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"disqusTitle": "California's 2015 Obamacare Premiums Will Increase Modestly",
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"content": "\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screen shot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>Officials with Covered California, the state's Obamacare marketplace, say premiums will go up an average 4.2 percent statewide in 2015 for the 1.4 million Californians currently enrolled in insurance through the exchange.\u003c/p>\n\u003cp>Peter Lee, executive director of the agency, was clearly delighted. \"This is good news for Californians,\" he said, \"and an example of how Covered California and the Affordable Care Act are working to make health insurance affordable.\"\u003c/p>\n\u003cp>Lee said premiums would vary by people's age and where they live in California. Californians will have a choice of plans from the state's four major insurers: Anthem Blue Cross, Blue Shield, Kaiser and Health Net -- as well as six regional players: Chinese Community Health Plan, L.A. Care, Molina Healthcare, Sharp Health Care, Valley Health Care and Western Health Advantage.\u003c/p>\n\u003cp>Lee said that for the million-plus people currently insured through the exchange:\u003c/p>\n\u003cul>\n\u003cli>16 percent: will see rates remain stable or go down\u003c/li>\n\u003cli>35 percent: will see premiums increase 1-5 percent\u003c/li>\n\u003cli>36 percent: will see increases of 5-8 percent\u003c/li>\n\u003cli>13 percent: will see increases over 8 percent, some as high as 15 percent\u003c/li>\n\u003c/ul>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>UCLA health policy professor Gerald Kominski called the exchange's single-digit increases after years of double-digit premium increases in California an \"amazing achievement.\"\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">\"It sets a standard in the market and sends a \u003c/span>message\u003cspan style=\"color: #000000\"> that excessive rate increases aren't really justified.\" \u003c/span>\u003c/span>\u003c/p>\n\u003cp>Dave Jones, California's insurance commissioner, is less enthusiastic. Jones is backing Proposition 45, a November ballot measure that would give the state's insurance commissioner the authority to reject excessive health insurance premiums, a power he does not have now.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/161182850&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>While Jones, a backer of the Affordable Care Act, admitted that \"the news today is good,\" he sees a political motivation behind these lower increases. \"The health insurers have hit the pause button\" on increases, he said in a press conference. He believes insurers have held their fire so as not to create a backlash from the California electorate -- and enable the passage of Proposition 45.\u003c/p>\n\u003cp>\"There's no guarantee insurers will continue to\" keep rate increases low without Prop. 45, Jones said. \"That's authority we still need.\"\u003c/p>\n\u003cp>Peter Lee dismissed the idea that 2015 premiums are artificially low, saying that he had been involved in \"deep actuarial reviews\" with insurers and said that \"the last thing we want is rebound rate hikes\" in future years.\u003c/p>\n\u003cp>As part of the rate review process, regulators at the Department of Managed Health Care and Jones' Department of Insurance will be reviewing rates in the coming weeks to ensure they are neither too high nor too low, Lee said. If premiums were set too low, an insurer might not have sufficient resources to cover the health care costs of its customers.\u003c/p>\n\u003cp>Jones confirmed that his staff would look at this issue, but said he \"can't imagine that these rates are inadequate.\"\u003c/p>\n\u003cp>When rates were introduced last year, for Covered California's opening year, many experts at that time said they were surprisingly low and thought it could be a \"loss leader\" strategy, Kominski said, to get people into the market and then \"jack up prices\" later.\u003c/p>\n\u003cp>\"That didn't happen,\" Kominski said. \"I don't think the insurers are lying in wait, waiting to spring enormous increases on the public next year.\"\u003c/p>\n\u003cp>Open enrollment for 2015 begins on Nov. 15. Covered California has opened its \"\u003ca href=\"http://www.coveredca.com/shopandcompare/#calculator\" target=\"_blank\">Shop and Compare\u003c/a>\" tool for people who want to check prices now.\u003c/p>\n\u003cp>The benefits in the plans will be largely unchanged, although children's dental benefits will be included in all Covered California plans next year. Adult dental will be offered at an additional cost.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem> KQED health reporter April Dembosky contributed to this report.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Rates will increase an average 4.2% statewide for people who buy insurance through Covered California.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screen shot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>Officials with Covered California, the state's Obamacare marketplace, say premiums will go up an average 4.2 percent statewide in 2015 for the 1.4 million Californians currently enrolled in insurance through the exchange.\u003c/p>\n\u003cp>Peter Lee, executive director of the agency, was clearly delighted. \"This is good news for Californians,\" he said, \"and an example of how Covered California and the Affordable Care Act are working to make health insurance affordable.\"\u003c/p>\n\u003cp>Lee said premiums would vary by people's age and where they live in California. Californians will have a choice of plans from the state's four major insurers: Anthem Blue Cross, Blue Shield, Kaiser and Health Net -- as well as six regional players: Chinese Community Health Plan, L.A. Care, Molina Healthcare, Sharp Health Care, Valley Health Care and Western Health Advantage.\u003c/p>\n\u003cp>Lee said that for the million-plus people currently insured through the exchange:\u003c/p>\n\u003cul>\n\u003cli>16 percent: will see rates remain stable or go down\u003c/li>\n\u003cli>35 percent: will see premiums increase 1-5 percent\u003c/li>\n\u003cli>36 percent: will see increases of 5-8 percent\u003c/li>\n\u003cli>13 percent: will see increases over 8 percent, some as high as 15 percent\u003c/li>\n\u003c/ul>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>UCLA health policy professor Gerald Kominski called the exchange's single-digit increases after years of double-digit premium increases in California an \"amazing achievement.\"\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">\"It sets a standard in the market and sends a \u003c/span>message\u003cspan style=\"color: #000000\"> that excessive rate increases aren't really justified.\" \u003c/span>\u003c/span>\u003c/p>\n\u003cp>Dave Jones, California's insurance commissioner, is less enthusiastic. Jones is backing Proposition 45, a November ballot measure that would give the state's insurance commissioner the authority to reject excessive health insurance premiums, a power he does not have now.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/161182850&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>While Jones, a backer of the Affordable Care Act, admitted that \"the news today is good,\" he sees a political motivation behind these lower increases. \"The health insurers have hit the pause button\" on increases, he said in a press conference. He believes insurers have held their fire so as not to create a backlash from the California electorate -- and enable the passage of Proposition 45.\u003c/p>\n\u003cp>\"There's no guarantee insurers will continue to\" keep rate increases low without Prop. 45, Jones said. \"That's authority we still need.\"\u003c/p>\n\u003cp>Peter Lee dismissed the idea that 2015 premiums are artificially low, saying that he had been involved in \"deep actuarial reviews\" with insurers and said that \"the last thing we want is rebound rate hikes\" in future years.\u003c/p>\n\u003cp>As part of the rate review process, regulators at the Department of Managed Health Care and Jones' Department of Insurance will be reviewing rates in the coming weeks to ensure they are neither too high nor too low, Lee said. If premiums were set too low, an insurer might not have sufficient resources to cover the health care costs of its customers.\u003c/p>\n\u003cp>Jones confirmed that his staff would look at this issue, but said he \"can't imagine that these rates are inadequate.\"\u003c/p>\n\u003cp>When rates were introduced last year, for Covered California's opening year, many experts at that time said they were surprisingly low and thought it could be a \"loss leader\" strategy, Kominski said, to get people into the market and then \"jack up prices\" later.\u003c/p>\n\u003cp>\"That didn't happen,\" Kominski said. \"I don't think the insurers are lying in wait, waiting to spring enormous increases on the public next year.\"\u003c/p>\n\u003cp>Open enrollment for 2015 begins on Nov. 15. Covered California has opened its \"\u003ca href=\"http://www.coveredca.com/shopandcompare/#calculator\" target=\"_blank\">Shop and Compare\u003c/a>\" tool for people who want to check prices now.\u003c/p>\n\u003cp>The benefits in the plans will be largely unchanged, although children's dental benefits will be included in all Covered California plans next year. Adult dental will be offered at an additional cost.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem> KQED health reporter April Dembosky contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Survey: 3 Million Californians Newly Insured Under Obamacare",
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"content": "\u003cfigure id=\"attachment_20198\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Sandra-Lopez-2.jpg\">\u003cimg class=\"size-large wp-image-20198\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Sandra-Lopez-2-640x427.jpg\" alt=\"Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/30/california-uninsured-marketplace-enrollment-survey.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>A significant portion of previously uninsured Californians gained medical coverage through the nation’s health care law – about six in 10 during the state’s first open enrollment, according to a survey released Wednesday.\u003c/p>\n\u003cp>All told, about 3.4 million people who didn’t have health insurance before sign-ups began last fall are now covered, according to the survey by the Kaiser Family Foundation.\u003c/p>\n\u003cp>The largest share of the previously uninsured -- 25 percent -- enrolled through the state’s Medi-Cal program, which has long covered poor families but was expanded this year to include adults without children. Nine percent purchased private plans through the subsidized insurance marketplace, Covered California, which opened in October. And 12 percent became insured through their jobs, the researchers found.\u003c!--more-->\u003c/p>\n\u003cp>Sara Rosenbaum, health law professor at George Washington University, said the state’s progress has national importance.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“California is such an outsized presence in terms of uninsured people,” she said. “For California to have made this progress has a major effect on the national uninsured numbers.”\u003c/p>\n\u003cp>About 1.4 million people purchased private plans through the insurance marketplace by the end of open enrollment – far more than any other state, according to Covered California. Nearly 2 million had enrolled in Medi-Cal.\u003c/p>\n\u003cp>Allynne Noelle, a principal dancer for the Los Angeles ballet, chose a Blue Shield plan offered by her employer through Covered California’s small business exchange. And although the $5,000 deductible is “extremely high” for her, she’s relieved, she said.\u003c/p>\n\u003cp>“This new coverage is a peace of mind,” she said. “It will save me from drowning in medical bills.”\u003c/p>\n\u003cp>The number of previously uninsured Californians cited by the survey who have gained coverage is much larger than expected, said Gerald Kominski, director of the UCLA Center for Health Policy Research, which helped create the official enrollment projections for Covered California.\u003c/p>\n\u003cp>“If the numbers are accurate and borne out by larger studies … I think it is an indication that the law is working even better than many of us anticipated,” he said.\u003c/p>\n\u003cp>\u003cstrong>Still Uninsured\u003c/strong>\u003c/p>\n\u003cp>Even though the state exceeded its own expectations for coverage, more than 40 percent of those previously uninsured still don’t have health insurance, according to the survey. Some said they didn’t enroll because of the cost, while others feared that signing up would bring attention to their family’s immigration status. Those who are in the U.S. illegally are not eligible for coverage.\u003c/p>\n\u003cp>The remaining uninsured may be hard to reach. More than 80 percent either have never been covered or haven’t had a plan in at least two years, the survey found. About 60 percent are Latino.\u003c/p>\n\u003cp>“It would be nice to have coverage,” said Steve Mercill, 59, who most of his life has worked jobs that didn’t offer coverage. He is now a paid caregiver for his father, a retired doctor, in a small town near the Oregon border.\u003c/p>\n\u003cp>Mercill tried to purchase a plan through Covered California last year but said he couldn’t get the website to work and couldn’t get the help he needed through the call center. He plans to try again in the fall.\u003c/p>\n\u003cp>The Kaiser Family Foundation survey focused on those without coverage last fall, before open enrollment.\u003c/p>\n\u003cp>Kominski of UCLA said that by focusing only on those who were previously uninsured, the survey doesn’t paint a complete picture: While some people gained coverage, others lost it.\u003c/p>\n\u003cp>“There is churn in the health care system and this study does not account for that,” he said.\u003c/p>\n\u003cp>\u003cstrong>Aggressive Enrollment\u003c/strong>\u003c/p>\n\u003cp>Before the nation’s health law took effect, California had the highest number of uninsured in the nation, coming from highly diverse ethnic backgrounds and cultures. But the state embraced Obamacare before most others and was the first to create a state-run insurance exchange.\u003c/p>\n\u003cp>Though there were some initial technical problems in the enrollment process, they were fewer and less severe than those in the federal exchange and other states. In addition, the hospitals, community clinics and social services offices were aggressive in enrolling those eligible for Medi-Cal.\u003c/p>\n\u003cp>“The fact that a quarter of the previously uninsured Californians ended up enrolled in Medi-Cal points to what a key piece Medicaid is in the puzzle in getting more Americans covered,” said Mollyann Brodie, executive director of the Kaiser Family Foundation’s Public Opinion and Survey Research.\u003c/p>\n\u003cp>“That was a piece that often got less attention during open enrollment season,” she said.\u003c/p>\n\u003cp>Most of those who got covered said it was easy to sign up. Leslie Ziegler, 31, said signing up for insurance through the Covered California website only took about an hour. Before Obamacare, Ziegler, a San Francisco high-tech entrepreneur, had been turned down by several insurance companies because she had ulcerative colitis, a chronic disease that requires costly medication and treatment.\u003c/p>\n\u003cp>Companies can no longer deny coverage because of pre-existing conditions. Ziegler is thankful, saying having access to insurance and health care whenever she needs it is “a wonderful thing.”\u003c/p>\n\u003cp>Some respondents said, however, that it was difficult to confirm their coverage. Even now, hundreds of thousands of Medi-Cal applicants are waiting for cards confirming their eligibility.\u003c/p>\n\u003cp>Teresa Martinez sought help at a Los Angeles health clinic to sign up for Medi-Cal, but months later, she is still waiting for her card. Martinez, a Koreatown hair stylist, said she is anxious to see a doctor to treat arthritis and pain in her leg, as well as help her keep her blood sugar in check to fend off diabetes.\u003c/p>\n\u003cp>\u003cstrong>‘A Huge Relief’\u003c/strong>\u003c/p>\n\u003cp>Despite an early lag in Latino enrollment, the survey found that more than half of previously uninsured Latinos ultimately got coverage.\u003c/p>\n\u003cp>“It’s a huge relief,” said Newport Beach restaurateur Sandra Lopez, a 41-year-old Mexican immigrant \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/16/latina-small-business-owner-enters-the-covered-california-insurance-marketplace/\" target=\"_blank\">who enrolled her family,\u003c/a> including a young adult son with epilepsy, in a subsidized private plan through California’s exchange.\u003c/p>\n\u003cp>The state’s far-reaching efforts to spread the word about the law and get people signed up made a difference, researchers said. About 60 percent of Medi-Cal or Covered California enrollees had someone help them sign up. About seven in ten uninsured Californians who were contacted about signing up did so, compared to about half of people who were not contacted.\u003c/p>\n\u003cp>“Outreach was such an important predictor in whether an uninsured person got health insurance or not,” Brodie said. But friends and family did not have much of an impact on whether people enrolled.\u003c/p>\n\u003cp>Meifeng Lui, 52, said her family of five had been uninsured for four years because they could not afford coverage. Lui said she was “very grateful and so blessed” that the enrollment counselors spoke their language at the Chinese Community Health Plan in San Francisco and helped her enroll in a private plan through Covered California.\u003c/p>\n\u003cp>“I was so happy because someone knew what to do,” said Lui.\u003c/p>\n\u003cp>When Maria Garcia decided to enroll under Obamacare, she sought help from a counselor at the Ravenswood Family Health Center near her home in East Palo Alto.\u003c/p>\n\u003cp>She didn't feel comfortable navigating Covered California’s site. Within hours, she said, the counselor helped her settle on a Kaiser Permanente plan, for which she'd pay just $36 a month thanks to a subsidy from the state.\u003c/p>\n\u003cp>According to the survey, most of those who got insurance said their plan is “a good value” for what they pay but nearly half of people who got plans other than Medi-Cal said that it has been difficult to afford the coverage.\u003c/p>\n\u003cp>Researchers found stark differences in how people signed up for Medi-Cal versus the subsidized private plans in Covered California. More than half of Medi-Cal recipients enrolled in person, compared to 15 percent over the Internet. More than half of Covered California enrollees, however, signed up over the Internet, compared to 15 percent in person.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The researchers surveyed 2,001 uninsured Californians last summer, then conducted a second round of interviews with many of the same people this spring. The margin of sampling error was plus or minus 4 percentage points. For subgroups sampled, the margins were slightly larger.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20198\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Sandra-Lopez-2.jpg\">\u003cimg class=\"size-large wp-image-20198\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Sandra-Lopez-2-640x427.jpg\" alt=\"Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/30/california-uninsured-marketplace-enrollment-survey.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>A significant portion of previously uninsured Californians gained medical coverage through the nation’s health care law – about six in 10 during the state’s first open enrollment, according to a survey released Wednesday.\u003c/p>\n\u003cp>All told, about 3.4 million people who didn’t have health insurance before sign-ups began last fall are now covered, according to the survey by the Kaiser Family Foundation.\u003c/p>\n\u003cp>The largest share of the previously uninsured -- 25 percent -- enrolled through the state’s Medi-Cal program, which has long covered poor families but was expanded this year to include adults without children. Nine percent purchased private plans through the subsidized insurance marketplace, Covered California, which opened in October. And 12 percent became insured through their jobs, the researchers found.\u003c!--more-->\u003c/p>\n\u003cp>Sara Rosenbaum, health law professor at George Washington University, said the state’s progress has national importance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“California is such an outsized presence in terms of uninsured people,” she said. “For California to have made this progress has a major effect on the national uninsured numbers.”\u003c/p>\n\u003cp>About 1.4 million people purchased private plans through the insurance marketplace by the end of open enrollment – far more than any other state, according to Covered California. Nearly 2 million had enrolled in Medi-Cal.\u003c/p>\n\u003cp>Allynne Noelle, a principal dancer for the Los Angeles ballet, chose a Blue Shield plan offered by her employer through Covered California’s small business exchange. And although the $5,000 deductible is “extremely high” for her, she’s relieved, she said.\u003c/p>\n\u003cp>“This new coverage is a peace of mind,” she said. “It will save me from drowning in medical bills.”\u003c/p>\n\u003cp>The number of previously uninsured Californians cited by the survey who have gained coverage is much larger than expected, said Gerald Kominski, director of the UCLA Center for Health Policy Research, which helped create the official enrollment projections for Covered California.\u003c/p>\n\u003cp>“If the numbers are accurate and borne out by larger studies … I think it is an indication that the law is working even better than many of us anticipated,” he said.\u003c/p>\n\u003cp>\u003cstrong>Still Uninsured\u003c/strong>\u003c/p>\n\u003cp>Even though the state exceeded its own expectations for coverage, more than 40 percent of those previously uninsured still don’t have health insurance, according to the survey. Some said they didn’t enroll because of the cost, while others feared that signing up would bring attention to their family’s immigration status. Those who are in the U.S. illegally are not eligible for coverage.\u003c/p>\n\u003cp>The remaining uninsured may be hard to reach. More than 80 percent either have never been covered or haven’t had a plan in at least two years, the survey found. About 60 percent are Latino.\u003c/p>\n\u003cp>“It would be nice to have coverage,” said Steve Mercill, 59, who most of his life has worked jobs that didn’t offer coverage. He is now a paid caregiver for his father, a retired doctor, in a small town near the Oregon border.\u003c/p>\n\u003cp>Mercill tried to purchase a plan through Covered California last year but said he couldn’t get the website to work and couldn’t get the help he needed through the call center. He plans to try again in the fall.\u003c/p>\n\u003cp>The Kaiser Family Foundation survey focused on those without coverage last fall, before open enrollment.\u003c/p>\n\u003cp>Kominski of UCLA said that by focusing only on those who were previously uninsured, the survey doesn’t paint a complete picture: While some people gained coverage, others lost it.\u003c/p>\n\u003cp>“There is churn in the health care system and this study does not account for that,” he said.\u003c/p>\n\u003cp>\u003cstrong>Aggressive Enrollment\u003c/strong>\u003c/p>\n\u003cp>Before the nation’s health law took effect, California had the highest number of uninsured in the nation, coming from highly diverse ethnic backgrounds and cultures. But the state embraced Obamacare before most others and was the first to create a state-run insurance exchange.\u003c/p>\n\u003cp>Though there were some initial technical problems in the enrollment process, they were fewer and less severe than those in the federal exchange and other states. In addition, the hospitals, community clinics and social services offices were aggressive in enrolling those eligible for Medi-Cal.\u003c/p>\n\u003cp>“The fact that a quarter of the previously uninsured Californians ended up enrolled in Medi-Cal points to what a key piece Medicaid is in the puzzle in getting more Americans covered,” said Mollyann Brodie, executive director of the Kaiser Family Foundation’s Public Opinion and Survey Research.\u003c/p>\n\u003cp>“That was a piece that often got less attention during open enrollment season,” she said.\u003c/p>\n\u003cp>Most of those who got covered said it was easy to sign up. Leslie Ziegler, 31, said signing up for insurance through the Covered California website only took about an hour. Before Obamacare, Ziegler, a San Francisco high-tech entrepreneur, had been turned down by several insurance companies because she had ulcerative colitis, a chronic disease that requires costly medication and treatment.\u003c/p>\n\u003cp>Companies can no longer deny coverage because of pre-existing conditions. Ziegler is thankful, saying having access to insurance and health care whenever she needs it is “a wonderful thing.”\u003c/p>\n\u003cp>Some respondents said, however, that it was difficult to confirm their coverage. Even now, hundreds of thousands of Medi-Cal applicants are waiting for cards confirming their eligibility.\u003c/p>\n\u003cp>Teresa Martinez sought help at a Los Angeles health clinic to sign up for Medi-Cal, but months later, she is still waiting for her card. Martinez, a Koreatown hair stylist, said she is anxious to see a doctor to treat arthritis and pain in her leg, as well as help her keep her blood sugar in check to fend off diabetes.\u003c/p>\n\u003cp>\u003cstrong>‘A Huge Relief’\u003c/strong>\u003c/p>\n\u003cp>Despite an early lag in Latino enrollment, the survey found that more than half of previously uninsured Latinos ultimately got coverage.\u003c/p>\n\u003cp>“It’s a huge relief,” said Newport Beach restaurateur Sandra Lopez, a 41-year-old Mexican immigrant \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/16/latina-small-business-owner-enters-the-covered-california-insurance-marketplace/\" target=\"_blank\">who enrolled her family,\u003c/a> including a young adult son with epilepsy, in a subsidized private plan through California’s exchange.\u003c/p>\n\u003cp>The state’s far-reaching efforts to spread the word about the law and get people signed up made a difference, researchers said. About 60 percent of Medi-Cal or Covered California enrollees had someone help them sign up. About seven in ten uninsured Californians who were contacted about signing up did so, compared to about half of people who were not contacted.\u003c/p>\n\u003cp>“Outreach was such an important predictor in whether an uninsured person got health insurance or not,” Brodie said. But friends and family did not have much of an impact on whether people enrolled.\u003c/p>\n\u003cp>Meifeng Lui, 52, said her family of five had been uninsured for four years because they could not afford coverage. Lui said she was “very grateful and so blessed” that the enrollment counselors spoke their language at the Chinese Community Health Plan in San Francisco and helped her enroll in a private plan through Covered California.\u003c/p>\n\u003cp>“I was so happy because someone knew what to do,” said Lui.\u003c/p>\n\u003cp>When Maria Garcia decided to enroll under Obamacare, she sought help from a counselor at the Ravenswood Family Health Center near her home in East Palo Alto.\u003c/p>\n\u003cp>She didn't feel comfortable navigating Covered California’s site. Within hours, she said, the counselor helped her settle on a Kaiser Permanente plan, for which she'd pay just $36 a month thanks to a subsidy from the state.\u003c/p>\n\u003cp>According to the survey, most of those who got insurance said their plan is “a good value” for what they pay but nearly half of people who got plans other than Medi-Cal said that it has been difficult to afford the coverage.\u003c/p>\n\u003cp>Researchers found stark differences in how people signed up for Medi-Cal versus the subsidized private plans in Covered California. More than half of Medi-Cal recipients enrolled in person, compared to 15 percent over the Internet. More than half of Covered California enrollees, however, signed up over the Internet, compared to 15 percent in person.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers surveyed 2,001 uninsured Californians last summer, then conducted a second round of interviews with many of the same people this spring. The margin of sampling error was plus or minus 4 percentage points. For subgroups sampled, the margins were slightly larger.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "CA Insurance Commissioner: Insurers Fear Prop. 45, Will Keep Health Rates Low",
"title": "CA Insurance Commissioner: Insurers Fear Prop. 45, Will Keep Health Rates Low",
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"content": "\u003cfigure id=\"attachment_13022\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/96226495-e1382074913159.jpg\">\u003cimg class=\"size-large wp-image-13022\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/96226495-620x413.jpg\" alt=\"(Getty Images)\" width=\"620\" height=\"413\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>A new analysis from the Department of Insurance confirms what has been reported since the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/10/18/why-some-are-seeing-premiums-go-up-as-affordable-care-act-goes-into-effect-obamacare/\" target=\"_blank\">Covered California exchange opened last October\u003c/a>: Some people saw steep premium increases after the rollout of the Affordable Care Act.\u003c/p>\n\u003cp>According to the department's analysis non-subsidy eligible individuals saw average increases ranging from 22 to 88 percent, depending on their age and where they lived. The review was done of all health plans -- including those managed for the Department of Managed Health Care -- and looked at premiums from California's four largest carriers, Anthem Blue Cross, Kaiser, Blue Shield and Health Net.\u003c/p>\n\u003cp>The release appeared to be politically timed. Covered California's rates for \u003cem>next\u003c/em> year are due on Thursday, and the rumble is that new premiums will show only modest increases.\u003c!--more-->\u003c/p>\n\u003cp>Insurance Commissioner Dave Jones say that's for one reason --\u003ca href=\"http://www.sos.ca.gov/elections/vig-public-display/110414-general-election/prop-45/prop-45-text.pdf\" target=\"_blank\"> Proposition 45\u003c/a> coming on this November's ballot. The ballot measure would give the state's insurance commissioner the authority to reject excessive health insurance rate hikes. Jones believes health insurers are keeping premiums lower than they would have otherwise without the threat of the proposition.\u003c/p>\n\u003cp>\"I fully expect that the degree of those increases will be modest at best,\" Jones said, \"because Proposition 45 is on the ballot, and they are very concerned about creating any sort of backlash from Californians.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>UCLA health policy professor Gerald Kominski expressed no surprise at the news of the department of insurance's analysis and its report of increases in premiums. He said that the Affordable Care Act requires both standardized plans and guaranteed issue, meaning that no one can be turned down because of a preexisting condition. Those two factors alone, he said, account for higher premiums.\u003c/p>\n\u003cp>\"In 2013, premiums were artificially lower, and prior to the ACA, premiums could be held down by excluding high-risk patients from the market and by offering skinny benefits.\"\u003c/p>\n\u003cp>The California Association of Health Plans, an industry group, chastised Jones for \"looking backward\" when open enrollment for 2015 is coming soon.\u003c/p>\n\u003cp>\"The ACA ushered in a new era of health care coverage,\" said vice president Charles Bacchi in a release. \"While some paid more for this expanded health care coverage, many Californians paid less and benefited from subsidies.\"\u003c/p>\n\u003cp>More than a \u003ca href=\"http://news.coveredca.com/2014/04/covered-californias-historic-first-open.html\" target=\"_blank\">million Californians qualified for subsidies\u003c/a> in the 2014 open enrollment. Some non-subsidy eligible Californians saw \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/10/18/why-some-are-seeing-premiums-go-up-as-affordable-care-act-goes-into-effect-obamacare/\" target=\"_blank\">premiums go down\u003c/a>. Jones asserted that most of the three million people who purchased individual or small group insurance outside of Covered California (in other words, people who were not eligible for a subsidy) \"got significant rate increases.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For its part, Covered California released a one-line statement in response to the department's analysis: \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">\"Covered California is looking forward to announcing its 2015 rates this Thursday.\"\u003c/span>\u003c/span>\u003c/p>\n\n",
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"excerpt": "Proposition 45 would give CA's insurance commissioner the authority to reject excessive health premiums.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_13022\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/96226495-e1382074913159.jpg\">\u003cimg class=\"size-large wp-image-13022\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/96226495-620x413.jpg\" alt=\"(Getty Images)\" width=\"620\" height=\"413\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>A new analysis from the Department of Insurance confirms what has been reported since the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/10/18/why-some-are-seeing-premiums-go-up-as-affordable-care-act-goes-into-effect-obamacare/\" target=\"_blank\">Covered California exchange opened last October\u003c/a>: Some people saw steep premium increases after the rollout of the Affordable Care Act.\u003c/p>\n\u003cp>According to the department's analysis non-subsidy eligible individuals saw average increases ranging from 22 to 88 percent, depending on their age and where they lived. The review was done of all health plans -- including those managed for the Department of Managed Health Care -- and looked at premiums from California's four largest carriers, Anthem Blue Cross, Kaiser, Blue Shield and Health Net.\u003c/p>\n\u003cp>The release appeared to be politically timed. Covered California's rates for \u003cem>next\u003c/em> year are due on Thursday, and the rumble is that new premiums will show only modest increases.\u003c!--more-->\u003c/p>\n\u003cp>Insurance Commissioner Dave Jones say that's for one reason --\u003ca href=\"http://www.sos.ca.gov/elections/vig-public-display/110414-general-election/prop-45/prop-45-text.pdf\" target=\"_blank\"> Proposition 45\u003c/a> coming on this November's ballot. The ballot measure would give the state's insurance commissioner the authority to reject excessive health insurance rate hikes. Jones believes health insurers are keeping premiums lower than they would have otherwise without the threat of the proposition.\u003c/p>\n\u003cp>\"I fully expect that the degree of those increases will be modest at best,\" Jones said, \"because Proposition 45 is on the ballot, and they are very concerned about creating any sort of backlash from Californians.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>UCLA health policy professor Gerald Kominski expressed no surprise at the news of the department of insurance's analysis and its report of increases in premiums. He said that the Affordable Care Act requires both standardized plans and guaranteed issue, meaning that no one can be turned down because of a preexisting condition. Those two factors alone, he said, account for higher premiums.\u003c/p>\n\u003cp>\"In 2013, premiums were artificially lower, and prior to the ACA, premiums could be held down by excluding high-risk patients from the market and by offering skinny benefits.\"\u003c/p>\n\u003cp>The California Association of Health Plans, an industry group, chastised Jones for \"looking backward\" when open enrollment for 2015 is coming soon.\u003c/p>\n\u003cp>\"The ACA ushered in a new era of health care coverage,\" said vice president Charles Bacchi in a release. \"While some paid more for this expanded health care coverage, many Californians paid less and benefited from subsidies.\"\u003c/p>\n\u003cp>More than a \u003ca href=\"http://news.coveredca.com/2014/04/covered-californias-historic-first-open.html\" target=\"_blank\">million Californians qualified for subsidies\u003c/a> in the 2014 open enrollment. Some non-subsidy eligible Californians saw \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/10/18/why-some-are-seeing-premiums-go-up-as-affordable-care-act-goes-into-effect-obamacare/\" target=\"_blank\">premiums go down\u003c/a>. Jones asserted that most of the three million people who purchased individual or small group insurance outside of Covered California (in other words, people who were not eligible for a subsidy) \"got significant rate increases.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For its part, Covered California released a one-line statement in response to the department's analysis: \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">\"Covered California is looking forward to announcing its 2015 rates this Thursday.\"\u003c/span>\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "'Narrow Networks' Frustrate Consumers in California and Nationwide",
"title": "'Narrow Networks' Frustrate Consumers in California and Nationwide",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_20364\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/7060187729_9c3c7debb3_k.jpg\">\u003cimg class=\"size-large wp-image-20364\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/7060187729_9c3c7debb3_k-640x480.jpg\" alt=\"(Helen K/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Helen K/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Appleby\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/28/Limitations-Of-New-Health-Plans-Rankle-Some-Enrollees.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Marcia Perez of Palo Alto may live 2,000 miles Nancy Pippenger in Indiana, but the two women have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”\u003c/aside>\n\u003cp>“They said, ‘We take the old plan, but not the new one,’” says Perez, who is an attorney in Palo Alto.\u003c/p>\n\u003cp>In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.\u003c/p>\n\u003cp>Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions across the country start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s totally different,” said Pippenger, 57, whose new Anthem Blue Cross plan doesn’t pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. “To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”\u003c/p>\n\u003cp>Consumer groups argue many enrollees were misled. In California, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/09/lawsuit-anthem-blue-cross-committed-fraudulent-enrollment-practices/\" target=\"_blank\">consumers filed class-action lawsuits \u003c/a>against some insurers, alleging they were given inaccurate information about their plans’ limitations and about which doctors and hospitals participate in them.\u003c/p>\n\u003cp>Nationally, regulators and insurance agents are inundated with complaints, while state lawmakers are considering rules to ensure consumers’ access to doctors. For 2015 plans which will be on sale beginning in November, the federal Department of Health and Human Services said it will more closely scrutinize whether networks are adequate.\u003c/p>\n\u003cp>Insurers say they are simply trying to provide low-cost plans in a challenging environment. The new federal health law doesn’t let them reject enrollees with health problems or charge them more just because they are sick. So they are using the few tools left to them -- contracting with smaller groups of hospitals and doctors willing to accept lower reimbursements; requiring referrals for specialty care and limiting coverage outside those networks.\u003c/p>\n\u003cp>“Obamacare products have lower prices than they would have if they had had [larger] commercial networks,” said Robert Laszewski, an industry consultant and former insurance executive. “They're one-size-fits-all networks designed for low-income people accessing insurance for the first time.”\u003c/p>\n\u003cp>\u003cstrong>Lower Prices, Limited Choice\u003c/strong>\u003c/p>\n\u003cp>Lower monthly premiums made such plans attractive to many consumers on Covered California and the other new exchanges. Some chose tightly managed plans -- HMOs or so-called exclusive provider organizations (EPOs) -- specifically because of their cost, in some cases, without realizing the tradeoffs.\u003c/p>\n\u003cp>Others had no choice.\u003c/p>\n\u003cp>In California, Anthem Blue Cross offers plans with no out-of-network benefits in Los Angeles, San Diego and San Francisco, although another type of plan is available in other California counties. The insurer offers only HMO-like plans through the new markets in six of the 14 states it serves, including New Hampshire, where it is the only insurer.\u003c/p>\n\u003cp>Anthem spokeswoman Kristin Binns said the insurer decided to move heavily into managed care in many of its markets after research showed most consumers, especially those who were uninsured, cared about price first and foremost.\u003c/p>\n\u003cp>“HMOs give them much more access than they were afforded before,” Binns said.\u003c/p>\n\u003cp>Still, she said Anthem expects to roll out plans with out-of-network coverage in 2015 in some areas where it does not offer them. She would not specify the regions.\u003c/p>\n\u003cp>Other insurers made similar decisions, offering managed care plans as the only choice for residents buying through the new marketplaces in counties in Indiana, Georgia, South Carolina, Virginia, Florida, Wisconsin and Mississippi, according to government data analyzed by Kaiser Health News. Nationally, 43 percent of mid-level “silver” plans offered in California, New York and 34 states using the federal marketplace healthcare.gov have no coverage outside their networks, a study by the American Cancer Society Cancer Action Network found.\u003c/p>\n\u003cp>“They’re all doing it,” says Wall Street analyst Ana Gupte of Leerink Swann, an investment bank. “Obamacare is putting pressure on their margins, so they’re on the hook to moderate costs.”\u003c/p>\n\u003cp>But along with consumers, lawmakers and regulators have begun to push back.\u003c/p>\n\u003cp>In California, managed care regulators are investigating Anthem and another insurer, Blue Shield of California, after receiving numerous complaints about access to doctors and hospitals.\u003c/p>\n\u003cp>Lawmakers in 22 states debated laws this year and last related to network adequacy, although the vast majority failed to pass, according to the National Conference of State Legislatures. In Washington state, administrative rules announced this spring require insurers to provide enough primary care doctors so enrollees can get an appointment within 10 days and 30 miles of their home or workplace. Directories of participating providers must be updated monthly.\u003c/p>\n\u003cp>“I have heard from many consumers … who were upset to find their health plan no longer included their trusted doctor or hospital … and some discovered this only after they enrolled,” Washington Insurance Commissioner Mike Kreidler said in an announcement of the rules in April.\u003c/p>\n\u003cp>\u003cstrong>Scrambling To Find Doctors\u003c/strong>\u003c/p>\n\u003cp>Brian Liechty of TCU Insurance in Plymouth, Ind., said he has helped “hundreds” of clients sign up for tightly managed plans – including Pippenger, when her work-based plan was discontinued.\u003c/p>\n\u003cp>“For the right person who is willing to go where they must and live with rules, it allows them to buy a health insurance policy they could never touch before,” he said. “So, there are some good things, but balancing it out, there are some equally bad things for people who previously had insurance.”\u003c/p>\n\u003cp>Patient advocates agree that managed care can be done well but caution that some policies could leave patients scrambling to find doctors – and on the hook for thousands of dollars if they go out of network.\u003c/p>\n\u003cp>“If highly specialized care -- an academic medical center or a cancer center -- is not available in a plan’s network … some plans will send you to an out-of-network provider, but it’s not required,” said Laura Skopec, senior policy analyst at the Cancer Action Network.\u003c/p>\n\u003cp>Going out of a managed care plan’s network \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/08/obamacare-plans-illuminate-high-cost-of-going-out-of-network/\" target=\"_blank\">often means \u003c/a>p\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/08/obamacare-plans-illuminate-high-cost-of-going-out-of-network/\" target=\"_blank\">atients foot the entire bill\u003c/a>, which can be financially devastating in cases of serious illness. In other types of insurance plans, a portion of the out-of-network bill might be covered, but\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/08/obamacare-plans-illuminate-high-cost-of-going-out-of-network/\" target=\"_blank\"> consumers still face sharply higher costs\u003c/a> than if they see a network provider.\u003c/p>\n\u003cp>Pippenger said that because she was in pain and knew she might need surgery, she checked the provider directory for her new plan, looking for an orthopedic surgeon within 30 miles. She found five who specialized in hips and knees, but felt anxious because she knew nothing about them.\u003c/p>\n\u003cp>“I want to go back to the doctor who did my other knee,” she said.\u003c/p>\n\u003cp>She paid for an initial consultation with him, but realized she couldn’t afford the cost of having him fix her second knee.\u003c/p>\n\u003cp>Adding to the problem this year were some plans’ incomplete or inaccurate lists of participating doctors and hospitals.\u003c/p>\n\u003cp>Perez, 46, bought her insurance through Covered California, the state's health insurance marketplace. Before enrolling, the immigration attorney says she was assured by the plan and her doctors that they were in Anthem’s network. Only later did she find out that none of those affiliated with her local hospital, Stanford Medical Center, are in it.\u003c/p>\n\u003cp>Perez said she was unable to find a doctor affiliated with Stanford or another nearby hospital, so she filed a complaint with state regulators and was granted a waiver to switch plans.\u003c/p>\n\u003cp>“I’ve been paying a premium since March for medical care that I’ve never been able to access,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"xDHQBJo0v3q5t58Pm5Skw6p8djqT3jYX\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20364\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/7060187729_9c3c7debb3_k.jpg\">\u003cimg class=\"size-large wp-image-20364\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/7060187729_9c3c7debb3_k-640x480.jpg\" alt=\"(Helen K/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Helen K/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Appleby\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/28/Limitations-Of-New-Health-Plans-Rankle-Some-Enrollees.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Marcia Perez of Palo Alto may live 2,000 miles Nancy Pippenger in Indiana, but the two women have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”\u003c/aside>\n\u003cp>“They said, ‘We take the old plan, but not the new one,’” says Perez, who is an attorney in Palo Alto.\u003c/p>\n\u003cp>In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.\u003c/p>\n\u003cp>Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions across the country start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s totally different,” said Pippenger, 57, whose new Anthem Blue Cross plan doesn’t pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. “To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”\u003c/p>\n\u003cp>Consumer groups argue many enrollees were misled. In California, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/09/lawsuit-anthem-blue-cross-committed-fraudulent-enrollment-practices/\" target=\"_blank\">consumers filed class-action lawsuits \u003c/a>against some insurers, alleging they were given inaccurate information about their plans’ limitations and about which doctors and hospitals participate in them.\u003c/p>\n\u003cp>Nationally, regulators and insurance agents are inundated with complaints, while state lawmakers are considering rules to ensure consumers’ access to doctors. For 2015 plans which will be on sale beginning in November, the federal Department of Health and Human Services said it will more closely scrutinize whether networks are adequate.\u003c/p>\n\u003cp>Insurers say they are simply trying to provide low-cost plans in a challenging environment. The new federal health law doesn’t let them reject enrollees with health problems or charge them more just because they are sick. So they are using the few tools left to them -- contracting with smaller groups of hospitals and doctors willing to accept lower reimbursements; requiring referrals for specialty care and limiting coverage outside those networks.\u003c/p>\n\u003cp>“Obamacare products have lower prices than they would have if they had had [larger] commercial networks,” said Robert Laszewski, an industry consultant and former insurance executive. “They're one-size-fits-all networks designed for low-income people accessing insurance for the first time.”\u003c/p>\n\u003cp>\u003cstrong>Lower Prices, Limited Choice\u003c/strong>\u003c/p>\n\u003cp>Lower monthly premiums made such plans attractive to many consumers on Covered California and the other new exchanges. Some chose tightly managed plans -- HMOs or so-called exclusive provider organizations (EPOs) -- specifically because of their cost, in some cases, without realizing the tradeoffs.\u003c/p>\n\u003cp>Others had no choice.\u003c/p>\n\u003cp>In California, Anthem Blue Cross offers plans with no out-of-network benefits in Los Angeles, San Diego and San Francisco, although another type of plan is available in other California counties. The insurer offers only HMO-like plans through the new markets in six of the 14 states it serves, including New Hampshire, where it is the only insurer.\u003c/p>\n\u003cp>Anthem spokeswoman Kristin Binns said the insurer decided to move heavily into managed care in many of its markets after research showed most consumers, especially those who were uninsured, cared about price first and foremost.\u003c/p>\n\u003cp>“HMOs give them much more access than they were afforded before,” Binns said.\u003c/p>\n\u003cp>Still, she said Anthem expects to roll out plans with out-of-network coverage in 2015 in some areas where it does not offer them. She would not specify the regions.\u003c/p>\n\u003cp>Other insurers made similar decisions, offering managed care plans as the only choice for residents buying through the new marketplaces in counties in Indiana, Georgia, South Carolina, Virginia, Florida, Wisconsin and Mississippi, according to government data analyzed by Kaiser Health News. Nationally, 43 percent of mid-level “silver” plans offered in California, New York and 34 states using the federal marketplace healthcare.gov have no coverage outside their networks, a study by the American Cancer Society Cancer Action Network found.\u003c/p>\n\u003cp>“They’re all doing it,” says Wall Street analyst Ana Gupte of Leerink Swann, an investment bank. “Obamacare is putting pressure on their margins, so they’re on the hook to moderate costs.”\u003c/p>\n\u003cp>But along with consumers, lawmakers and regulators have begun to push back.\u003c/p>\n\u003cp>In California, managed care regulators are investigating Anthem and another insurer, Blue Shield of California, after receiving numerous complaints about access to doctors and hospitals.\u003c/p>\n\u003cp>Lawmakers in 22 states debated laws this year and last related to network adequacy, although the vast majority failed to pass, according to the National Conference of State Legislatures. In Washington state, administrative rules announced this spring require insurers to provide enough primary care doctors so enrollees can get an appointment within 10 days and 30 miles of their home or workplace. Directories of participating providers must be updated monthly.\u003c/p>\n\u003cp>“I have heard from many consumers … who were upset to find their health plan no longer included their trusted doctor or hospital … and some discovered this only after they enrolled,” Washington Insurance Commissioner Mike Kreidler said in an announcement of the rules in April.\u003c/p>\n\u003cp>\u003cstrong>Scrambling To Find Doctors\u003c/strong>\u003c/p>\n\u003cp>Brian Liechty of TCU Insurance in Plymouth, Ind., said he has helped “hundreds” of clients sign up for tightly managed plans – including Pippenger, when her work-based plan was discontinued.\u003c/p>\n\u003cp>“For the right person who is willing to go where they must and live with rules, it allows them to buy a health insurance policy they could never touch before,” he said. “So, there are some good things, but balancing it out, there are some equally bad things for people who previously had insurance.”\u003c/p>\n\u003cp>Patient advocates agree that managed care can be done well but caution that some policies could leave patients scrambling to find doctors – and on the hook for thousands of dollars if they go out of network.\u003c/p>\n\u003cp>“If highly specialized care -- an academic medical center or a cancer center -- is not available in a plan’s network … some plans will send you to an out-of-network provider, but it’s not required,” said Laura Skopec, senior policy analyst at the Cancer Action Network.\u003c/p>\n\u003cp>Going out of a managed care plan’s network \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/08/obamacare-plans-illuminate-high-cost-of-going-out-of-network/\" target=\"_blank\">often means \u003c/a>p\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/08/obamacare-plans-illuminate-high-cost-of-going-out-of-network/\" target=\"_blank\">atients foot the entire bill\u003c/a>, which can be financially devastating in cases of serious illness. In other types of insurance plans, a portion of the out-of-network bill might be covered, but\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/08/obamacare-plans-illuminate-high-cost-of-going-out-of-network/\" target=\"_blank\"> consumers still face sharply higher costs\u003c/a> than if they see a network provider.\u003c/p>\n\u003cp>Pippenger said that because she was in pain and knew she might need surgery, she checked the provider directory for her new plan, looking for an orthopedic surgeon within 30 miles. She found five who specialized in hips and knees, but felt anxious because she knew nothing about them.\u003c/p>\n\u003cp>“I want to go back to the doctor who did my other knee,” she said.\u003c/p>\n\u003cp>She paid for an initial consultation with him, but realized she couldn’t afford the cost of having him fix her second knee.\u003c/p>\n\u003cp>Adding to the problem this year were some plans’ incomplete or inaccurate lists of participating doctors and hospitals.\u003c/p>\n\u003cp>Perez, 46, bought her insurance through Covered California, the state's health insurance marketplace. Before enrolling, the immigration attorney says she was assured by the plan and her doctors that they were in Anthem’s network. Only later did she find out that none of those affiliated with her local hospital, Stanford Medical Center, are in it.\u003c/p>\n\u003cp>Perez said she was unable to find a doctor affiliated with Stanford or another nearby hospital, so she filed a complaint with state regulators and was granted a waiver to switch plans.\u003c/p>\n\u003cp>“I’ve been paying a premium since March for medical care that I’ve never been able to access,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Critics Say Covered California Ill-Equipped to Help Former Foster Youth",
"title": "Critics Say Covered California Ill-Equipped to Help Former Foster Youth",
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"content": "\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>Former foster youth lined up at Covered California's last board meeting to complain about the hoops they have to jump through to enroll in Medi-Cal, the state's health plan for the poor.\u003c/p>\n\u003cp>“Navigating adulthood is challenging enough, let alone trying to find insurance to cover your medical needs,” said Vanessa Hernandez, who spent 14 years in foster care. She says her younger brother tried twice to sign up online before he gave up.\u003c/p>\n\u003cp>“Currently the process is very unclear, it’s hard to navigate, and it’s not very accessible,” she said.\u003c!--more-->\u003c/p>\n\u003cp>For most young people, The Affordable Care Act allows them to stay on their parents’ insurance until they turn 26. But when California foster youth \u003ca href=\"http://www.childsworld.ca.gov/res/pdf/AB12FactSheet.pdf\" target=\"_blank\">age out of the system\u003c/a> between ages 18 and 21, they often have no one. So federal lawmakers added a special provision to the health law that allows these young adults to stay on Medicaid -- called Medi-Cal in California -- until age 26, regardless of their income.\u003c/p>\n\u003cp>“Former foster youth are extremely vulnerable,” says Jessica Haspel a policy associate at the advocacy nonprofit Children Now. She says any obstacles or delays to enrollment are especially problematic for foster youth. Many have special health needs stemming from a history of abuse or neglect and may rely on important medication for things like diabetes or anxiety. \u003ca href=\"http://www.ncd.gov/newsroom/PolicyCorner/05062013\" target=\"_blank\">Studies show \u003c/a>nearly one in three former foster youth exhibit signs of post-traumatic stress disorder -- which is itself about twice the rate of American war veterans.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/160128590&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>“They may have been offered counseling when they were a child, but were not in a position where they were really able or ready to process it,” Haspel says. “As an adult, they want to take advantage of counseling and services to help them deal with everything that they’ve been through.”\u003c/p>\n\u003cp>She says the Covered California website isn't programmed properly to enroll former foster youth into coverage. And call center employees aren't educated about the new provision. As a result, some youth are being told they don't qualify when they do, or they are put in a queue when they should be fast-tracked into coverage.\u003c/p>\n\u003cp>“We are constantly working hard to resolve some of those issues,” says Anne Gonzales, Covered California spokesperson.\u003c/p>\n\u003cp>She says the agency is beefing up training and updating its guide for service center reps. Website fixes are scheduled for the winter.\u003c/p>\n\u003cp>“We are currently urging anyone who thinks they missed out on benefits to sign up now,” she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But youth advocates are advising young people to sidestep Covered California altogether, and to go to their county social services office instead to sign up for Medi-Cal in person.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>Former foster youth lined up at Covered California's last board meeting to complain about the hoops they have to jump through to enroll in Medi-Cal, the state's health plan for the poor.\u003c/p>\n\u003cp>“Navigating adulthood is challenging enough, let alone trying to find insurance to cover your medical needs,” said Vanessa Hernandez, who spent 14 years in foster care. She says her younger brother tried twice to sign up online before he gave up.\u003c/p>\n\u003cp>“Currently the process is very unclear, it’s hard to navigate, and it’s not very accessible,” she said.\u003c!--more-->\u003c/p>\n\u003cp>For most young people, The Affordable Care Act allows them to stay on their parents’ insurance until they turn 26. But when California foster youth \u003ca href=\"http://www.childsworld.ca.gov/res/pdf/AB12FactSheet.pdf\" target=\"_blank\">age out of the system\u003c/a> between ages 18 and 21, they often have no one. So federal lawmakers added a special provision to the health law that allows these young adults to stay on Medicaid -- called Medi-Cal in California -- until age 26, regardless of their income.\u003c/p>\n\u003cp>“Former foster youth are extremely vulnerable,” says Jessica Haspel a policy associate at the advocacy nonprofit Children Now. She says any obstacles or delays to enrollment are especially problematic for foster youth. Many have special health needs stemming from a history of abuse or neglect and may rely on important medication for things like diabetes or anxiety. \u003ca href=\"http://www.ncd.gov/newsroom/PolicyCorner/05062013\" target=\"_blank\">Studies show \u003c/a>nearly one in three former foster youth exhibit signs of post-traumatic stress disorder -- which is itself about twice the rate of American war veterans.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/160128590&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>“They may have been offered counseling when they were a child, but were not in a position where they were really able or ready to process it,” Haspel says. “As an adult, they want to take advantage of counseling and services to help them deal with everything that they’ve been through.”\u003c/p>\n\u003cp>She says the Covered California website isn't programmed properly to enroll former foster youth into coverage. And call center employees aren't educated about the new provision. As a result, some youth are being told they don't qualify when they do, or they are put in a queue when they should be fast-tracked into coverage.\u003c/p>\n\u003cp>“We are constantly working hard to resolve some of those issues,” says Anne Gonzales, Covered California spokesperson.\u003c/p>\n\u003cp>She says the agency is beefing up training and updating its guide for service center reps. Website fixes are scheduled for the winter.\u003c/p>\n\u003cp>“We are currently urging anyone who thinks they missed out on benefits to sign up now,” she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But youth advocates are advising young people to sidestep Covered California altogether, and to go to their county social services office instead to sign up for Medi-Cal in person.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Latina Small Business Owner Enters the Insurance Marketplace",
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"content": "\u003cfigure id=\"attachment_20198\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Sandra-Lopez-2.jpg\">\u003cimg class=\"size-large wp-image-20198\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Sandra-Lopez-2-640x427.jpg\" alt=\"Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>By\u003cstrong> Heidi de Marco,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/16/A-Small-Business-Owner-Enters-The-Insurance-Marketplace.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Alongside one of Newport Beach's canals, blocks from the beach, Sandra Lopez is finally living her idea of the American dream.\u003c/p>\n\u003caside class=\"pullquote alignleft\">For years Lopez took home remedies or asked friends to bring her medicine from Mexico.\u003c/aside>\n\u003cp>In 1996, six years after crossing the border from Mexico without papers, she began working at Las Fajitas, a popular Mexican restaurant as a cashier and cook. With the help of her boss, she received a work visa in 2001.\u003c/p>\n\u003cp>Eleven years after that, she bought the business – a bustling establishment where Lopez knows most customers by name. Mexican lanterns hang from the ceiling, and cheers from a soccer match on TV fill the room.\u003c/p>\n\u003cp>Lopez, now a legal resident, said the income from her small business fluctuates monthly. “People think that because you own a business, you have lots of money…that life is easy,” she said. “But it’s hard work and I have so many bills to pay.”\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lopez, her husband, and an adult child in the household live on about $46,000 a year.\u003c/p>\n\u003cp>For years, she felt she couldn’t afford health insurance for herself, let alone her half dozen employees: “How can I offer them something I don’t even have?”\u003c/p>\n\u003cp>The 41-year-old had been uninsured since she came to the United States. “If I felt sick, then I would self-medicate,” she said. “I became my own doctor.”\u003c/p>\n\u003cp>Lopez took home remedies or asked friends to bring her medicine from Mexico. She thanks God that neither she nor her husband, a construction worker, needed any serious medical attention – but her 26-year-old son, Juan Angiano, hasn’t been so lucky.\u003c/p>\n\u003cp>Also a legal resident, he has epilepsy, which can be dangerous when not controlled with medication. His seizures are unpredictable and make getting a job nearly impossible. A recent ambulance ride and visit to the emergency room left the family with more than $9,700 in medical bills they couldn’t pay.\u003c/p>\n\u003cp>“I either paid the rent, or the electricity, or the hospital bill,” Lopez said.\u003c/p>\n\u003cp>So when she heard about the Affordable Care Act and the possibility of qualifying for a federal subsidy to pay the premiums, Lopez was eager to enroll.\u003c/p>\n\u003cfigure id=\"attachment_20205\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Jorge-Castaneda-1.jpg\">\u003cimg class=\"size-medium wp-image-20205\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Jorge-Castaneda-1-300x270.jpg\" alt=\"Jorge Castaneda, a cook at Lopez's restaurant has been uninsured most of his adult life. The 47-year-old says he hardly gets sick, but is waiting for his employer to offer health insurance (Heidi de Marco/Kaiser Health News).\" width=\"300\" height=\"270\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jorge Castaneda, a cook at Lopez's restaurant has been uninsured most of his adult life. The 47-year-old says he hardly gets sick, but is waiting for his employer to offer health insurance (Heidi de Marco/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>She went on the Covered California website, the state’s health insurance marketplace, and, after she spent almost two hours online, the site crashed. She almost gave up. “I also tried to call in, but all I got was a recording,” she said. “I left two message and never heard back.”\u003c/p>\n\u003cp>Determined to learn more, she sought help from an insurance agent who walked her through her options.\u003c/p>\n\u003cp>Based on her household income, Lopez qualified for a $750 monthly subsidy to purchase coverage for herself, her husband, and their son, who was then 25 and qualified under the law to be added to his parents’ policy. Although most young adults lose eligibility under their parents’ plans when they turn 26, his insurer is allowing him to retain his coverage because of his disability and dependent status, Lopez said.\u003c/p>\n\u003cp>For now, she pays a monthly premium of $331, with a $5,000 deductible – expensive, but well worth it to her. “Knowing that my son has insurance is comforting,” said Lopez. “It’s a huge relief.”\u003c/p>\n\u003cp>Now that her family is covered, she wants to research options for her staff. Her business is not required to offer health insurance because she has fewer than 50 employees, but she plans to look into the Small Employer Health Options Program (SHOP) and the tax breaks it offers next year.\u003c/p>\n\u003cp>“The fastest growing sector of small business owners is Latinas,” said Marci Avalos, Southern California outreach manager for the Small Business Majority, a nonprofit organization advocating for health-care reform. But they are least informed about their health insurance options, she said.\u003c/p>\n\u003cp>Thirty six percent of Latinas lacked health insurance in 2012, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>“It’s really important that we reach out to this community in Spanish,” said Avalos. “We know who really makes the decisions in the family when health care is concerned…it’s the women.”\u003c/p>\n\u003cp>For now, Lopez is still paying off private loans from when she took over the restaurant, so she encourages her employees to obtain health insurance through the state exchange. Some of them may qualify for Medi-Cal, the state health insurance program for the poor or disabled.\u003c/p>\n\u003cp>Jorge Castaneda, 47, has been a cook at the eatery since it opened in 1995. He has not been insured for most of his adult life. “It would be nice to have it, but I hardly get sick,” he said. “So I don’t really think about it.”\u003c/p>\n\u003cp>Not too long ago Lopez was in their shoes, looking to her boss for help -- now she wants to do the same for them.\u003c/p>\n\u003cp>“For now, I can only afford insurance for my family,” she said. “But my employees are family, too.”\u003c/p>\n\u003cp>\u003cem>Kaiser Health News videotaped an interview with Sandra Lopez while she was considering signing up with Covered California. Watch below:\u003c/em>\u003c/p>\n\u003cdiv>\u003ca class=\"embedly-card\" href=\"http://bcove.me/020qcxyf\">Small Business Owner Struggles To Afford Health Insurance\u003c/a>\u003c/div>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20198\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Sandra-Lopez-2.jpg\">\u003cimg class=\"size-large wp-image-20198\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Sandra-Lopez-2-640x427.jpg\" alt=\"Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>By\u003cstrong> Heidi de Marco,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/16/A-Small-Business-Owner-Enters-The-Insurance-Marketplace.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Alongside one of Newport Beach's canals, blocks from the beach, Sandra Lopez is finally living her idea of the American dream.\u003c/p>\n\u003caside class=\"pullquote alignleft\">For years Lopez took home remedies or asked friends to bring her medicine from Mexico.\u003c/aside>\n\u003cp>In 1996, six years after crossing the border from Mexico without papers, she began working at Las Fajitas, a popular Mexican restaurant as a cashier and cook. With the help of her boss, she received a work visa in 2001.\u003c/p>\n\u003cp>Eleven years after that, she bought the business – a bustling establishment where Lopez knows most customers by name. Mexican lanterns hang from the ceiling, and cheers from a soccer match on TV fill the room.\u003c/p>\n\u003cp>Lopez, now a legal resident, said the income from her small business fluctuates monthly. “People think that because you own a business, you have lots of money…that life is easy,” she said. “But it’s hard work and I have so many bills to pay.”\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lopez, her husband, and an adult child in the household live on about $46,000 a year.\u003c/p>\n\u003cp>For years, she felt she couldn’t afford health insurance for herself, let alone her half dozen employees: “How can I offer them something I don’t even have?”\u003c/p>\n\u003cp>The 41-year-old had been uninsured since she came to the United States. “If I felt sick, then I would self-medicate,” she said. “I became my own doctor.”\u003c/p>\n\u003cp>Lopez took home remedies or asked friends to bring her medicine from Mexico. She thanks God that neither she nor her husband, a construction worker, needed any serious medical attention – but her 26-year-old son, Juan Angiano, hasn’t been so lucky.\u003c/p>\n\u003cp>Also a legal resident, he has epilepsy, which can be dangerous when not controlled with medication. His seizures are unpredictable and make getting a job nearly impossible. A recent ambulance ride and visit to the emergency room left the family with more than $9,700 in medical bills they couldn’t pay.\u003c/p>\n\u003cp>“I either paid the rent, or the electricity, or the hospital bill,” Lopez said.\u003c/p>\n\u003cp>So when she heard about the Affordable Care Act and the possibility of qualifying for a federal subsidy to pay the premiums, Lopez was eager to enroll.\u003c/p>\n\u003cfigure id=\"attachment_20205\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Jorge-Castaneda-1.jpg\">\u003cimg class=\"size-medium wp-image-20205\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/Jorge-Castaneda-1-300x270.jpg\" alt=\"Jorge Castaneda, a cook at Lopez's restaurant has been uninsured most of his adult life. The 47-year-old says he hardly gets sick, but is waiting for his employer to offer health insurance (Heidi de Marco/Kaiser Health News).\" width=\"300\" height=\"270\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jorge Castaneda, a cook at Lopez's restaurant has been uninsured most of his adult life. The 47-year-old says he hardly gets sick, but is waiting for his employer to offer health insurance (Heidi de Marco/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>She went on the Covered California website, the state’s health insurance marketplace, and, after she spent almost two hours online, the site crashed. She almost gave up. “I also tried to call in, but all I got was a recording,” she said. “I left two message and never heard back.”\u003c/p>\n\u003cp>Determined to learn more, she sought help from an insurance agent who walked her through her options.\u003c/p>\n\u003cp>Based on her household income, Lopez qualified for a $750 monthly subsidy to purchase coverage for herself, her husband, and their son, who was then 25 and qualified under the law to be added to his parents’ policy. Although most young adults lose eligibility under their parents’ plans when they turn 26, his insurer is allowing him to retain his coverage because of his disability and dependent status, Lopez said.\u003c/p>\n\u003cp>For now, she pays a monthly premium of $331, with a $5,000 deductible – expensive, but well worth it to her. “Knowing that my son has insurance is comforting,” said Lopez. “It’s a huge relief.”\u003c/p>\n\u003cp>Now that her family is covered, she wants to research options for her staff. Her business is not required to offer health insurance because she has fewer than 50 employees, but she plans to look into the Small Employer Health Options Program (SHOP) and the tax breaks it offers next year.\u003c/p>\n\u003cp>“The fastest growing sector of small business owners is Latinas,” said Marci Avalos, Southern California outreach manager for the Small Business Majority, a nonprofit organization advocating for health-care reform. But they are least informed about their health insurance options, she said.\u003c/p>\n\u003cp>Thirty six percent of Latinas lacked health insurance in 2012, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>“It’s really important that we reach out to this community in Spanish,” said Avalos. “We know who really makes the decisions in the family when health care is concerned…it’s the women.”\u003c/p>\n\u003cp>For now, Lopez is still paying off private loans from when she took over the restaurant, so she encourages her employees to obtain health insurance through the state exchange. Some of them may qualify for Medi-Cal, the state health insurance program for the poor or disabled.\u003c/p>\n\u003cp>Jorge Castaneda, 47, has been a cook at the eatery since it opened in 1995. He has not been insured for most of his adult life. “It would be nice to have it, but I hardly get sick,” he said. “So I don’t really think about it.”\u003c/p>\n\u003cp>Not too long ago Lopez was in their shoes, looking to her boss for help -- now she wants to do the same for them.\u003c/p>\n\u003cp>“For now, I can only afford insurance for my family,” she said. “But my employees are family, too.”\u003c/p>\n\u003cp>\u003cem>Kaiser Health News videotaped an interview with Sandra Lopez while she was considering signing up with Covered California. Watch below:\u003c/em>\u003c/p>\n\u003cdiv>\u003ca class=\"embedly-card\" href=\"http://bcove.me/020qcxyf\">Small Business Owner Struggles To Afford Health Insurance\u003c/a>\u003c/div>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Anthem Blue Cross Sued Over Covered California Doctor Networks",
"title": "Anthem Blue Cross Sued Over Covered California Doctor Networks",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_17341\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/96525183-e1390846077644.jpg\">\u003cimg class=\"size-large wp-image-17341\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/96525183-640x426.jpg\" alt=\"The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images) \u003ccite>(David McNew/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Appleby,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/09/anthem-lawsuit-over-enrollment-practices.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Statewide insurance giant Anthem Blue Cross misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a \u003ca href=\"http://media.khn.webfactional.com/html/anthem-lawsuit/Felser.pdf\" target=\"_blank\">class action lawsuit\u003c/a> filed Tuesday.\u003c/p>\n\u003caside class=\"pullquote alignleft\">As a result, many consumers are on the hook for thousands in medical bills, advocacy group says.\u003c/aside>\n\u003cp>As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica.\u003c/p>\n\u003cp>Anthem spokesman Darrel Ng declined to comment directly on the lawsuit. He said Anthem has agreed to pay the claims of those who received treatment from inaccurately listed doctors during the first three months of the year.\u003c/p>\n\u003cp>However, that policy would not be extended for enrollees who discovered after March 31 that their doctors had been incorrectly listed, he said.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The suit says that Anthem, the state’s largest individual health insurer, delayed providing full information to consumers until it was too late for them to change coverage. Anthem also failed to disclose it had stopped offering any plans with out-of-network coverage in four of the state's biggest counties -- Los Angeles, Orange, San Francisco and San Diego, the suit says.\u003c/p>\n\u003cp>Anthem “intentionally misrepresented and concealed the limitations of their plans because it wanted a big market share,” said Jerry Flanagan of the consumer advocacy group. Co-counsel on the case is the Claremont law firm Shernoff Bidart Echeverria Bentley, which specializes in suing health insurers.\u003c/p>\n\u003cp>The suit comes as Consumer Watchdog helped put a measure on the November ballot that would give the state's insurance commissioner greater authority to veto rate increases.\u003c/p>\n\u003cp>Brought on behalf of Anthem enrollees who purchased individual coverage between Oct. 1, 2013 and March 31, 2014, the lawsuit reflects growing consumer pushback against so-called “narrow network” health plans, which are increasingly common, especially in the new online state and federal marketplaces. Anthem was a major player on California’s insurance exchange and the suit includes those who bought coverage online, as well as directly from the insurer.\u003c/p>\n\u003cp>Insurers have defended plans with limited provider networks as \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/11/28/why-narrow-networks-may-not-be-such-a-bad-idea/\" target=\"_blank\">a way of holding down premiums\u003c/a>. Many expected younger and healthier customers might be willing to give up broad access to providers for these lower costs.\u003c/p>\n\u003cp>But consumers are retaliating with lawsuits and complaints to state regulators. As a result of the rising complaints, state managed care regulators are investigating whether Anthem and, separately, Blue Shield of California, provided accurate information about the doctors and hospitals in their plans.\u003c/p>\n\u003cp>\u003cstrong>Six Enrollees' Stories\u003c/strong>\u003c/p>\n\u003cp>The Consumer Watchdog lawsuit names six Californians who purchased Anthem plans. Among them is Betsy Felser of Pasadena, who had coverage with Anthem for 20 years. Like hundreds of thousands of Anthem customers, she received a letter late last year stating that her preferred provider organization (PPO), which allows for in- and out-of-network care, was being cancelled, according to the lawsuit. The letter suggested a replacement Anthem plan “with the benefits you have come to count on.”\u003c/p>\n\u003cp>Before agreeing to switch, Felser, a physician, said she checked with five Anthem telephone representatives, making it clear she wanted to be in a PPO.\u003c/p>\n\u003cp>“I would never have gotten anything that wasn’t a PPO plan,” said Felser, 47, whose insurance also covers her young son. “They said they would give me the same coverage.”\u003c/p>\n\u003cp>She also checked Anthem’s website and the doctors she sees, including her son’s pediatrician, to make sure they were participating in the plans she was considering and was assured that they were, she said.\u003c/p>\n\u003cp>During those calls, none of Anthem’s representatives told Felser that the insurer was no longer offering PPOs in Los Angeles County, the lawsuit alleges. Nor did they tell her that the Anthem plans offered in her area would not cover care provided by out-of-network doctors or hospitals, according to the lawsuit.\u003c/p>\n\u003cp>When she received her identification cards, they were stamped with a PPO symbol. But when she tried to use the coverage, she found out her doctors – and her son’s pediatrician – were not in the network and that the plan was an exclusive provider organization (EPO), an extremely limited type of plan which pays nothing for out-of-network care.\u003c/p>\n\u003cp>“It pays zero, so I essentially have no coverage,” said Felser.\u003c/p>\n\u003cp>Anthem, while declining to comment on the Consumer Watchdog suit, had answered questions last week about an earlier lawsuit that raised similar issues.\u003c/p>\n\u003cp>Spokesman Ng said then that consumers were informed about what kind of plan they purchased, along with details about out-of-network benefits, in packets they received soon after enrolling. “All those materials clearly spelled out type of plan they were receiving,” he said.\u003c/p>\n\u003cp>But consumers would have to dig deep in a brochure on the Anthem website to find a footnote to a page 9 chart indicating that EPO plans have no out-of-network benefits.\u003c/p>\n\u003cp>Ng noted that Anthem’s EPO and PPO networks have the same doctors and hospitals for people with individual policies, although only the PPOs have out-of-network benefits. In recent weeks, Anthem said it has added 3,800 doctors to its networks.\u003c/p>\n\u003cp>\u003cstrong>'A Giant Mess'\u003c/strong>\u003c/p>\n\u003cp>As for the PPO symbol on identification cards, Ng said last week that it had been intended to protect consumers who sought emergency care out-of-state, in keeping with Blue Cross Blue Shield Association rules. Ng said Anthem recently got association approval to reissue the cards without the symbol.\u003c/p>\n\u003cp>But consumers say the damage was done. Josh Worth of Los Angeles said he was unable to get accurate information after receiving notice that his Anthem plan would be cancelled at the end of 2013. He said he called Anthem, as well as all the doctors he used — including his child’s pediatrician and his wife’s obstetrician — to be sure they were participating in the network.\u003c/p>\n\u003cp>“They all said, ‘yes, we’re going to be continuing to accept all Blue Cross PPOs,’ and that’s what I was told I was going to be getting,” said Worth, a 43-year-old graphic artist. In January, he said he enrolled his family in an Anthem plan with an $800 a month premium.\u003c/p>\n\u003cp>Worth received an ID card in late February that called his plan a “Pathway Tiered PPO,” according to the lawsuit. His son was born on March 31. Not long after, he said he began receiving bills from his wife’s obstetrician, who was not in the network. Nor was the baby’s pediatrician, he said.\u003c/p>\n\u003cp>As a result, he said he owes about $1,100 out of pocket for both. And although an Anthem telephone representative told him afterward that the hospital where his son was born was not in network, it actually is – and his bills there are being covered, he said.\u003c/p>\n\u003cp>“It’s a giant mess,” said Worth, who can’t switch plans until open enrollment resumes in the fall. “I was sold something I thought was one product, but when I used it, I found out it wasn’t. I’m not going to be going through Anthem again.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"BmR0WPZq6RSJcEntShDdrDz9FsVmJH8T\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17341\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/96525183-e1390846077644.jpg\">\u003cimg class=\"size-large wp-image-17341\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/96525183-640x426.jpg\" alt=\"The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images) \u003ccite>(David McNew/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Appleby,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/09/anthem-lawsuit-over-enrollment-practices.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Statewide insurance giant Anthem Blue Cross misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a \u003ca href=\"http://media.khn.webfactional.com/html/anthem-lawsuit/Felser.pdf\" target=\"_blank\">class action lawsuit\u003c/a> filed Tuesday.\u003c/p>\n\u003caside class=\"pullquote alignleft\">As a result, many consumers are on the hook for thousands in medical bills, advocacy group says.\u003c/aside>\n\u003cp>As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica.\u003c/p>\n\u003cp>Anthem spokesman Darrel Ng declined to comment directly on the lawsuit. He said Anthem has agreed to pay the claims of those who received treatment from inaccurately listed doctors during the first three months of the year.\u003c/p>\n\u003cp>However, that policy would not be extended for enrollees who discovered after March 31 that their doctors had been incorrectly listed, he said.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The suit says that Anthem, the state’s largest individual health insurer, delayed providing full information to consumers until it was too late for them to change coverage. Anthem also failed to disclose it had stopped offering any plans with out-of-network coverage in four of the state's biggest counties -- Los Angeles, Orange, San Francisco and San Diego, the suit says.\u003c/p>\n\u003cp>Anthem “intentionally misrepresented and concealed the limitations of their plans because it wanted a big market share,” said Jerry Flanagan of the consumer advocacy group. Co-counsel on the case is the Claremont law firm Shernoff Bidart Echeverria Bentley, which specializes in suing health insurers.\u003c/p>\n\u003cp>The suit comes as Consumer Watchdog helped put a measure on the November ballot that would give the state's insurance commissioner greater authority to veto rate increases.\u003c/p>\n\u003cp>Brought on behalf of Anthem enrollees who purchased individual coverage between Oct. 1, 2013 and March 31, 2014, the lawsuit reflects growing consumer pushback against so-called “narrow network” health plans, which are increasingly common, especially in the new online state and federal marketplaces. Anthem was a major player on California’s insurance exchange and the suit includes those who bought coverage online, as well as directly from the insurer.\u003c/p>\n\u003cp>Insurers have defended plans with limited provider networks as \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/11/28/why-narrow-networks-may-not-be-such-a-bad-idea/\" target=\"_blank\">a way of holding down premiums\u003c/a>. Many expected younger and healthier customers might be willing to give up broad access to providers for these lower costs.\u003c/p>\n\u003cp>But consumers are retaliating with lawsuits and complaints to state regulators. As a result of the rising complaints, state managed care regulators are investigating whether Anthem and, separately, Blue Shield of California, provided accurate information about the doctors and hospitals in their plans.\u003c/p>\n\u003cp>\u003cstrong>Six Enrollees' Stories\u003c/strong>\u003c/p>\n\u003cp>The Consumer Watchdog lawsuit names six Californians who purchased Anthem plans. Among them is Betsy Felser of Pasadena, who had coverage with Anthem for 20 years. Like hundreds of thousands of Anthem customers, she received a letter late last year stating that her preferred provider organization (PPO), which allows for in- and out-of-network care, was being cancelled, according to the lawsuit. The letter suggested a replacement Anthem plan “with the benefits you have come to count on.”\u003c/p>\n\u003cp>Before agreeing to switch, Felser, a physician, said she checked with five Anthem telephone representatives, making it clear she wanted to be in a PPO.\u003c/p>\n\u003cp>“I would never have gotten anything that wasn’t a PPO plan,” said Felser, 47, whose insurance also covers her young son. “They said they would give me the same coverage.”\u003c/p>\n\u003cp>She also checked Anthem’s website and the doctors she sees, including her son’s pediatrician, to make sure they were participating in the plans she was considering and was assured that they were, she said.\u003c/p>\n\u003cp>During those calls, none of Anthem’s representatives told Felser that the insurer was no longer offering PPOs in Los Angeles County, the lawsuit alleges. Nor did they tell her that the Anthem plans offered in her area would not cover care provided by out-of-network doctors or hospitals, according to the lawsuit.\u003c/p>\n\u003cp>When she received her identification cards, they were stamped with a PPO symbol. But when she tried to use the coverage, she found out her doctors – and her son’s pediatrician – were not in the network and that the plan was an exclusive provider organization (EPO), an extremely limited type of plan which pays nothing for out-of-network care.\u003c/p>\n\u003cp>“It pays zero, so I essentially have no coverage,” said Felser.\u003c/p>\n\u003cp>Anthem, while declining to comment on the Consumer Watchdog suit, had answered questions last week about an earlier lawsuit that raised similar issues.\u003c/p>\n\u003cp>Spokesman Ng said then that consumers were informed about what kind of plan they purchased, along with details about out-of-network benefits, in packets they received soon after enrolling. “All those materials clearly spelled out type of plan they were receiving,” he said.\u003c/p>\n\u003cp>But consumers would have to dig deep in a brochure on the Anthem website to find a footnote to a page 9 chart indicating that EPO plans have no out-of-network benefits.\u003c/p>\n\u003cp>Ng noted that Anthem’s EPO and PPO networks have the same doctors and hospitals for people with individual policies, although only the PPOs have out-of-network benefits. In recent weeks, Anthem said it has added 3,800 doctors to its networks.\u003c/p>\n\u003cp>\u003cstrong>'A Giant Mess'\u003c/strong>\u003c/p>\n\u003cp>As for the PPO symbol on identification cards, Ng said last week that it had been intended to protect consumers who sought emergency care out-of-state, in keeping with Blue Cross Blue Shield Association rules. Ng said Anthem recently got association approval to reissue the cards without the symbol.\u003c/p>\n\u003cp>But consumers say the damage was done. Josh Worth of Los Angeles said he was unable to get accurate information after receiving notice that his Anthem plan would be cancelled at the end of 2013. He said he called Anthem, as well as all the doctors he used — including his child’s pediatrician and his wife’s obstetrician — to be sure they were participating in the network.\u003c/p>\n\u003cp>“They all said, ‘yes, we’re going to be continuing to accept all Blue Cross PPOs,’ and that’s what I was told I was going to be getting,” said Worth, a 43-year-old graphic artist. In January, he said he enrolled his family in an Anthem plan with an $800 a month premium.\u003c/p>\n\u003cp>Worth received an ID card in late February that called his plan a “Pathway Tiered PPO,” according to the lawsuit. His son was born on March 31. Not long after, he said he began receiving bills from his wife’s obstetrician, who was not in the network. Nor was the baby’s pediatrician, he said.\u003c/p>\n\u003cp>As a result, he said he owes about $1,100 out of pocket for both. And although an Anthem telephone representative told him afterward that the hospital where his son was born was not in network, it actually is – and his bills there are being covered, he said.\u003c/p>\n\u003cp>“It’s a giant mess,” said Worth, who can’t switch plans until open enrollment resumes in the fall. “I was sold something I thought was one product, but when I used it, I found out it wasn’t. I’m not going to be going through Anthem again.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Nearly a Million People Backlogged in Medi-Cal Expansion",
"title": "Nearly a Million People Backlogged in Medi-Cal Expansion",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_20007\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/83121913crop.jpg\">\u003cimg class=\"size-large wp-image-20007\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/83121913crop-640x429.jpg\" alt=\"It's not clear when the backlog will be cleared. (Getty Images)\" width=\"640\" height=\"429\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">It's not clear when the backlog will be cleared. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Helen Shen,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/02/Mountainous-Backlog-Stalls-MediCal-Expansion-in-California.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>A massive backlog of Medi-Cal applications is well into its third month, and California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared.\u003c/p>\n\u003cp>The California Department of Health Care Services in Sacramento first reported 800,000 pending applications in April. By May, that number had grown by 100,000 and has not budged much since. As the state works through older applications, new ones continue each day to enter the system, which has been plagued by computer glitches and inefficient procedures for verifying applicants' personal information.\u003c/p>\n\u003cp>There are no estimates of processing times or how long delays will persist, though a state official said last month that new applications in May appeared to have slowed.\u003c!--more-->\u003c/p>\n\u003cp>\"All the resources are just devoted to getting people moving forward,\" said Norman Williams, a department spokesman.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Not only has application processing been delayed, the state has fallen behind in sending final notifications to enrollees, officials confirmed. Meanwhile, many people are showing up at community clinics and costly emergency rooms as they have in the past. Others are putting off care.\u003c/p>\n\u003cp>Although Medi-Cal coverage is retroactive from the time eligible patients apply, some don't trust they will be covered until they have a card in hand.\u003c/p>\n\u003cp>\"I'm afraid to go to the hospital,\" said Adolfo Rodriguez, 35, of East Palo Alto. \"I can't afford it.\"\u003c/p>\n\u003cp>Rodriguez’s Medi-Cal application has been pending since March. In the meantime, he said, he can't do his job as a truck driver – he needs to see a specialist about severe muscle and joint pain.\u003c/p>\n\u003cp>Part of the problem is high demand. In California, as in many of the 26 states that opted to expand Medicaid eligibility under the Affordable Care Act, people turned out in much higher numbers than projected. The state health department said it now expects 2.2 million people to enroll in Medi-Cal this month —300,000 more than estimated last fall.\u003c/p>\n\u003cp>Since last fall, 40 percent more people have signed up for Medi-Cal than the number who enrolled in private insurance through Covered California, the state’s health insurance exchange. Roughly 1.4 million of those applicants were newly eligible for Medi-Cal, which was expanded to serve people up to 138 percent of the federal poverty level. About 600,000 more were previously eligible for coverage but had not enrolled. Experts say the massive outreach campaigns across the country helped alert many of these people to their eligibility.\u003c/p>\n\u003cp>\u003cstrong>Unanswered Questions\u003c/strong>\u003c/p>\n\u003cp>State health officials said about half of the 900,000 pending applications have been filed within the past 45 days—the maximum processing period typically allowed by law. Little is known about the other half, and why they have exceeded this time window.\u003c/p>\n\u003cp>\"It's difficult to determine exactly who is in that 900,000 and for what reason,\" said Williams, the health department spokesman.\u003c/p>\n\u003cp>Although California experienced an initial swell of applications in December 2013, a second, enormous wave landed in March, as people scrambled to meet the deadline for obtaining insurance coverage.\u003c/p>\n\u003cp>\"We did not anticipate the surge in applications to this extent,\" said Anastasia Dodson, associate director of policy at the California Department of Health Care Services.\u003c/p>\n\u003cp>The state has refused to release the number of applications that were backlogged before April. \"The numbers for previous months probably wouldn't be accurate for readers,\" said Dodson. Among other reasons, she said that the health department did not realize how many duplicated applications were stuck in the mix, as frustrated users tried repeatedly to sign up for Medi-Cal. \"We had people who applied 30 times,\" Dodson said.\u003c/p>\n\u003cp>The department has since identified and removed duplicate applications to arrive at the figures that have been reported since April.\u003c/p>\n\u003cp>Though details remain sketchy, one problem was delayed development of an interface that would connect the state's new system with old county-based social services computer systems for verifying Medi-Cal eligibility. Some people were able to sign up smoothly by applying in-person at county health departments. But many applications submitted through the state website stalled.\u003c/p>\n\u003cp>Some applications have been delayed by missing or inaccurate information. Others have been slowed by outdated procedures for verifying residency—only recently replaced by an automated verification system.\u003c/p>\n\u003cp>Critics say that launching the Covered California insurance exchange was made a higher priority than improving the online enrollment process for Medi-Cal patients, despite their great numbers.\u003c/p>\n\u003cp>\"In a very short period of time, there was a lot of work to do, and I think the folks that make the priorities decided that the particular piece for Medi-Cal recipients could wait,\" said Frank Mecca, executive director of the County Welfare Directors Association of California.\u003c/p>\n\u003cp>\u003cstrong>Uncertainty For Providers And Patients\u003c/strong>\u003c/p>\n\u003cp>Although open enrollment for private insurance plans closed in April, Medi-Cal enrollment remains open year-round, leaving little breathing room for health officials.\u003c/p>\n\u003cp>The holdup in Medi-Cal approvals has led to financial uncertainty for many of California's community health clinics, which depend on Medi-Cal payments to supplement the reduced fees or fee waivers they accept from low-income, uninsured patients. A number of centers have recently expanded facilities, staff and services in anticipation of a wave of Medi-Cal patients and the extra cash they would bring.\u003c/p>\n\u003cp>\"We basically don't know if we're going to be receiving payment for the services we're providing,\" said Carmela Castellano-Garcia, chief executive of the California Primary Care Association, which represents more than 1,000 community clinics and health centers. Private providers are even more wary.\u003c/p>\n\u003cp>\"A typical private practice might say, 'You're uninsured,' and be unwilling to participate in that bureaucracy of claims that need to be paid retroactively,\" said Dylan Roby, a health policy professor at the University of California, Los Angeles. Patients, too, have been left in limbo.\u003c/p>\n\u003cp>“They're afraid they may not be approved and that they'll be stuck with this huge bill,\" said Irais Bazan, an enrollment and eligibility manager at Ravenswood Family Health Center in East Palo Alto.\u003c/p>\n\u003cp>Rodriguez said he that he did not know about his retroactive payment options when he visited a county hospital in San Mateo two months ago for his muscle and joint pains. He borrowed money from his brother to pay off the $1,400 bill—much larger than he had expected.\u003c/p>\n\u003cp>He could not afford the pain medications that the doctor prescribed. He still does not have a diagnosis and said he will not try again until his Medi-Cal card arrives.\u003c/p>\n\u003cp>Thomas Kurthy of Los Angeles is waiting for his Medi-Cal card so that he can get a physical and a colonoscopy. His father was recently treated for cancer, and Kurthy said he wants to stay on top of his health.\u003c/p>\n\u003cp>His last doctor's visit was in 2012. Since January, the 51-year-old garden designer has amassed a large folder of notes as he has tried to follow up with local health advocates, navigators, county health workers, and others who at various times have handled his Medi-Cal application.\u003c/p>\n\u003cp>\"I've been bounced around from office to office, person to person,\" said Kurthy. \"I think if I didn't stay on top of this, I would never hear from anybody.\"\u003c/p>\n\u003cp>Last month, a county health worker told Kurthy that his application had a good chance of being decided within the next 30 to 45 days.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org\" target=\"_blank\">Kaiser Health News\u003c/a> (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20007\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/83121913crop.jpg\">\u003cimg class=\"size-large wp-image-20007\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/83121913crop-640x429.jpg\" alt=\"It's not clear when the backlog will be cleared. (Getty Images)\" width=\"640\" height=\"429\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">It's not clear when the backlog will be cleared. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Helen Shen,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/02/Mountainous-Backlog-Stalls-MediCal-Expansion-in-California.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>A massive backlog of Medi-Cal applications is well into its third month, and California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared.\u003c/p>\n\u003cp>The California Department of Health Care Services in Sacramento first reported 800,000 pending applications in April. By May, that number had grown by 100,000 and has not budged much since. As the state works through older applications, new ones continue each day to enter the system, which has been plagued by computer glitches and inefficient procedures for verifying applicants' personal information.\u003c/p>\n\u003cp>There are no estimates of processing times or how long delays will persist, though a state official said last month that new applications in May appeared to have slowed.\u003c!--more-->\u003c/p>\n\u003cp>\"All the resources are just devoted to getting people moving forward,\" said Norman Williams, a department spokesman.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Not only has application processing been delayed, the state has fallen behind in sending final notifications to enrollees, officials confirmed. Meanwhile, many people are showing up at community clinics and costly emergency rooms as they have in the past. Others are putting off care.\u003c/p>\n\u003cp>Although Medi-Cal coverage is retroactive from the time eligible patients apply, some don't trust they will be covered until they have a card in hand.\u003c/p>\n\u003cp>\"I'm afraid to go to the hospital,\" said Adolfo Rodriguez, 35, of East Palo Alto. \"I can't afford it.\"\u003c/p>\n\u003cp>Rodriguez’s Medi-Cal application has been pending since March. In the meantime, he said, he can't do his job as a truck driver – he needs to see a specialist about severe muscle and joint pain.\u003c/p>\n\u003cp>Part of the problem is high demand. In California, as in many of the 26 states that opted to expand Medicaid eligibility under the Affordable Care Act, people turned out in much higher numbers than projected. The state health department said it now expects 2.2 million people to enroll in Medi-Cal this month —300,000 more than estimated last fall.\u003c/p>\n\u003cp>Since last fall, 40 percent more people have signed up for Medi-Cal than the number who enrolled in private insurance through Covered California, the state’s health insurance exchange. Roughly 1.4 million of those applicants were newly eligible for Medi-Cal, which was expanded to serve people up to 138 percent of the federal poverty level. About 600,000 more were previously eligible for coverage but had not enrolled. Experts say the massive outreach campaigns across the country helped alert many of these people to their eligibility.\u003c/p>\n\u003cp>\u003cstrong>Unanswered Questions\u003c/strong>\u003c/p>\n\u003cp>State health officials said about half of the 900,000 pending applications have been filed within the past 45 days—the maximum processing period typically allowed by law. Little is known about the other half, and why they have exceeded this time window.\u003c/p>\n\u003cp>\"It's difficult to determine exactly who is in that 900,000 and for what reason,\" said Williams, the health department spokesman.\u003c/p>\n\u003cp>Although California experienced an initial swell of applications in December 2013, a second, enormous wave landed in March, as people scrambled to meet the deadline for obtaining insurance coverage.\u003c/p>\n\u003cp>\"We did not anticipate the surge in applications to this extent,\" said Anastasia Dodson, associate director of policy at the California Department of Health Care Services.\u003c/p>\n\u003cp>The state has refused to release the number of applications that were backlogged before April. \"The numbers for previous months probably wouldn't be accurate for readers,\" said Dodson. Among other reasons, she said that the health department did not realize how many duplicated applications were stuck in the mix, as frustrated users tried repeatedly to sign up for Medi-Cal. \"We had people who applied 30 times,\" Dodson said.\u003c/p>\n\u003cp>The department has since identified and removed duplicate applications to arrive at the figures that have been reported since April.\u003c/p>\n\u003cp>Though details remain sketchy, one problem was delayed development of an interface that would connect the state's new system with old county-based social services computer systems for verifying Medi-Cal eligibility. Some people were able to sign up smoothly by applying in-person at county health departments. But many applications submitted through the state website stalled.\u003c/p>\n\u003cp>Some applications have been delayed by missing or inaccurate information. Others have been slowed by outdated procedures for verifying residency—only recently replaced by an automated verification system.\u003c/p>\n\u003cp>Critics say that launching the Covered California insurance exchange was made a higher priority than improving the online enrollment process for Medi-Cal patients, despite their great numbers.\u003c/p>\n\u003cp>\"In a very short period of time, there was a lot of work to do, and I think the folks that make the priorities decided that the particular piece for Medi-Cal recipients could wait,\" said Frank Mecca, executive director of the County Welfare Directors Association of California.\u003c/p>\n\u003cp>\u003cstrong>Uncertainty For Providers And Patients\u003c/strong>\u003c/p>\n\u003cp>Although open enrollment for private insurance plans closed in April, Medi-Cal enrollment remains open year-round, leaving little breathing room for health officials.\u003c/p>\n\u003cp>The holdup in Medi-Cal approvals has led to financial uncertainty for many of California's community health clinics, which depend on Medi-Cal payments to supplement the reduced fees or fee waivers they accept from low-income, uninsured patients. A number of centers have recently expanded facilities, staff and services in anticipation of a wave of Medi-Cal patients and the extra cash they would bring.\u003c/p>\n\u003cp>\"We basically don't know if we're going to be receiving payment for the services we're providing,\" said Carmela Castellano-Garcia, chief executive of the California Primary Care Association, which represents more than 1,000 community clinics and health centers. Private providers are even more wary.\u003c/p>\n\u003cp>\"A typical private practice might say, 'You're uninsured,' and be unwilling to participate in that bureaucracy of claims that need to be paid retroactively,\" said Dylan Roby, a health policy professor at the University of California, Los Angeles. Patients, too, have been left in limbo.\u003c/p>\n\u003cp>“They're afraid they may not be approved and that they'll be stuck with this huge bill,\" said Irais Bazan, an enrollment and eligibility manager at Ravenswood Family Health Center in East Palo Alto.\u003c/p>\n\u003cp>Rodriguez said he that he did not know about his retroactive payment options when he visited a county hospital in San Mateo two months ago for his muscle and joint pains. He borrowed money from his brother to pay off the $1,400 bill—much larger than he had expected.\u003c/p>\n\u003cp>He could not afford the pain medications that the doctor prescribed. He still does not have a diagnosis and said he will not try again until his Medi-Cal card arrives.\u003c/p>\n\u003cp>Thomas Kurthy of Los Angeles is waiting for his Medi-Cal card so that he can get a physical and a colonoscopy. His father was recently treated for cancer, and Kurthy said he wants to stay on top of his health.\u003c/p>\n\u003cp>His last doctor's visit was in 2012. Since January, the 51-year-old garden designer has amassed a large folder of notes as he has tried to follow up with local health advocates, navigators, county health workers, and others who at various times have handled his Medi-Cal application.\u003c/p>\n\u003cp>\"I've been bounced around from office to office, person to person,\" said Kurthy. \"I think if I didn't stay on top of this, I would never hear from anybody.\"\u003c/p>\n\u003cp>Last month, a county health worker told Kurthy that his application had a good chance of being decided within the next 30 to 45 days.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org\" target=\"_blank\">Kaiser Health News\u003c/a> (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Opposing Sides Testify Before State Committee over Insurance Proposition",
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"content": "\u003cfigure id=\"attachment_16359\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/PEterLeeCROP-e1386913666627.jpg\">\u003cimg class=\"size-large wp-image-16359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/PEterLeeCROP-640x464.jpg\" alt=\"Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.\" width=\"640\" height=\"464\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan>State insurance commissioner Dave Jones is flatly rejecting accusations that a proposition on November's ballot would undermine the implementation of the Affordable Care Act in California.\u003c/span>\u003c/p>\n\u003cp>If passed by voters, Proposition 45 would give the commissioner the power to reject excessive rate hikes for health insurance –- and, he argues, keep health premiums affordable for consumers. Last month, Covered California, the state’s health insurance exchange, said the measure could compromise its operations, possibly causing delays in approving health plans before they are federally mandated to go on sale to consumers, or curtailing its own authority to negotiate the details of plans with insurers.\u003c/p>\n\u003cp>“These conclusions are fundamentally flawed,” Jones said on Wednesday, speaking before the state’s joint legislative committee on health.\u003c!--more-->\u003c/p>\n\u003cp>Jones issued a letter to the members of the committee detailing responses to the concerns and questions raised by Covered California. He said delays were unlikely given the small number of health insurers (40) and plans (100 per year) the commissioner would be tasked with overseeing under the initiative. This is compared to property insurers (500) and rate filings (7,000 year) currently overseen by his department.\u003c/p>\n\u003cp>He also emphasized that the scope of review under the measure would be limited to rates only. Covered California officials called the wording of the proposition “broad,” and said it could be interpreted to grant the commissioner power to review not only rates, but also specific benefits of health plans and the network of providers included in a plan.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It doesn’t. It doesn’t,” Jones said at the hearing. He argued that if voters do not pass the proposition, California would see less competition in the health insurance market, leaving consumers with less choice and ever-increasing health insurance premiums. He said Covered California failed to negotiate better rates for consumers last year, noting premiums on individual plans for 2013 had increased between 21 and 88 percent the following year.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said there is more to plans than just the premiums. Testifying at Wednesday’s hearing, he conceded on the point of timing, expressing new confidence that his and Jones’ agencies could work together to meet federally set deadlines for approving health plans before the start of open enrollment in mid-November. However, he said there could still be negative implications.\u003c/p>\n\u003cp>His main concern is that health insurers will simply withdraw their plans from the marketplace if the rates are rejected by the commissioner. This would leave consumers with less plans to choose from, and complicate how federal subsidies are calculated for all the consumers in that region. Subsidies, the financial assistance provided by the federal government to pay for plans, are calculated based, in part, on the number of plans available for sale in a particular market and prices. If one plan withdraws, or offers the previous year’s plan at the previous year’s rate, that complicates the calculation.\u003c/p>\n\u003cp>“The only thing we can be sure of is the uncertainty of the products that would be available,” Lee said.\u003c/p>\n\u003cp>Lee also responded to questions from committee members who worried that the measure would cause health insurers to become singularly focused on keeping rates down at the expense of the benefits included in health plans.\u003c/p>\n\u003cp>“People can get something cheap, but it may not have a good value,” said Assemblymember Richard Pan (D-Sacramento). “I hear from physicians who take care of minority populations. It is important that they are part of networks…and it is important for Covered California to make sure we have plans that pay attention to those things.”\u003c/p>\n\u003cp>Lee said the measure might compromise Covered California’s power to negotiate these plan designs, as well as efforts to promote innovation among plans. He said his agency wants to encourage plans to try new care delivery models or payment models that emphasize preventive care and could ultimately result in better health for patients in the long term.\u003c/p>\n\u003cp>“It may be that contracting with them costs more on the front end, but has better back end results in terms of outcomes,” he said, adding that the opportunity to experiment with these models could be lost of insurers focus only on providing the cheapest plan now. “This ripple effect is one of the big uncertainties.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Members of the joint committee called on both sides to conduct further analysis.\u003c/p>\n\n",
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"excerpt": "Prop. 45 would give the CA insurance commissioner power to reject excessive health insurance premiums.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16359\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/PEterLeeCROP-e1386913666627.jpg\">\u003cimg class=\"size-large wp-image-16359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/PEterLeeCROP-640x464.jpg\" alt=\"Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.\" width=\"640\" height=\"464\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan>State insurance commissioner Dave Jones is flatly rejecting accusations that a proposition on November's ballot would undermine the implementation of the Affordable Care Act in California.\u003c/span>\u003c/p>\n\u003cp>If passed by voters, Proposition 45 would give the commissioner the power to reject excessive rate hikes for health insurance –- and, he argues, keep health premiums affordable for consumers. Last month, Covered California, the state’s health insurance exchange, said the measure could compromise its operations, possibly causing delays in approving health plans before they are federally mandated to go on sale to consumers, or curtailing its own authority to negotiate the details of plans with insurers.\u003c/p>\n\u003cp>“These conclusions are fundamentally flawed,” Jones said on Wednesday, speaking before the state’s joint legislative committee on health.\u003c!--more-->\u003c/p>\n\u003cp>Jones issued a letter to the members of the committee detailing responses to the concerns and questions raised by Covered California. He said delays were unlikely given the small number of health insurers (40) and plans (100 per year) the commissioner would be tasked with overseeing under the initiative. This is compared to property insurers (500) and rate filings (7,000 year) currently overseen by his department.\u003c/p>\n\u003cp>He also emphasized that the scope of review under the measure would be limited to rates only. Covered California officials called the wording of the proposition “broad,” and said it could be interpreted to grant the commissioner power to review not only rates, but also specific benefits of health plans and the network of providers included in a plan.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It doesn’t. It doesn’t,” Jones said at the hearing. He argued that if voters do not pass the proposition, California would see less competition in the health insurance market, leaving consumers with less choice and ever-increasing health insurance premiums. He said Covered California failed to negotiate better rates for consumers last year, noting premiums on individual plans for 2013 had increased between 21 and 88 percent the following year.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said there is more to plans than just the premiums. Testifying at Wednesday’s hearing, he conceded on the point of timing, expressing new confidence that his and Jones’ agencies could work together to meet federally set deadlines for approving health plans before the start of open enrollment in mid-November. However, he said there could still be negative implications.\u003c/p>\n\u003cp>His main concern is that health insurers will simply withdraw their plans from the marketplace if the rates are rejected by the commissioner. This would leave consumers with less plans to choose from, and complicate how federal subsidies are calculated for all the consumers in that region. Subsidies, the financial assistance provided by the federal government to pay for plans, are calculated based, in part, on the number of plans available for sale in a particular market and prices. If one plan withdraws, or offers the previous year’s plan at the previous year’s rate, that complicates the calculation.\u003c/p>\n\u003cp>“The only thing we can be sure of is the uncertainty of the products that would be available,” Lee said.\u003c/p>\n\u003cp>Lee also responded to questions from committee members who worried that the measure would cause health insurers to become singularly focused on keeping rates down at the expense of the benefits included in health plans.\u003c/p>\n\u003cp>“People can get something cheap, but it may not have a good value,” said Assemblymember Richard Pan (D-Sacramento). “I hear from physicians who take care of minority populations. It is important that they are part of networks…and it is important for Covered California to make sure we have plans that pay attention to those things.”\u003c/p>\n\u003cp>Lee said the measure might compromise Covered California’s power to negotiate these plan designs, as well as efforts to promote innovation among plans. He said his agency wants to encourage plans to try new care delivery models or payment models that emphasize preventive care and could ultimately result in better health for patients in the long term.\u003c/p>\n\u003cp>“It may be that contracting with them costs more on the front end, but has better back end results in terms of outcomes,” he said, adding that the opportunity to experiment with these models could be lost of insurers focus only on providing the cheapest plan now. “This ripple effect is one of the big uncertainties.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Members of the joint committee called on both sides to conduct further analysis.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hobby Lobby Decision Has Limited Impact in California",
"title": "Hobby Lobby Decision Has Limited Impact in California",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_19909\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/451505174.jpg\">\u003cimg class=\"size-large wp-image-19909\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/451505174-640x420.jpg\" alt=\" Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Most women in California won't be affected by Monday's U.S. Supreme Court \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/Supreme-Court-Limits-Contraceptive-Mandate-For-Certain-Employers.aspx\" target=\"_blank\">landmark decision \u003c/a>in Sebelius v. Hobby Lobby. The Christian owners of the craft store chain challenged the Affordable Care Act's requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.\u003c/p>\n\u003cp>But it's not so easy in California. That’s because the ruling doesn’t apply to state laws. California has had the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB39&search_keywords=\" target=\"_blank\">Women's Contraceptive Equity Act\u003c/a> on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.\u003c/p>\n\u003cp>“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”\u003c/p>\n\u003cp>She says the state law is still in full effect after Monday's Supreme Court ruling.\u003c!--more-->\u003c/p>\n\u003cp>“If there is anything that is not the boss’ business, it is whether an employee uses contraception,” she says. “That is the rule in California.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>More than two dozen\u003ca href=\"http://www.guttmacher.org/statecenter/spibs/spib_ICC.pdf\" target=\"_blank\"> other states have similar laws\u003c/a>, including Texas, Massachusetts, and New Jersey. Those state laws stick because of the legal reasoning on which the Court based its ruling. Lawyers for Hobby Lobby argued the company could claim religious rights under a federal law, the Religious Freedom Restoration Act, and the First Amendment of the Constitution.\u003c/p>\n\u003cp>“The Court decided not to rely on the First Amendment claim, but instead to rely on the statutory claim,” says Joel Paul, law professor at U.C. Hastings College of the Law. “That means the decision only applies to federal laws. If a state, like California, requires employers to provide contraceptive coverage, that law survives this decision.”\u003c/p>\n\u003cp>But there is an exception to the exception. Hobby Lobby is self-insured, meaning the company hires an insurer to manage care, but Hobby Lobby puts up the money to cover its employees’ claims and accepts all liability if the claims end up exceeding the money it initially sets aside.\u003c/p>\n\u003cp>Companies that self-insure are governed by a federal law known as ERISA, the Employee Retirement Income Security Act. They are not required to comply with state laws, like California’s contraceptive equity act. So Hobby Lobby, which has 26 locations in California, is not required to provide birth control coverage to those employees.\u003c/p>\n\u003cp>The company did not comment on the details of the state law, but issued a statement saying it was “overjoyed” by the court's decision.\u003c/p>\n\u003cp>“The nation’s highest court has re-affirmed the vital importance of religious liberty as one of our country's founding principles,\" said Barbara Green, co-founder of Hobby Lobby.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/156863156&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>Most companies in California that choose to self-insure are large, public companies that do not fall into the category of companies the Court’s decision is limited to – \"closely held\" companies, where half the company is owned by five individuals or fewer.\u003c/p>\n\u003cp>Janice Rocco, a spokesperson for the California Department of Insurance, said the exact number of companies that fall into both categories - closely held and self insured - is unknown, but expected to be small.\u003c/p>\n\u003cp>“I’m not sure there would be a huge number of employers availing themselves of this decision,” she said. “At least in California, the applicability of the decision on employers is going to be minimal in terms of there being changes.”\u003c/p>\n\u003cp>But the California law has gaps and health care advocates plan to use political momentum against the court's ruling to push for further changes in the state law. The contraceptive equity act does not require companies to provide contraceptives at no charge to the patient, the way the Affordable Care Act does. A bill currently working its way through the state legislature would eliminate co-pays and other cost sharing for birth control. It would also prevent insurers from requiring women to “fail” cheaper birth control methods before paying for more expensive ones.\u003c/p>\n\u003cp>“There's one insurer in California that makes women take oral contraceptive pills for three months before she can get access to the ring, when the ring might be the best method for her,” said Susan Berke Fogel of the National Health Law Program. “Or, others are imposing cost sharing on IUDs [intra-uterine devices], which makes it absolutely unaffordable.”\u003c/p>\n\u003cp>She believes the Supreme Court decision in Hobby Lobby will embolden California lawmakers to pass the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And there's at least one more twist in the complicated interpretation of the court's decision. Julie Rovner reports for Kaiser Health News that large companies are subject to a year 2000 \u003ca href=\"http://www.eeoc.gov/policy/docs/decision-contraception.html\" target=\"_blank\">ruling from the Equal Employment Opportunity Commission\u003c/a>. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/contraception-mandate-state-laws-EEOC-pregnancy-discrimination-act.aspx\" target=\"_blank\">From KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>[The ruling stated] that employers that fail to cover contraception as part of their health insurance benefit package are \u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\">discriminating against women\u003c/a> in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.\u003c/p>\n\u003cp>So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.\u003c/p>\n\u003cp>Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://www.newrepublic.com/article/118303/hobby-lobby-case-what-if-court-strikes-down-contraception-mandate\" target=\"_blank\">others have suggested \u003c/a>that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.\u003c/p>\n\u003cp>“There will be no shortage of exciting moments in the coming months,” said Amiri.\u003c/p>\u003c/blockquote>\n\n",
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"excerpt": "While a Calif. law on contraceptive equity supersedes the court's decision, that law has limits, too.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19909\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/451505174.jpg\">\u003cimg class=\"size-large wp-image-19909\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/451505174-640x420.jpg\" alt=\" Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Most women in California won't be affected by Monday's U.S. Supreme Court \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/Supreme-Court-Limits-Contraceptive-Mandate-For-Certain-Employers.aspx\" target=\"_blank\">landmark decision \u003c/a>in Sebelius v. Hobby Lobby. The Christian owners of the craft store chain challenged the Affordable Care Act's requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.\u003c/p>\n\u003cp>But it's not so easy in California. That’s because the ruling doesn’t apply to state laws. California has had the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB39&search_keywords=\" target=\"_blank\">Women's Contraceptive Equity Act\u003c/a> on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.\u003c/p>\n\u003cp>“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”\u003c/p>\n\u003cp>She says the state law is still in full effect after Monday's Supreme Court ruling.\u003c!--more-->\u003c/p>\n\u003cp>“If there is anything that is not the boss’ business, it is whether an employee uses contraception,” she says. “That is the rule in California.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>More than two dozen\u003ca href=\"http://www.guttmacher.org/statecenter/spibs/spib_ICC.pdf\" target=\"_blank\"> other states have similar laws\u003c/a>, including Texas, Massachusetts, and New Jersey. Those state laws stick because of the legal reasoning on which the Court based its ruling. Lawyers for Hobby Lobby argued the company could claim religious rights under a federal law, the Religious Freedom Restoration Act, and the First Amendment of the Constitution.\u003c/p>\n\u003cp>“The Court decided not to rely on the First Amendment claim, but instead to rely on the statutory claim,” says Joel Paul, law professor at U.C. Hastings College of the Law. “That means the decision only applies to federal laws. If a state, like California, requires employers to provide contraceptive coverage, that law survives this decision.”\u003c/p>\n\u003cp>But there is an exception to the exception. Hobby Lobby is self-insured, meaning the company hires an insurer to manage care, but Hobby Lobby puts up the money to cover its employees’ claims and accepts all liability if the claims end up exceeding the money it initially sets aside.\u003c/p>\n\u003cp>Companies that self-insure are governed by a federal law known as ERISA, the Employee Retirement Income Security Act. They are not required to comply with state laws, like California’s contraceptive equity act. So Hobby Lobby, which has 26 locations in California, is not required to provide birth control coverage to those employees.\u003c/p>\n\u003cp>The company did not comment on the details of the state law, but issued a statement saying it was “overjoyed” by the court's decision.\u003c/p>\n\u003cp>“The nation’s highest court has re-affirmed the vital importance of religious liberty as one of our country's founding principles,\" said Barbara Green, co-founder of Hobby Lobby.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/156863156&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>Most companies in California that choose to self-insure are large, public companies that do not fall into the category of companies the Court’s decision is limited to – \"closely held\" companies, where half the company is owned by five individuals or fewer.\u003c/p>\n\u003cp>Janice Rocco, a spokesperson for the California Department of Insurance, said the exact number of companies that fall into both categories - closely held and self insured - is unknown, but expected to be small.\u003c/p>\n\u003cp>“I’m not sure there would be a huge number of employers availing themselves of this decision,” she said. “At least in California, the applicability of the decision on employers is going to be minimal in terms of there being changes.”\u003c/p>\n\u003cp>But the California law has gaps and health care advocates plan to use political momentum against the court's ruling to push for further changes in the state law. The contraceptive equity act does not require companies to provide contraceptives at no charge to the patient, the way the Affordable Care Act does. A bill currently working its way through the state legislature would eliminate co-pays and other cost sharing for birth control. It would also prevent insurers from requiring women to “fail” cheaper birth control methods before paying for more expensive ones.\u003c/p>\n\u003cp>“There's one insurer in California that makes women take oral contraceptive pills for three months before she can get access to the ring, when the ring might be the best method for her,” said Susan Berke Fogel of the National Health Law Program. “Or, others are imposing cost sharing on IUDs [intra-uterine devices], which makes it absolutely unaffordable.”\u003c/p>\n\u003cp>She believes the Supreme Court decision in Hobby Lobby will embolden California lawmakers to pass the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And there's at least one more twist in the complicated interpretation of the court's decision. Julie Rovner reports for Kaiser Health News that large companies are subject to a year 2000 \u003ca href=\"http://www.eeoc.gov/policy/docs/decision-contraception.html\" target=\"_blank\">ruling from the Equal Employment Opportunity Commission\u003c/a>. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/contraception-mandate-state-laws-EEOC-pregnancy-discrimination-act.aspx\" target=\"_blank\">From KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>[The ruling stated] that employers that fail to cover contraception as part of their health insurance benefit package are \u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\">discriminating against women\u003c/a> in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.\u003c/p>\n\u003cp>So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.\u003c/p>\n\u003cp>Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://www.newrepublic.com/article/118303/hobby-lobby-case-what-if-court-strikes-down-contraception-mandate\" target=\"_blank\">others have suggested \u003c/a>that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.\u003c/p>\n\u003cp>“There will be no shortage of exciting moments in the coming months,” said Amiri.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cspan>Most women in California won't be affected by Monday's U.S. Supreme Court landmark decision in \u003c/span>\u003cem style=\"font-size: 14px\">Sebelius v. Hobby Lobby\u003c/em>\u003cspan>. The Christian owners of the craft store chain challenged the Affordable Care Act's requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.\u003c/span>\u003c/p>\n\u003cp>But it's not so easy in California. That’s because the ruling doesn’t apply to state laws. And California has had the Women's Contraceptive Equity Act on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.\u003c/p>\n\u003cp>“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”\u003c!--more-->\u003c/p>\n\u003cp>She says the state law is still in full effect after Monday's Supreme Court ruling.\u003c/p>\n\u003cp>“If there is anything that is not the boss’ business, it is whether an employee uses contraception,” she says. “That is the rule in California.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>More than two dozen other states have similar laws, including Texas, Massachusetts, and New Jersey. The laws stick because of the legal reasoning on which the Court based its ruling. Lawyers for Hobby Lobby argued the company could claim religious rights under a federal law, the Religious Freedom Restoration Act, and the First Amendment of the Constitution.\u003c/p>\n\u003cp>“The Court decided not to rely on the First Amendment claim, but instead to rely on the statutory claim,” says Joel Paul, law professor at UC Hastings College of the Law. “That means the decision only applies to federal laws. If a state, like California, requires employers to provide contraceptive coverage, that law survives this decision.”\u003c/p>\n\u003cp>But there is an exception to the exception. Hobby Lobby is self-insured, meaning the company hires an insurer to manage care, but Hobby Lobby puts up the money to cover its employees’ claims and accepts all liability if the claims end up exceeding the money it initially sets aside.\u003c/p>\n\u003cp>Companies that self-insure are governed by a federal law, the Employee Retirement Income Security Act, or ERISA . They are not required to comply with state laws, like California’s contraceptive equity act. So Hobby Lobby, which has 26 locations in California, is not required to provide birth control coverage to those employees.\u003c/p>\n\u003cp>The company did not comment on the details of the state law, but issued a statement saying it was “overjoyed” by the overall decision.\u003c/p>\n\u003cp>“The nation’s highest court has re-affirmed the vital importance of religious liberty as one of our country's founding principles,\" said Barbara Green, co-founder of Hobby Lobby.\u003c/p>\n\u003cp>Most companies in California that choose to self-insure are large, public companies that do not fall into the category of companies the Court’s decision is limited to – \"closely held\" companies, where half the company is owned by five individuals or fewer.\u003c/p>\n\u003cp>Janice Rocco, a spokesperson for the California Department of Insurance, said the exact number of companies that fall into both categories - closely held and self insured - is unknown, but expected to be small.\u003c/p>\n\u003cp>“I’m not sure there would be a huge number of employers availing themselves of this decision,” she said. “At least in California, the applicability of the decision on employers is going to be minimal in terms of there being changes.”\u003c/p>\n\u003cp>Health care advocates do plan to use political momentum against the ruling to push for further changes in California law. The contraceptive equity act does not require companies\u003cbr>\nto provide contraceptives at no charge to the patient, the way the Affordable Care Act does. A bill currently working its way through the state legislature would eliminate co-pays and other cost sharing for birth control. It would also prevent insurers from requiring women to “fail” cheaper birth control methods before paying for more expensive ones.\u003c/p>\n\u003cp>“There's one insurer in California that makes women take oral contraceptive pills for three months before she can get access to the ring, when the ring might be the best method for her,” said Susan Berke Fogel of the National Health Law Program. “Or, others are imposing cost sharing on IUDs [intra-uterine devices], which makes it absolutely unaffordable.”\u003c/p>\n\u003cp>She believes the Supreme Court decision in Hobby Lobby will embolden California lawmakers to pass the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And there's at least one more twist in the complicated interpretation of the court's decision. Julie Rovner reports for Kaiser Health News that large companies are subject to a year 2000 \u003ca href=\"http://www.eeoc.gov/policy/docs/decision-contraception.html\" target=\"_blank\">ruling from the Equal Employment Opportunity Commission\u003c/a>. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/contraception-mandate-state-laws-EEOC-pregnancy-discrimination-act.aspx\" target=\"_blank\">From KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>[The ruling stated] that employers that fail to cover contraception as part of their health insurance benefit package are \u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\">discriminating against women\u003c/a> in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.\u003c/p>\n\u003cp>So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.\u003c/p>\n\u003cp>Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://www.newrepublic.com/article/118303/hobby-lobby-case-what-if-court-strikes-down-contraception-mandate\" target=\"_blank\">others have suggested \u003c/a>that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.\u003c/p>\n\u003cp>“There will be no shortage of exciting moments in the coming months,” said Amiri.\u003c/p>\u003c/blockquote>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan>Most women in California won't be affected by Monday's U.S. Supreme Court landmark decision in \u003c/span>\u003cem style=\"font-size: 14px\">Sebelius v. Hobby Lobby\u003c/em>\u003cspan>. The Christian owners of the craft store chain challenged the Affordable Care Act's requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.\u003c/span>\u003c/p>\n\u003cp>But it's not so easy in California. That’s because the ruling doesn’t apply to state laws. And California has had the Women's Contraceptive Equity Act on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.\u003c/p>\n\u003cp>“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”\u003c!--more-->\u003c/p>\n\u003cp>She says the state law is still in full effect after Monday's Supreme Court ruling.\u003c/p>\n\u003cp>“If there is anything that is not the boss’ business, it is whether an employee uses contraception,” she says. “That is the rule in California.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>More than two dozen other states have similar laws, including Texas, Massachusetts, and New Jersey. The laws stick because of the legal reasoning on which the Court based its ruling. Lawyers for Hobby Lobby argued the company could claim religious rights under a federal law, the Religious Freedom Restoration Act, and the First Amendment of the Constitution.\u003c/p>\n\u003cp>“The Court decided not to rely on the First Amendment claim, but instead to rely on the statutory claim,” says Joel Paul, law professor at UC Hastings College of the Law. “That means the decision only applies to federal laws. If a state, like California, requires employers to provide contraceptive coverage, that law survives this decision.”\u003c/p>\n\u003cp>But there is an exception to the exception. Hobby Lobby is self-insured, meaning the company hires an insurer to manage care, but Hobby Lobby puts up the money to cover its employees’ claims and accepts all liability if the claims end up exceeding the money it initially sets aside.\u003c/p>\n\u003cp>Companies that self-insure are governed by a federal law, the Employee Retirement Income Security Act, or ERISA . They are not required to comply with state laws, like California’s contraceptive equity act. So Hobby Lobby, which has 26 locations in California, is not required to provide birth control coverage to those employees.\u003c/p>\n\u003cp>The company did not comment on the details of the state law, but issued a statement saying it was “overjoyed” by the overall decision.\u003c/p>\n\u003cp>“The nation’s highest court has re-affirmed the vital importance of religious liberty as one of our country's founding principles,\" said Barbara Green, co-founder of Hobby Lobby.\u003c/p>\n\u003cp>Most companies in California that choose to self-insure are large, public companies that do not fall into the category of companies the Court’s decision is limited to – \"closely held\" companies, where half the company is owned by five individuals or fewer.\u003c/p>\n\u003cp>Janice Rocco, a spokesperson for the California Department of Insurance, said the exact number of companies that fall into both categories - closely held and self insured - is unknown, but expected to be small.\u003c/p>\n\u003cp>“I’m not sure there would be a huge number of employers availing themselves of this decision,” she said. “At least in California, the applicability of the decision on employers is going to be minimal in terms of there being changes.”\u003c/p>\n\u003cp>Health care advocates do plan to use political momentum against the ruling to push for further changes in California law. The contraceptive equity act does not require companies\u003cbr>\nto provide contraceptives at no charge to the patient, the way the Affordable Care Act does. A bill currently working its way through the state legislature would eliminate co-pays and other cost sharing for birth control. It would also prevent insurers from requiring women to “fail” cheaper birth control methods before paying for more expensive ones.\u003c/p>\n\u003cp>“There's one insurer in California that makes women take oral contraceptive pills for three months before she can get access to the ring, when the ring might be the best method for her,” said Susan Berke Fogel of the National Health Law Program. “Or, others are imposing cost sharing on IUDs [intra-uterine devices], which makes it absolutely unaffordable.”\u003c/p>\n\u003cp>She believes the Supreme Court decision in Hobby Lobby will embolden California lawmakers to pass the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And there's at least one more twist in the complicated interpretation of the court's decision. Julie Rovner reports for Kaiser Health News that large companies are subject to a year 2000 \u003ca href=\"http://www.eeoc.gov/policy/docs/decision-contraception.html\" target=\"_blank\">ruling from the Equal Employment Opportunity Commission\u003c/a>. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/contraception-mandate-state-laws-EEOC-pregnancy-discrimination-act.aspx\" target=\"_blank\">From KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>[The ruling stated] that employers that fail to cover contraception as part of their health insurance benefit package are \u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\">discriminating against women\u003c/a> in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.\u003c/p>\n\u003cp>So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.\u003c/p>\n\u003cp>Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://www.newrepublic.com/article/118303/hobby-lobby-case-what-if-court-strikes-down-contraception-mandate\" target=\"_blank\">others have suggested \u003c/a>that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.\u003c/p>\n\u003cp>“There will be no shortage of exciting moments in the coming months,” said Amiri.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Needs Better Outreach to Limited-English Speakers, Advocates Say",
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"content": "\u003cfigure id=\"attachment_16988\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/CoveredCA_Spanish-e1388775098705.jpg\">\u003cimg class=\"size-large wp-image-16988\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/CoveredCA_Spanish-640x480.jpg\" alt=\"A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish. \" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish.\u003c/figcaption>\u003c/figure>\n\u003cp>Covered California may have had strong overall enrollment, but people who do not speak English as a first language are underrepresented in the state's health insurance marketplace, according to an analysis from Berkeley's Greenlining Institute.\u003c/p>\n\u003cp>The\u003ca href=\"http://greenlining.org/wp-content/uploads/2014/06/iHealth-Report-print-friendly.pdf\" target=\"_blank\"> report \u003c/a>relied on Covered California data, which showed that 20 percent of enrollees do not speak English as a primary language. That's compared with\u003ca href=\"http://censusreporter.org/profiles/04000US06-california/\" target=\"_blank\"> 44 percent of Californians\u003c/a> overall.\u003c/p>\n\u003cp>\"We know California is a diverse state ethnically and linguistically,\" said Jordan Medina, a health policy fellow with Greenlining and lead author of the study. \"Moving forward, if the Affordable Care Act is going to work in California, we have to make sure those populations are represented in the health insurance marketplace.\"\u003c!--more-->\u003c/p>\n\u003cp>As part of its analysis, Greenlining interviewed certified enrollment counselors working to help people sign up for insurance through Covered California. While online sign-up was available in English and Spanish, people who spoke other languages had only printed material available. Counselors reported that they ran out of materials in at least some languages.\u003c/p>\n\u003cp>Counselors said they preferred helping people sign up by using the online portal, but since it was available only in English and Spanish, it slowed them down. A counselor with an agency that worked with Japanese-Americans told Greenlining, \"We tried to use the website, because that's what Covered California suggested we do, but the line-by-line translation with elderly Japanese-Americans made the process extremely tedious.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Greenlining called on Covered California to make the online sign-up available in the 13 most common languages spoken in California.\u003c/p>\n\u003cp>Covered California spokeswoman Anne Gonzales said the agency is looking into this, \"\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">but there is no firm date on when that functionality will be added, or which languages will be added.\"\u003c/span>\u003c/span>\u003c/p>\n\u003cp>Problems with both the Spanish-language marketing campaign and the Spanish-language website were\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\"> widely reported\u003c/a> earlier this year, and Greenlining mentioned these issues. Gonzales pointed to a Spanish-language working group at Covered California that \"recalibrated and focused resources\" on making improvements in these areas. She said Covered California is currently reviewing its resources for Asian-language translations as well, including Mandarin, Korean, Vietnamese and Hmong.\u003c/p>\n\u003cp>Curiously, one of the major issues Greenlining pointed out has already been addressed by the Covered California board. In the first open enrollment period, certified enrollment counselors were paid $58 for every person they enrolled in a plan. But counselors told Greenlining that the fee did not compensate them for the level of work required.\u003c/p>\n\u003cp>Gonzales said that Covered California is \"moving away from that business model.\" During the first open enrollment, there was a division between outreach/education and enrollment. Covered California grantees doing educational events could not also sign people up for insurance.\u003c/p>\n\u003cp>That's changing now. Covered California is \u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/PPT%20-%20Covered%20California%20Policy%20and%20Action%20Items_June%2019,%202014.pdf\" target=\"_blank\">instituting a \"navigator\" mode\u003c/a>l and will award a total of $16.9 million in grants to organizations that will handle \"outreach, education and enrollment.\"\u003c/p>\n\u003cp>Greenlining also called on Covered California to move forward on hiring a diversity officer.\u003c/p>\n\u003cp>\"At the end of the day, this helps with accountability,\" Medina said. \"If you have someone whose sole responsibility it is to make sure that all materials -- whether that be on the Web or printed materials -- if there’s one person in charge of that, it makes it really easy for community groups to partner with Covered California to make sure it’s done in an equitable way.”\u003c/p>\n\u003cp>Greenlining credited Covered California, saying that the state \"led the nation in implementing the Affordable Care Act,\" but Medina also observed that the rollout was always expected to be a multi-year effort. \"As we move farther into implementation, Covered California is going to have to really pay attention to hard-to-reach groups,\" he said. \"That's particularly crucial to outreach to Californians who don't speak English well.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"N6YDe3GBE9KI5r58HlM0Xrvwzvipav7x\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16988\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/CoveredCA_Spanish-e1388775098705.jpg\">\u003cimg class=\"size-large wp-image-16988\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/CoveredCA_Spanish-640x480.jpg\" alt=\"A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish. \" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish.\u003c/figcaption>\u003c/figure>\n\u003cp>Covered California may have had strong overall enrollment, but people who do not speak English as a first language are underrepresented in the state's health insurance marketplace, according to an analysis from Berkeley's Greenlining Institute.\u003c/p>\n\u003cp>The\u003ca href=\"http://greenlining.org/wp-content/uploads/2014/06/iHealth-Report-print-friendly.pdf\" target=\"_blank\"> report \u003c/a>relied on Covered California data, which showed that 20 percent of enrollees do not speak English as a primary language. That's compared with\u003ca href=\"http://censusreporter.org/profiles/04000US06-california/\" target=\"_blank\"> 44 percent of Californians\u003c/a> overall.\u003c/p>\n\u003cp>\"We know California is a diverse state ethnically and linguistically,\" said Jordan Medina, a health policy fellow with Greenlining and lead author of the study. \"Moving forward, if the Affordable Care Act is going to work in California, we have to make sure those populations are represented in the health insurance marketplace.\"\u003c!--more-->\u003c/p>\n\u003cp>As part of its analysis, Greenlining interviewed certified enrollment counselors working to help people sign up for insurance through Covered California. While online sign-up was available in English and Spanish, people who spoke other languages had only printed material available. Counselors reported that they ran out of materials in at least some languages.\u003c/p>\n\u003cp>Counselors said they preferred helping people sign up by using the online portal, but since it was available only in English and Spanish, it slowed them down. A counselor with an agency that worked with Japanese-Americans told Greenlining, \"We tried to use the website, because that's what Covered California suggested we do, but the line-by-line translation with elderly Japanese-Americans made the process extremely tedious.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Greenlining called on Covered California to make the online sign-up available in the 13 most common languages spoken in California.\u003c/p>\n\u003cp>Covered California spokeswoman Anne Gonzales said the agency is looking into this, \"\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">but there is no firm date on when that functionality will be added, or which languages will be added.\"\u003c/span>\u003c/span>\u003c/p>\n\u003cp>Problems with both the Spanish-language marketing campaign and the Spanish-language website were\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\"> widely reported\u003c/a> earlier this year, and Greenlining mentioned these issues. Gonzales pointed to a Spanish-language working group at Covered California that \"recalibrated and focused resources\" on making improvements in these areas. She said Covered California is currently reviewing its resources for Asian-language translations as well, including Mandarin, Korean, Vietnamese and Hmong.\u003c/p>\n\u003cp>Curiously, one of the major issues Greenlining pointed out has already been addressed by the Covered California board. In the first open enrollment period, certified enrollment counselors were paid $58 for every person they enrolled in a plan. But counselors told Greenlining that the fee did not compensate them for the level of work required.\u003c/p>\n\u003cp>Gonzales said that Covered California is \"moving away from that business model.\" During the first open enrollment, there was a division between outreach/education and enrollment. Covered California grantees doing educational events could not also sign people up for insurance.\u003c/p>\n\u003cp>That's changing now. Covered California is \u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/PPT%20-%20Covered%20California%20Policy%20and%20Action%20Items_June%2019,%202014.pdf\" target=\"_blank\">instituting a \"navigator\" mode\u003c/a>l and will award a total of $16.9 million in grants to organizations that will handle \"outreach, education and enrollment.\"\u003c/p>\n\u003cp>Greenlining also called on Covered California to move forward on hiring a diversity officer.\u003c/p>\n\u003cp>\"At the end of the day, this helps with accountability,\" Medina said. \"If you have someone whose sole responsibility it is to make sure that all materials -- whether that be on the Web or printed materials -- if there’s one person in charge of that, it makes it really easy for community groups to partner with Covered California to make sure it’s done in an equitable way.”\u003c/p>\n\u003cp>Greenlining credited Covered California, saying that the state \"led the nation in implementing the Affordable Care Act,\" but Medina also observed that the rollout was always expected to be a multi-year effort. \"As we move farther into implementation, Covered California is going to have to really pay attention to hard-to-reach groups,\" he said. \"That's particularly crucial to outreach to Californians who don't speak English well.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"N6YDe3GBE9KI5r58HlM0Xrvwzvipav7x\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"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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"meta": {
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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",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"officialWebsiteLink": "http://freakonomics.com/",
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"meta": {
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"source": "WNYC"
},
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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"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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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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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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},
"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",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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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",
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"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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"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"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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