\u003cp>The tax penalty hasn’t deterred some people from signing up for short-term plans, especially the young and healthy: 18- to 34-year-olds accounted for more than half the buyers of short-term plans last year at both eHealth and \u003ca href=\"https://www.agilehealthinsurance.com/\" target=\"_blank\">AgileHealthInsurance.com\u003c/a>, another Mountain view-based company, which sells only short-term health insurance plans.\u003c/p>\n\u003cp>“The biggest demographic is millennials,” says Sam Gibbs, Agile’s executive director. That is, the same young and healthy people considered key to the stability and success of the ACA’s health insurance exchanges.\u003c/p>\n\u003cp>George Goldman, a 22-year-old Century City resident, dropped his regular health insurance plan early last year because he was paying $300 a month for coverage he didn’t think he needed.\u003c/p>\n\u003cp>“It was a financial decision,” he says. “I don’t care if I’m fined.”\u003c/p>\n\u003cp>Later in the year, however, Goldman became nervous without coverage and purchased a short-term plan from eHealth for the final months of 2015. It cost a little over $200 a month, and covered a visit to the emergency room.\u003c/p>\n\u003cp>This year, he enrolled in a regular health plan again because he thought he was taking on too much risk. “It’s still a financial burden, but when you need it, you need it,” he says.\u003c/p>\n\u003cp>Before you try a short-term plan, consider the pros and cons:\u003c/p>\n\u003cp>\u003cstrong>PROS\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>You can buy them any time of year.\u003c/li>\n\u003cli>Their premiums are generally lower than major medical insurance plans. The average premium for short-term plans sold by eHealth in California last year was $177 per month, Purpura says.\u003c/li>\n\u003cli>They may have broader networks of doctors and hospitals than some plans available from exchanges.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>CONS\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>They won’t accept you if you have pre-existing conditions, or if they do, they won’t cover them.\u003c/li>\n\u003cli>They may not cover benefits such as maternity care, preventive services or prescription drugs. Some may offer drug or dental discount plans, but those aren’t the same as insurance.\u003c/li>\n\u003cli>They last less than a year and you have to reapply at the end of each term. There’s no guarantee you’ll be accepted again, especially if you got seriously ill while you had coverage.\u003c/li>\n\u003c/ul>\n\u003cp>“Term health insurance isn’t good for someone who has chronic health conditions or who takes expensive medications,” Coleman says.\u003c/p>\n\u003cp>If you think it will be cheaper to buy a short-term plan and pay the ACA tax, make sure you’re using the correct equation.\u003c/p>\n\u003cp>\u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Calculating-the-Payment\" target=\"_blank\">For the 2016 tax year\u003c/a>, the tax penalty grows to $695 per adult or 2.5 percent of annual household income, \u003cem>whichever is greater\u003c/em>. “\u003ca href=\"https://californiahealthline.wordpress.com/news/more-time-to-avoid-the-obamacare-tax-penalty/\" target=\"_blank\">Whichever is greater\u003c/a>” means you could owe thousands of dollars.\u003c/p>\n\u003cp>In general, health consumer advocates warn against short-term plans and urge you to see if you qualify for a \u003ca href=\"http://www.lifescript.com/health/centers/health_care/navigating_the_system/8_ways_to_get_health_insurance_even_if_you_missed_open_enrollment.aspx\" target=\"_blank\">special-enrollment period\u003c/a> to get a full-fledged plan. Though the federal government says it will \u003ca href=\"http://khn.org/morning-breakout/after-insurer-outcry-feds-offer-rules-to-rein-in-special-enrollment-sign-ups/\" target=\"_blank\">tighten the rules\u003c/a> governing special-enrollment periods, many of you still will qualify if you have legitimate qualifying life events.\u003c/p>\n\u003cp>“If you have an alternative to get regular health insurance, certainly try that first,” urges Cheryl Fish-Parcham, private insurance program director for \u003ca href=\"http://familiesusa.org/\" target=\"_blank\">Families USA\u003c/a>.\u003c/p>\n\u003cp>Finally, if you do have short-term insurance and aren’t happy with the level of care or service, contact the plan first. If you’re still having trouble, reach out to the \u003ca href=\"http://www.insurance.ca.gov/\" target=\"_blank\">California Department of Insurance\u003c/a> (800-927-4357).\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California HealthCare Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Doles Out Millions to Insurers for Hepatitis C Drugs",
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"content": "\u003cp>In an unusual funding arrangement, California is paying private health plans hundreds of millions of dollars in supplemental payments to cover the high price of hepatitis C drugs for patients in Medi-Cal managed care plans.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Dollars that were intended for a wide array of medical services started being gobbled up by just one drug.'\u003ccite>Charles Bacchi, California Association of Health Plans\u003c/cite>\u003c/aside>\n\u003cp>While Medi-Cal is California's program of health insurance for people who are low income, nearly 80 percent of beneficiaries are in managed care plans run by private health insurance companies. The companies are paid a flat rate per member each month to cover all health care needs.\u003c/p>\n\u003cp>The funding agreement was reached after health plans raised \"alarm\" over the high cost of new hepatitis C drugs and plans had to dig into reserves because of the drugs' cost, says Charles Bacchi, president of the California Association of Health Plans, an industry trade group.\u003c/p>\n\u003cp>“Dollars that were intended for a wide array of medical services started being gobbled up by just one drug,” Bacchi said.\u003c/p>\n\u003cp>A spokesperson for the state's Department of Health Care Services says it's the first time the state has paid health plans a supplemental money just to cover the high cost of a drug. Specifically, Sovaldi, a hepatitis C drug retailing at $1,000 per pill, has sent \u003ca href=\"http://www.wsj.com/articles/gileads-1-000-hep-c-pill-is-hard-for-states-to-swallow-1428525426\" target=\"_blank\">treatment prices soaring.\u003c/a> The drug is made by Gilead Sciences in Foster City.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Although the members of Bacchi’s trade group directly benefit from the supplemental payments, he says the additional money is not a “sustainable” solution to the underlying problem of high-priced drugs.\u003c/p>\n\u003cp>Here are some of the details about the supplemental government funding stream to Medi-Cal plans:\u003c/p>\n\u003cul>\n\u003cli>Health plans invoiced California for $387.5 million for hepatitis C drugs between July 2014 and November 2015, according to the California Department of Health Care Services. The payments come from a mix of federal and state dollars.\u003c/li>\n\u003cli>During that time period, 3,624 Medi-Cal managed care members with hepatitis C were treated.\u003c/li>\n\u003cli>By CALmatters' calculations, the payments amount to $106,926 per patient. The number reflects other drugs used to treat hepatitis C, and isn’t solely the price of Sovaldi and Harvoni, another new, pricey drug to treat hepatis C.\u003c/li>\n\u003cli>Payments to plans are expected to continue in the next fiscal year. The California Department of Health Care Services has budgeted $303.4 million for health plans for 2016–17.\u003c/li>\n\u003c/ul>\n\u003cp>While California will receive some money back from drugmakers in the form of rebates, the ultimate price the state pays for the drugs is confidential, according to the Department of Health Care Services.\u003c/p>\n\u003cp>Limiting the cost of pharmaceuticals is the basis of a \u003ca href=\"http://www.sos.ca.gov/administration/news-releases-and-advisories/2015-news-releases-and-advisories/new-measure-eligible-californias-november-2016-ballot3/\" target=\"_blank\">ballot initiative\u003c/a> expected to be before California voters this November. The proposal would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp>The state health care agency says its payments to insurers of Medi-Cal patients for hepatitis C drugs are a “very unique” solution, one that they may use for other high-cost drugs in the future. The state says the current hepatitis C payments may be reassessed in a year or two as it expects the price of the drugs to go down.\u003c/p>\n\u003cp>“As the prescribing of the drugs levels off, as the population and the overall nature of who’s getting it settles down, we may get to a point where we look at carving that responsibility back into the plans’ … rate,” said Jennifer Kent, director of the California Department of Health Care Services.\u003c/p>\n\u003cp>But California’s spending on hepatitis C drugs doesn’t end there.\u003c/p>\n\u003cp>For the rest of the Medi-Cal population — the 2.7 million people who are not in a private managed care plan and whose health care services are directly reimbursed by the state — a \u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.finance.senate.gov/ranking-members-news/wyden-grassley-sovaldi-investigation-finds-revenue-driven-pricing-strategy-behind-84-000-hepatitis-drug\" target=\"_blank\" rel=\"nofollow\">U.S. Senate Finance Committee\u003c/a> reports the following for the year 2014:\u003c/p>\n\u003cul>\n\u003cli>California paid almost $22 million to treat 280 hepatitis C patients with Sovaldi.\u003c/li>\n\u003cli>California paid more than $2.8 million for 57 Harvoni prescriptions.\u003c/li>\n\u003c/ul>\n\u003cp>According to the U.S. Senate report, 237,000 people in Medi-Cal are infected with hepatitis C. So, doing the math between the 3,624 managed care patients and the 337 covered directly by the state, means less than 2 percent of those infected have been treated with the new drugs -- at a cost of hundreds of millions of dollars already.\u003c/p>\n\u003cp>“In order for taxpayers of the state of California to afford to provide people the necessary treatments,” says Bacchi, “we have to have drug pricing society can afford to pay.”\u003c/p>\n\u003cp>At CALmatters, \u003ca href=\"https://medium.com/california-s-legal-drug-dilemma/the-obscurity-of-drug-spending-in-medi-cal-4ccf1df97392#.ii6y9pxr6\" target=\"_blank\">we’re exploring how a drug’s cost affects patient access.\u003c/a> If you are a hepatitis C patient, or other chronic disease patient who is having difficulty getting drugs, we’d like to hear from you.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" target=\"_blank\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://pauline@calmatters.org/\" rel=\"nofollow\">email us\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In an unusual funding arrangement, California is paying private health plans hundreds of millions of dollars in supplemental payments to cover the high price of hepatitis C drugs for patients in Medi-Cal managed care plans.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Dollars that were intended for a wide array of medical services started being gobbled up by just one drug.'\u003ccite>Charles Bacchi, California Association of Health Plans\u003c/cite>\u003c/aside>\n\u003cp>While Medi-Cal is California's program of health insurance for people who are low income, nearly 80 percent of beneficiaries are in managed care plans run by private health insurance companies. The companies are paid a flat rate per member each month to cover all health care needs.\u003c/p>\n\u003cp>The funding agreement was reached after health plans raised \"alarm\" over the high cost of new hepatitis C drugs and plans had to dig into reserves because of the drugs' cost, says Charles Bacchi, president of the California Association of Health Plans, an industry trade group.\u003c/p>\n\u003cp>“Dollars that were intended for a wide array of medical services started being gobbled up by just one drug,” Bacchi said.\u003c/p>\n\u003cp>A spokesperson for the state's Department of Health Care Services says it's the first time the state has paid health plans a supplemental money just to cover the high cost of a drug. Specifically, Sovaldi, a hepatitis C drug retailing at $1,000 per pill, has sent \u003ca href=\"http://www.wsj.com/articles/gileads-1-000-hep-c-pill-is-hard-for-states-to-swallow-1428525426\" target=\"_blank\">treatment prices soaring.\u003c/a> The drug is made by Gilead Sciences in Foster City.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Although the members of Bacchi’s trade group directly benefit from the supplemental payments, he says the additional money is not a “sustainable” solution to the underlying problem of high-priced drugs.\u003c/p>\n\u003cp>Here are some of the details about the supplemental government funding stream to Medi-Cal plans:\u003c/p>\n\u003cul>\n\u003cli>Health plans invoiced California for $387.5 million for hepatitis C drugs between July 2014 and November 2015, according to the California Department of Health Care Services. The payments come from a mix of federal and state dollars.\u003c/li>\n\u003cli>During that time period, 3,624 Medi-Cal managed care members with hepatitis C were treated.\u003c/li>\n\u003cli>By CALmatters' calculations, the payments amount to $106,926 per patient. The number reflects other drugs used to treat hepatitis C, and isn’t solely the price of Sovaldi and Harvoni, another new, pricey drug to treat hepatis C.\u003c/li>\n\u003cli>Payments to plans are expected to continue in the next fiscal year. The California Department of Health Care Services has budgeted $303.4 million for health plans for 2016–17.\u003c/li>\n\u003c/ul>\n\u003cp>While California will receive some money back from drugmakers in the form of rebates, the ultimate price the state pays for the drugs is confidential, according to the Department of Health Care Services.\u003c/p>\n\u003cp>Limiting the cost of pharmaceuticals is the basis of a \u003ca href=\"http://www.sos.ca.gov/administration/news-releases-and-advisories/2015-news-releases-and-advisories/new-measure-eligible-californias-november-2016-ballot3/\" target=\"_blank\">ballot initiative\u003c/a> expected to be before California voters this November. The proposal would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp>The state health care agency says its payments to insurers of Medi-Cal patients for hepatitis C drugs are a “very unique” solution, one that they may use for other high-cost drugs in the future. The state says the current hepatitis C payments may be reassessed in a year or two as it expects the price of the drugs to go down.\u003c/p>\n\u003cp>“As the prescribing of the drugs levels off, as the population and the overall nature of who’s getting it settles down, we may get to a point where we look at carving that responsibility back into the plans’ … rate,” said Jennifer Kent, director of the California Department of Health Care Services.\u003c/p>\n\u003cp>But California’s spending on hepatitis C drugs doesn’t end there.\u003c/p>\n\u003cp>For the rest of the Medi-Cal population — the 2.7 million people who are not in a private managed care plan and whose health care services are directly reimbursed by the state — a \u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.finance.senate.gov/ranking-members-news/wyden-grassley-sovaldi-investigation-finds-revenue-driven-pricing-strategy-behind-84-000-hepatitis-drug\" target=\"_blank\" rel=\"nofollow\">U.S. Senate Finance Committee\u003c/a> reports the following for the year 2014:\u003c/p>\n\u003cul>\n\u003cli>California paid almost $22 million to treat 280 hepatitis C patients with Sovaldi.\u003c/li>\n\u003cli>California paid more than $2.8 million for 57 Harvoni prescriptions.\u003c/li>\n\u003c/ul>\n\u003cp>According to the U.S. Senate report, 237,000 people in Medi-Cal are infected with hepatitis C. So, doing the math between the 3,624 managed care patients and the 337 covered directly by the state, means less than 2 percent of those infected have been treated with the new drugs -- at a cost of hundreds of millions of dollars already.\u003c/p>\n\u003cp>“In order for taxpayers of the state of California to afford to provide people the necessary treatments,” says Bacchi, “we have to have drug pricing society can afford to pay.”\u003c/p>\n\u003cp>At CALmatters, \u003ca href=\"https://medium.com/california-s-legal-drug-dilemma/the-obscurity-of-drug-spending-in-medi-cal-4ccf1df97392#.ii6y9pxr6\" target=\"_blank\">we’re exploring how a drug’s cost affects patient access.\u003c/a> If you are a hepatitis C patient, or other chronic disease patient who is having difficulty getting drugs, we’d like to hear from you.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" target=\"_blank\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://pauline@calmatters.org/\" rel=\"nofollow\">email us\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Lifesaving Flights Can Come With Life-Changing Bills",
"title": "Lifesaving Flights Can Come With Life-Changing Bills",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Butte is an old mining town, tucked away in the southwest corner of Montana with a population of about 34,000. Locals enjoy many things you can't find elsewhere — campgrounds a quick drive from downtown and gorgeous mountain ranges nearby. But in Butte, as in much of rural America, advanced medical care is absent.\u003c/p>\n\u003caside class=\"pullquote alignright\">The air ambulance company was not in their insurance network, and they got a bill for $56,000.\u003c/aside>\n\u003cp>People in Butte who experience serious trauma or need specialty care rely on air ambulance flights to get them the help they need.\u003c/p>\n\u003cp>There were close to 3,000 air ambulance flights in Montana in 2014, and Amy Thomson was on one of them, curled up among the medical bags in the back of the fixed-wing plane. Her 2-month-old daughter, Isla, had a failing heart, and the hospital that could help her was 600 miles away.\u003c/p>\n\u003cp>\"They did such wonderful care of her, and they tried to take great care of me, but in that moment I couldn't let go,\" Thomson says. \"I was so afraid that if I closed my eyes that would be my last vision of her.\"\u003c/p>\n\u003cp>Thomson watched as Isla was placed in a small box strapped to a gurney inside the air ambulance flown by Airlift Northwest.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Seattle Children's Hospital saved Isla's life. Her family's health insurance took care of the costs beyond her deductible — except for that critical air ambulance ride to Seattle.\u003c/p>\n\u003cp>The Thomsons read their insurance plan and interpreted it to mean that any emergency medical transportation was covered.\u003c/p>\n\u003cp>But it turned out the air ambulance company was out of their network, and they got a bill for $56,000.\u003c/p>\n\u003cp>Thomson remembers looking at the bill and thinking, \" 'You've got to be kidding me!' Here is the flight that ultimately saved Isla's life by getting her to where she needs to be. And yet is going to put us potentially in financial ruin. Or at least kill our future dreams as a family.\"\u003c/p>\n\u003cp>When a patient needs an air ambulance, the first priority is getting needed care as fast as possible. Patients don't always know who is going to pick them up or if the ambulance is an in-network provider.\u003c/p>\n\u003cp>That can make a huge difference — and lead to huge bills.\u003c/p>\n\u003cp>\"Of all the complaints we have received in our office, not one person was uninsured,\" says Jesse Laslovich, legal counsel for Montana's insurance commissioner. \"They're all insured. And they are frustrated as heck that they're still getting $50,000-balance bills.\"\u003c/p>\n\u003cfigure id=\"attachment_141589\" class=\"wp-caption aligncenter\" style=\"max-width: 1266px\">\u003cimg class=\"size-full wp-image-141589\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM.png\" alt=\"Isla Thomson with her older sister. Isla turned 2 years old in November. \" width=\"1266\" height=\"952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM.png 1266w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-400x301.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-800x602.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-768x578.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-1180x887.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-960x722.png 960w\" sizes=\"(max-width: 1266px) 100vw, 1266px\">\u003cfigcaption class=\"wp-caption-text\">Isla Thomson with her older sister. Isla turned 2 years old in November. \u003ccite>(Courtesy of the Thomson family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>States can regulate some medical aspects of air ambulances, but federal laws prevent states from limiting aviation rates, routes and services.\u003c/p>\n\u003cp>The cost of an air ambulance bill is split into two main parts, according to \u003ca href=\"http://leg.mt.gov/content/Committees/Interim/2015-2016/Economic-Affairs/Meetings/Dec-2015/hjr29-survey-responses.pdf\">a study completed by the Montana Legislature\u003c/a>. First, a liftoff fee, which ranges from $8,500 to $15,200 in Montana, plus a per-mile charge for the flight, which ranges from $26 to $133 a mile.\u003c/p>\n\u003cp>Some air ambulance companies offer membership programs as protection from big bills. For an annual fee of about $60 to $100, patients who use that company's services face no cost beyond what their health insurance pays.\u003c/p>\n\u003cp>But Laslovich says that doesn't always work, because patients can't always know who is coming to pick them up.\u003c/p>\n\u003cp>\"You want to know what my personal opinion is about what the problem is?\" Laslovich asks. \"It's money.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">For people who think they are protected from crippling health care bills because they have insurance, the cost of an ambulance ride can be a shock.\u003c/aside>\n\u003cp>There is a lack of understanding about the actual costs of running an air ambulance business, says \u003ca href=\"http://aams.org/our-staff/rick-sherlock/\">Rick Sherlock\u003c/a>, the president of the Association of Air Medical Services. The costs include specialized labor, training, equipment and fuel.\u003c/p>\n\u003cp>\"So those cost drivers are there, and [it's necessary] to maintain readiness to respond 24 hours a day, seven days a week, 365 days a year,\" Sherlock says.\u003c/p>\n\u003cp>He says some air ambulance companies remain out of insurance networks because they can't always reach in-network deals that allow them to stay profitable.\u003c/p>\n\u003cp>\"I think what you also have to look at is that negotiations between [air ambulance] companies and insurance companies take place when there's good negotiations on both sides,\" Sherlock says. \"In situations where there may be only one or two insurance options in an area, it's harder and harder to negotiate on a level playing field.\"\u003c/p>\n\u003cp>There are only three health insurance companies operating in Montana, and at least 14 air ambulance providers. At the time of Isla's trip to Seattle Children's Hospital, the Thomsons' insurer, PacificSource, had no in-network agreements with any air ambulance company in the family's area. (\u003ca href=\"https://pacificsource.com/about-us/overview.aspx\">PacificSource\u003c/a> didn't return calls seeking comment.)\u003c/p>\n\u003cp>For people who think they are protected from crippling health care bills because they have insurance, the cost of an ambulance ride can be a shock.\u003c/p>\n\u003cp>A Montana interim legislative committee is now investigating the wide range of pricing by air ambulance companies within the state. The state of Maryland has taken on a \u003ca href=\"http://www.bizjournals.com/baltimore/news/2015/08/21/maryland-insurance-administration-investigating-20.html\">similar investigation\u003c/a>.\u003c/p>\n\u003cp>In North Dakota an air ambulance company \u003ca href=\"http://bismarcktribune.com/news/state-and-regional/n-d-law-test-case-for-preventing-air-ambulance-price/article_2ad667ea-9fcb-534a-a88d-7225551e56a2.html\">is suing the state\u003c/a> for adding \u003ca href=\"http://www.legis.nd.gov/assembly/64-2015/documents/15-0688-02000.pdf?20151223141631\">regulations\u003c/a> on the industry.\u003c/p>\n\u003cp>Thomson ended up not having to pay for her flight, but only after repeated appeals. According to Thomson, on the same day they were arranging a time to meet with a lawyer, she was notified by her insurance company that it would pay an additional amount of about $30,000, as well as the $13,000 out-of-network fee to the air ambulance company. The air ambulance firm waived the rest of its fee.\u003c/p>\n\u003cp>Isla turned 2 in November. She's a healthy child with big blue eyes, but at times her mother still worries.\u003c/p>\n\u003cp>\"Nobody takes a life flight for a joy ride,\" she says. \"You're not going on Kayak.com and booking a life flight.\"\u003c/p>\n\u003cp>Thomson didn't think the flight should be free but says the huge bill felt wrong. \"I ethically believe this is a part of health care,\" she says. \"This is not some separate entity. There is something ethically wrong that these companies are profiteering off of people's worst moments in their lives.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with \u003c/em>\u003ca href=\"http://mtpr.org/\">Montana Public Radio\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n",
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"excerpt": "People in big, sparsely populated states like Montana rely on air ambulances to get to medical specialists they need. But the lifesaving flights can be hugely expensive and not covered by insurance.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Butte is an old mining town, tucked away in the southwest corner of Montana with a population of about 34,000. Locals enjoy many things you can't find elsewhere — campgrounds a quick drive from downtown and gorgeous mountain ranges nearby. But in Butte, as in much of rural America, advanced medical care is absent.\u003c/p>\n\u003caside class=\"pullquote alignright\">The air ambulance company was not in their insurance network, and they got a bill for $56,000.\u003c/aside>\n\u003cp>People in Butte who experience serious trauma or need specialty care rely on air ambulance flights to get them the help they need.\u003c/p>\n\u003cp>There were close to 3,000 air ambulance flights in Montana in 2014, and Amy Thomson was on one of them, curled up among the medical bags in the back of the fixed-wing plane. Her 2-month-old daughter, Isla, had a failing heart, and the hospital that could help her was 600 miles away.\u003c/p>\n\u003cp>\"They did such wonderful care of her, and they tried to take great care of me, but in that moment I couldn't let go,\" Thomson says. \"I was so afraid that if I closed my eyes that would be my last vision of her.\"\u003c/p>\n\u003cp>Thomson watched as Isla was placed in a small box strapped to a gurney inside the air ambulance flown by Airlift Northwest.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Seattle Children's Hospital saved Isla's life. Her family's health insurance took care of the costs beyond her deductible — except for that critical air ambulance ride to Seattle.\u003c/p>\n\u003cp>The Thomsons read their insurance plan and interpreted it to mean that any emergency medical transportation was covered.\u003c/p>\n\u003cp>But it turned out the air ambulance company was out of their network, and they got a bill for $56,000.\u003c/p>\n\u003cp>Thomson remembers looking at the bill and thinking, \" 'You've got to be kidding me!' Here is the flight that ultimately saved Isla's life by getting her to where she needs to be. And yet is going to put us potentially in financial ruin. Or at least kill our future dreams as a family.\"\u003c/p>\n\u003cp>When a patient needs an air ambulance, the first priority is getting needed care as fast as possible. Patients don't always know who is going to pick them up or if the ambulance is an in-network provider.\u003c/p>\n\u003cp>That can make a huge difference — and lead to huge bills.\u003c/p>\n\u003cp>\"Of all the complaints we have received in our office, not one person was uninsured,\" says Jesse Laslovich, legal counsel for Montana's insurance commissioner. \"They're all insured. And they are frustrated as heck that they're still getting $50,000-balance bills.\"\u003c/p>\n\u003cfigure id=\"attachment_141589\" class=\"wp-caption aligncenter\" style=\"max-width: 1266px\">\u003cimg class=\"size-full wp-image-141589\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM.png\" alt=\"Isla Thomson with her older sister. Isla turned 2 years old in November. \" width=\"1266\" height=\"952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM.png 1266w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-400x301.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-800x602.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-768x578.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-1180x887.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-960x722.png 960w\" sizes=\"(max-width: 1266px) 100vw, 1266px\">\u003cfigcaption class=\"wp-caption-text\">Isla Thomson with her older sister. Isla turned 2 years old in November. \u003ccite>(Courtesy of the Thomson family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>States can regulate some medical aspects of air ambulances, but federal laws prevent states from limiting aviation rates, routes and services.\u003c/p>\n\u003cp>The cost of an air ambulance bill is split into two main parts, according to \u003ca href=\"http://leg.mt.gov/content/Committees/Interim/2015-2016/Economic-Affairs/Meetings/Dec-2015/hjr29-survey-responses.pdf\">a study completed by the Montana Legislature\u003c/a>. First, a liftoff fee, which ranges from $8,500 to $15,200 in Montana, plus a per-mile charge for the flight, which ranges from $26 to $133 a mile.\u003c/p>\n\u003cp>Some air ambulance companies offer membership programs as protection from big bills. For an annual fee of about $60 to $100, patients who use that company's services face no cost beyond what their health insurance pays.\u003c/p>\n\u003cp>But Laslovich says that doesn't always work, because patients can't always know who is coming to pick them up.\u003c/p>\n\u003cp>\"You want to know what my personal opinion is about what the problem is?\" Laslovich asks. \"It's money.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">For people who think they are protected from crippling health care bills because they have insurance, the cost of an ambulance ride can be a shock.\u003c/aside>\n\u003cp>There is a lack of understanding about the actual costs of running an air ambulance business, says \u003ca href=\"http://aams.org/our-staff/rick-sherlock/\">Rick Sherlock\u003c/a>, the president of the Association of Air Medical Services. The costs include specialized labor, training, equipment and fuel.\u003c/p>\n\u003cp>\"So those cost drivers are there, and [it's necessary] to maintain readiness to respond 24 hours a day, seven days a week, 365 days a year,\" Sherlock says.\u003c/p>\n\u003cp>He says some air ambulance companies remain out of insurance networks because they can't always reach in-network deals that allow them to stay profitable.\u003c/p>\n\u003cp>\"I think what you also have to look at is that negotiations between [air ambulance] companies and insurance companies take place when there's good negotiations on both sides,\" Sherlock says. \"In situations where there may be only one or two insurance options in an area, it's harder and harder to negotiate on a level playing field.\"\u003c/p>\n\u003cp>There are only three health insurance companies operating in Montana, and at least 14 air ambulance providers. At the time of Isla's trip to Seattle Children's Hospital, the Thomsons' insurer, PacificSource, had no in-network agreements with any air ambulance company in the family's area. (\u003ca href=\"https://pacificsource.com/about-us/overview.aspx\">PacificSource\u003c/a> didn't return calls seeking comment.)\u003c/p>\n\u003cp>For people who think they are protected from crippling health care bills because they have insurance, the cost of an ambulance ride can be a shock.\u003c/p>\n\u003cp>A Montana interim legislative committee is now investigating the wide range of pricing by air ambulance companies within the state. The state of Maryland has taken on a \u003ca href=\"http://www.bizjournals.com/baltimore/news/2015/08/21/maryland-insurance-administration-investigating-20.html\">similar investigation\u003c/a>.\u003c/p>\n\u003cp>In North Dakota an air ambulance company \u003ca href=\"http://bismarcktribune.com/news/state-and-regional/n-d-law-test-case-for-preventing-air-ambulance-price/article_2ad667ea-9fcb-534a-a88d-7225551e56a2.html\">is suing the state\u003c/a> for adding \u003ca href=\"http://www.legis.nd.gov/assembly/64-2015/documents/15-0688-02000.pdf?20151223141631\">regulations\u003c/a> on the industry.\u003c/p>\n\u003cp>Thomson ended up not having to pay for her flight, but only after repeated appeals. According to Thomson, on the same day they were arranging a time to meet with a lawyer, she was notified by her insurance company that it would pay an additional amount of about $30,000, as well as the $13,000 out-of-network fee to the air ambulance company. The air ambulance firm waived the rest of its fee.\u003c/p>\n\u003cp>Isla turned 2 in November. She's a healthy child with big blue eyes, but at times her mother still worries.\u003c/p>\n\u003cp>\"Nobody takes a life flight for a joy ride,\" she says. \"You're not going on Kayak.com and booking a life flight.\"\u003c/p>\n\u003cp>Thomson didn't think the flight should be free but says the huge bill felt wrong. \"I ethically believe this is a part of health care,\" she says. \"This is not some separate entity. There is something ethically wrong that these companies are profiteering off of people's worst moments in their lives.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with \u003c/em>\u003ca href=\"http://mtpr.org/\">Montana Public Radio\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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},
"closealltabs": {
"id": "closealltabs",
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"order": 1
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"source": "Commonwealth Club of California"
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"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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"order": 9
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"meta": {
"site": "radio",
"source": "WNYC"
},
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"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
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"id": "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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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
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"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"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",
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"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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},
"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/",
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},
"link": "/radio/program/pbs-newshour",
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"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",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
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"officialWebsiteLink": "/perspectives/",
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
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"npr": "https://www.npr.org/podcasts/432309616/perspectives",
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},
"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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