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"content": "\u003cp>By Kelley Weiss, CHCF Center for Health Reporting\u003c/p>\n\u003cfigure id=\"attachment_11209\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/08/new-version-of-workplace-wellness-programs-carrot-or-stick/dsc_0056/\" rel=\"attachment wp-att-11209\">\u003cimg class=\"size-medium wp-image-11209\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/DSC_0056-300x200.jpg\" alt=\"Kimberley Macgregor, a bookkeeper at a Burbank Ralphs, looks over which “healthy activities” she’ll do to offset her health care costs. She says she didn’t know about the new wellness program until KQED contacted her. (Photo: Kelley Weiss)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kimberley Macgregor, a bookkeeper at a Burbank Ralphs, looks over which “healthy activities” she’ll do to offset her health care costs. She says she didn’t know about the new wellness program until KQED contacted her. (Photo: Kelley Weiss, CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>Kimberley Macgregor, a bookkeeper at a Ralphs in Burbank, says it’s almost impossible to stay up to date on her health benefits.\u003c/p>\n\u003cp>She flips through a glossy pamphlet which features an array of fruits and vegetables and a woman meditating. It explains her company’s wellness program.\u003c/p>\n\u003cp>Macgregor is debating over which of the seven “healthy activities” in the wellness program to choose. She says she’ll opt for a biometric screening that uses a blood sample to check things like cholesterol and blood pressure.\u003c/p>\n\u003cp>“All and all it’s good for you because it gives you awareness of where you stand when it comes to health issues,\" Macgregor says. \"Maybe it can catch diseases early so that you have enough time to change it.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">If employees don’t participate in the disease management program their deductible goes up by $500.\u003c/aside>\n\u003cp>Macgregor says she didn’t know everything about the changes to the program this year until I contacted her -- and she's her union's representative in the Ralph's where she works. If she doesn't participate in the program, she's on the hook for more money.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This year Ralphs is giving Macgregor $375 dollars less to offset her health care costs. But if she does four of the seven “healthy activities” she can earn it back.\u003c/p>\n\u003cp>Macgregor will then only have to pay $250 dollars towards her $1000 health insurance deductible. But she finds the whole thing a bit creepy.\u003c!--more-->\u003c/p>\n\u003cp>“Your health is not between your doctor and you anymore,” she says. “You might as well invite the insurance company to sit in that little chair to the right and you might as well invite the company that you work for to stand in the corner and just be in the room with you with your doctor.”\u003c/p>\n\u003cp>She says she understands that health care costs are skyrocketing, so for businesses it all comes down to the bottom line: saving money.\u003c/p>\n\u003cp>Kathy Finn is a negotiator with the Southern California branch of the United Food and Commercial Workers. The union negotiates health benefits for more than 100,000 people. She says that employers initially proposed wellness programs to achieve what they call cost containment.\u003c/p>\n\u003cp>In its latest contract with Ralphs, Vons and Albertsons, Finn says the union agreed to expand the wellness program. She says otherwise workers would have had to pay more or get fewer benefits.\u003c/p>\n\u003cp>At first glance she says the wellness program looks great because workers can earn $150 for each activity.\u003c/p>\n\u003cp>“But in my opinion it’s kind of like it’s a stick masquerading as a carrot,” Finn says. “If you compare it to what we had just in our last contract, we took something away and we’re forcing you to earn it back.\"\u003c/p>\n\u003cp>She points to the new chronic disease management program. A third party combs through claims data and flags employees with severe cases of diabetes, heart disease or asthma. Finn says it’s about 4,000 people. They then offer them a personal nurse and discounts on prescription drug costs. But, it’s still a hard sell.\u003c/p>\n\u003cp>“It’d be great if we could get everyone to participate,” Finn says. “But from the get-go we know that not everyone is going to participate.”\u003c/p>\n\u003cp>If employees don’t participate in the disease management program their deductible goes up by $500. Finn says even using this stick, less than a third of people have enrolled. She believes that a lot of the grocery workers will just stop going to the doctor.\u003c/p>\n\u003cp>That worries the executive director of the consumer advocacy group Health Access California, Anthony Wright. He’s a huge cheerleader for the Affordable Care Act because he says it gives people better access to health care.\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html\">President Obama’s health care law\u003c/a> also allows businesses to use wellness programs to financially penalize workers for not losing weight or lowering their cholesterol. That, Wright believes, undermines the very foundation of the law.\u003c/p>\n\u003cp>“Some efforts to encourage worksite wellness being tied to either premiums or cost sharing in health insurance provides the insurers a back door opportunity for making distinctions between healthier and unhealthier people which is what we’re trying to get away from in the Affordable Care Act,” Wright says.\u003c/p>\n\u003cp>Ralphs' parent company Kroger and the California Grocers Association did not respond to repeated requests for comments.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.towerswatson.com/en/Insights/IC-Types/Survey-Research-Results/2012/10/health-care-changes-ahead-survey-report\">survey shows more than half of large businesses\u003c/a> are considering adopting wellness plans with financial penalties in coming years.\u003c/p>\n\u003cp>That sounds about right to union negotiators like Kathy Finn. She says the one thing that’s clear about wellness programs is that they’re about saving companies money. If workers get healthier as a result, she says that’s a bonus.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced in collaboration with the \u003c/em>\u003ca href=\"http://centerforhealthreporting.org\">\u003cem>California HealthCare Foundation Center for Health Reporting\u003c/em>\u003c/a>, \u003cem>a nonprofit news organization that focuses on California health issues. Based at the \u003c/em>\u003ca href=\"http://annenberg.usc.edu/\">\u003cem>USC Annenberg School for Communication and Journalism\u003c/em>\u003c/a>\u003cem>, the center is funded by the nonpartisan \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>California HealthCare Foundation.\u003c/em>\u003c/a>\u003c/p>\n\n",
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"excerpt": "Kimberley Macgregor, a bookkeeper at a Ralphs in Burbank, says it’s almost impossible to stay up to date on her health benefits.\r\n\r\nShe flips through a glossy pamphlet featuring an array of fruits and vegetables and a woman in meditation that explains her company’s wellness program.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Kelley Weiss, CHCF Center for Health Reporting\u003c/p>\n\u003cfigure id=\"attachment_11209\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/08/new-version-of-workplace-wellness-programs-carrot-or-stick/dsc_0056/\" rel=\"attachment wp-att-11209\">\u003cimg class=\"size-medium wp-image-11209\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/DSC_0056-300x200.jpg\" alt=\"Kimberley Macgregor, a bookkeeper at a Burbank Ralphs, looks over which “healthy activities” she’ll do to offset her health care costs. She says she didn’t know about the new wellness program until KQED contacted her. (Photo: Kelley Weiss)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kimberley Macgregor, a bookkeeper at a Burbank Ralphs, looks over which “healthy activities” she’ll do to offset her health care costs. She says she didn’t know about the new wellness program until KQED contacted her. (Photo: Kelley Weiss, CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>Kimberley Macgregor, a bookkeeper at a Ralphs in Burbank, says it’s almost impossible to stay up to date on her health benefits.\u003c/p>\n\u003cp>She flips through a glossy pamphlet which features an array of fruits and vegetables and a woman meditating. It explains her company’s wellness program.\u003c/p>\n\u003cp>Macgregor is debating over which of the seven “healthy activities” in the wellness program to choose. She says she’ll opt for a biometric screening that uses a blood sample to check things like cholesterol and blood pressure.\u003c/p>\n\u003cp>“All and all it’s good for you because it gives you awareness of where you stand when it comes to health issues,\" Macgregor says. \"Maybe it can catch diseases early so that you have enough time to change it.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">If employees don’t participate in the disease management program their deductible goes up by $500.\u003c/aside>\n\u003cp>Macgregor says she didn’t know everything about the changes to the program this year until I contacted her -- and she's her union's representative in the Ralph's where she works. If she doesn't participate in the program, she's on the hook for more money.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This year Ralphs is giving Macgregor $375 dollars less to offset her health care costs. But if she does four of the seven “healthy activities” she can earn it back.\u003c/p>\n\u003cp>Macgregor will then only have to pay $250 dollars towards her $1000 health insurance deductible. But she finds the whole thing a bit creepy.\u003c!--more-->\u003c/p>\n\u003cp>“Your health is not between your doctor and you anymore,” she says. “You might as well invite the insurance company to sit in that little chair to the right and you might as well invite the company that you work for to stand in the corner and just be in the room with you with your doctor.”\u003c/p>\n\u003cp>She says she understands that health care costs are skyrocketing, so for businesses it all comes down to the bottom line: saving money.\u003c/p>\n\u003cp>Kathy Finn is a negotiator with the Southern California branch of the United Food and Commercial Workers. The union negotiates health benefits for more than 100,000 people. She says that employers initially proposed wellness programs to achieve what they call cost containment.\u003c/p>\n\u003cp>In its latest contract with Ralphs, Vons and Albertsons, Finn says the union agreed to expand the wellness program. She says otherwise workers would have had to pay more or get fewer benefits.\u003c/p>\n\u003cp>At first glance she says the wellness program looks great because workers can earn $150 for each activity.\u003c/p>\n\u003cp>“But in my opinion it’s kind of like it’s a stick masquerading as a carrot,” Finn says. “If you compare it to what we had just in our last contract, we took something away and we’re forcing you to earn it back.\"\u003c/p>\n\u003cp>She points to the new chronic disease management program. A third party combs through claims data and flags employees with severe cases of diabetes, heart disease or asthma. Finn says it’s about 4,000 people. They then offer them a personal nurse and discounts on prescription drug costs. But, it’s still a hard sell.\u003c/p>\n\u003cp>“It’d be great if we could get everyone to participate,” Finn says. “But from the get-go we know that not everyone is going to participate.”\u003c/p>\n\u003cp>If employees don’t participate in the disease management program their deductible goes up by $500. Finn says even using this stick, less than a third of people have enrolled. She believes that a lot of the grocery workers will just stop going to the doctor.\u003c/p>\n\u003cp>That worries the executive director of the consumer advocacy group Health Access California, Anthony Wright. He’s a huge cheerleader for the Affordable Care Act because he says it gives people better access to health care.\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html\">President Obama’s health care law\u003c/a> also allows businesses to use wellness programs to financially penalize workers for not losing weight or lowering their cholesterol. That, Wright believes, undermines the very foundation of the law.\u003c/p>\n\u003cp>“Some efforts to encourage worksite wellness being tied to either premiums or cost sharing in health insurance provides the insurers a back door opportunity for making distinctions between healthier and unhealthier people which is what we’re trying to get away from in the Affordable Care Act,” Wright says.\u003c/p>\n\u003cp>Ralphs' parent company Kroger and the California Grocers Association did not respond to repeated requests for comments.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.towerswatson.com/en/Insights/IC-Types/Survey-Research-Results/2012/10/health-care-changes-ahead-survey-report\">survey shows more than half of large businesses\u003c/a> are considering adopting wellness plans with financial penalties in coming years.\u003c/p>\n\u003cp>That sounds about right to union negotiators like Kathy Finn. She says the one thing that’s clear about wellness programs is that they’re about saving companies money. If workers get healthier as a result, she says that’s a bonus.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced in collaboration with the \u003c/em>\u003ca href=\"http://centerforhealthreporting.org\">\u003cem>California HealthCare Foundation Center for Health Reporting\u003c/em>\u003c/a>, \u003cem>a nonprofit news organization that focuses on California health issues. Based at the \u003c/em>\u003ca href=\"http://annenberg.usc.edu/\">\u003cem>USC Annenberg School for Communication and Journalism\u003c/em>\u003c/a>\u003cem>, the center is funded by the nonpartisan \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>California HealthCare Foundation.\u003c/em>\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How to Expand Medi-Cal? Assembly Weighs Gov. Brown's Two Proposals",
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"content": "\u003cp>By Scott Detrow\u003c/p>\n\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/sacramento_capital_seliaymiwell_flickr/\" rel=\"attachment wp-att-9250\">\u003cimg class=\"size-medium wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The Brown Administration \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/10/governors-proposals-for-medicaid-expansion/\" target=\"_blank\">has laid out\u003c/a> two options for expanding Medi-Cal, California's health insurance program for the poor, and county governments don’t seem to like either one.\u003c/p>\n\u003cp>For decades, California’s counties have been charged with providing health care for people who fall through the health insurance cracks – that is, adults who earn too much money to be eligible for Medi-Cal coverage, but still can’t afford to buy insurance. So county governments have a lot at stake as California decides how to pay for the federal health care overhaul's Medicaid expansion.\u003c/p>\n\u003cp>Some context: the Affordable Care Act initially required states to expand their Medicaid rolls so that people who earn up to 138 percent of the federal poverty line (about $15,000) could qualify for coverage. The United States Supreme Court struck down the requirement, leaving it up to states to decide whether or not they wanted to expand Medicaid.\u003c/p>\n\u003cp>The Brown Administration supports expanding Medi-Cal, and has laid out two different options for doing so. Option one essentially expands the existing Medi-Cal system. Option two puts each of California's 58 counties in charge of the new coverage. That means counties, not the state, would have to pay for additional insurance costs once the federal government stops footing 100 percent of the bill in 2017.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Option One: The State Continues Running Medi-Cal\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>County officials’ main concern, voiced during a Wednesday Assembly budget hearing in Sacramento, is that Gov. Brown wants them to give something back as part of option one, if the state expands the existing system. “This option would require a discussion with the counties around the appropriate state and local relationship in the funding and delivery of health care,” Brown's budget summary states, “and what additional programs the counties should be responsible for if the state assumed the majority of health care costs.”\u003c/p>\n\u003cp>The \u003ca href=\"http://www.lao.ca.gov/analysis/2013/health/ACA/medi-cal-expansion-021913.pdf\" target=\"_blank\">Legislative Analyst’s Office estimates\u003c/a> the state – or counties, under option two – would pay about $600 million of the health care costs in 2020, when the federal government foots 90 percent of the bill.\u003c/p>\n\u003cp>Still, the LAO estimates county-level savings would outweigh county-level costs for the next decade. But counties argue they’ll still be providing health care to the uninsured, even with a highly successful Medi-Cal expansion. Dr. Mitch Katz is the director of Los Angeles County Health Services. He told legislators two million uninsured people live in Los Angeles County. “We believe, if all goes well, one million [uninsured people] will newly gain insurance, and one million will remain residually uninsured.” He said Los Angeles County would spend $500 million providing health care under that scenario.\u003c/p>\n\u003cp>\u003cstrong>Option Two: Each County Runs Its Own Program\u003c/strong>\u003c/p>\n\u003cp>County officials aren’t too fond of Brown’s second option, either. Kelly Brooks-Lindsey with the California State Association of Counties said it would be a logistical challenge to put a system in place by the federal government’s January 1 deadline. “All 58 counties would have to have a low-income health expansion on the same day – January 1, 2014 – in order to draw down 100 percent federal match,” she said. “So if there was one county that couldn’t get their program up and running, it would delay the expansion in all 58 counties.”\u003c/p>\n\u003cp>And different counties have different systems. Some operate their own hospitals and clinics. Others pay private hospitals to care for poor patients. The federal government would also need to grant California a waiver, to make the county-level system happen.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Brooks-Lindsey said to meet their deadlines, counties need an answer soon -- especially if the governor and legislature opt for the more complex county-level option. “If we could get a framework by March, April, the sooner the better.”\u003c/p>\n\n",
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"excerpt": "The Brown Administration has laid out two options for expanding California’s Medi-Cal health insurance program, and county governments don’t seem to like either one.\r\n\r\nFor decades, California’s counties have been charged with providing health care for people who fall through the health insurance cracks – that is, adults who earn too much money to be eligible for Medi-Cal coverage, but still can’t afford an insurance plan. So county governments have a lot at stake as California decides whether or not to implement the Affordable Care Act’s optional Medicaid expansion.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Scott Detrow\u003c/p>\n\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/sacramento_capital_seliaymiwell_flickr/\" rel=\"attachment wp-att-9250\">\u003cimg class=\"size-medium wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The Brown Administration \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/10/governors-proposals-for-medicaid-expansion/\" target=\"_blank\">has laid out\u003c/a> two options for expanding Medi-Cal, California's health insurance program for the poor, and county governments don’t seem to like either one.\u003c/p>\n\u003cp>For decades, California’s counties have been charged with providing health care for people who fall through the health insurance cracks – that is, adults who earn too much money to be eligible for Medi-Cal coverage, but still can’t afford to buy insurance. So county governments have a lot at stake as California decides how to pay for the federal health care overhaul's Medicaid expansion.\u003c/p>\n\u003cp>Some context: the Affordable Care Act initially required states to expand their Medicaid rolls so that people who earn up to 138 percent of the federal poverty line (about $15,000) could qualify for coverage. The United States Supreme Court struck down the requirement, leaving it up to states to decide whether or not they wanted to expand Medicaid.\u003c/p>\n\u003cp>The Brown Administration supports expanding Medi-Cal, and has laid out two different options for doing so. Option one essentially expands the existing Medi-Cal system. Option two puts each of California's 58 counties in charge of the new coverage. That means counties, not the state, would have to pay for additional insurance costs once the federal government stops footing 100 percent of the bill in 2017.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Option One: The State Continues Running Medi-Cal\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>County officials’ main concern, voiced during a Wednesday Assembly budget hearing in Sacramento, is that Gov. Brown wants them to give something back as part of option one, if the state expands the existing system. “This option would require a discussion with the counties around the appropriate state and local relationship in the funding and delivery of health care,” Brown's budget summary states, “and what additional programs the counties should be responsible for if the state assumed the majority of health care costs.”\u003c/p>\n\u003cp>The \u003ca href=\"http://www.lao.ca.gov/analysis/2013/health/ACA/medi-cal-expansion-021913.pdf\" target=\"_blank\">Legislative Analyst’s Office estimates\u003c/a> the state – or counties, under option two – would pay about $600 million of the health care costs in 2020, when the federal government foots 90 percent of the bill.\u003c/p>\n\u003cp>Still, the LAO estimates county-level savings would outweigh county-level costs for the next decade. But counties argue they’ll still be providing health care to the uninsured, even with a highly successful Medi-Cal expansion. Dr. Mitch Katz is the director of Los Angeles County Health Services. He told legislators two million uninsured people live in Los Angeles County. “We believe, if all goes well, one million [uninsured people] will newly gain insurance, and one million will remain residually uninsured.” He said Los Angeles County would spend $500 million providing health care under that scenario.\u003c/p>\n\u003cp>\u003cstrong>Option Two: Each County Runs Its Own Program\u003c/strong>\u003c/p>\n\u003cp>County officials aren’t too fond of Brown’s second option, either. Kelly Brooks-Lindsey with the California State Association of Counties said it would be a logistical challenge to put a system in place by the federal government’s January 1 deadline. “All 58 counties would have to have a low-income health expansion on the same day – January 1, 2014 – in order to draw down 100 percent federal match,” she said. “So if there was one county that couldn’t get their program up and running, it would delay the expansion in all 58 counties.”\u003c/p>\n\u003cp>And different counties have different systems. Some operate their own hospitals and clinics. Others pay private hospitals to care for poor patients. The federal government would also need to grant California a waiver, to make the county-level system happen.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Brooks-Lindsey said to meet their deadlines, counties need an answer soon -- especially if the governor and legislature opt for the more complex county-level option. “If we could get a framework by March, April, the sooner the better.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Hard Enough Understanding Health Law in English; Try in Mongolian, Khmer or Even Spanish",
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"content": "\u003cp>\u003cstrong>By Judy Lin, Associated Press\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/hard-enough-understanding-health-law-in-english-try-in-mongolian-khmer-or-even-spanish/screen-shot-2013-03-04-at-10-15-47-am/\" rel=\"attachment wp-att-10960\">\u003cimg class=\"alignleft size-full wp-image-10960\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-04-at-10.15.47-AM.png\" alt=\"Screen Shot 2013-03-04 at 10.15.47 AM\" width=\"295\" height=\"154\">\u003c/a>OAKLAND, Calif. (AP) — Set on a gritty corner of Oakland's International Boulevard, the nonprofit Street Level Health Project offers free checkups to patients who speak a total of 22 languages, from recent Mongolian immigrants seeking a doctor to Burmese refugees in need of a basic dental exam.\u003c/p>\n\u003cp>It also provides a window into one of the challenges for state officials who are trying to implement the Affordable Care Act, President Barack Obama's sweeping health care overhaul.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"'Covered California' translates to 'California Cubierto' in Spanish -- but what exactly does it mean?\"\u003c/aside>\n\u003cp>Understanding the law is a challenge even for governors, state lawmakers and agency officials, but delivering its message to non-English speakers who can benefit from it is shaping up as a special complication. That is especially true in California and other states with large and diverse immigrant populations.\u003c/p>\n\u003cp>California has the largest minority population of any state, about 22.3 million people. That's followed by Texas with 13.7 million, and New York with 8.1 million.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In California, two-thirds of the estimated 2.6 million adults who will be eligible for federal subsidies in the health care exchange will be people of color. Roughly 1 million of those eligible will speak English less than very well, according to\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/01/how-big-a-barrier-is-language-to-enrolling-in-health-exchange/\" target=\"_blank\"> a joint study\u003c/a> by the California Pan-Ethnic Health Network and the UCLA Center for Health Policy Research and the University of California, Berkeley Labor Center.\u003c/p>\n\u003cp>With such diversity in cultures and language, the report's authors said the success of health care reform \"hinges in large part on how well the state conducts culturally and linguistically competent outreach and enrollment efforts.\"\u003c/p>\n\u003cp>\"If the exchange did no targeted outreach, there could be 110,000 fewer limited-English proficient individuals enrolled,\" said Cary Sanders, director of policy analysis for CPEHN, an Oakland-based multicultural health advocacy group.\u003c/p>\n\u003cp>\u003cstrong>What's in a name?\u003c/strong>\u003c/p>\n\u003cp>Even the relatively mundane task of developing a brand for California's new health care exchange has prompted some angst.\u003c/p>\n\u003cp>The exchange's staff tried to come up with a name that signified health insurance and would translate well into Spanish, Chinese, Tagalog, Vietnamese and other languages commonly used in California.\u003c/p>\n\u003cp>The exchange's five-member board settled on \"Covered California\" and is currently testing tag lines to see which words resonate best in focus groups. Advocates disappointed by the name are hoping the board selects a tag line that will be simple to understand and translate.\u003c/p>\n\u003cp>Zaya Jaden, a 35-year-old immigrant from Mongolia, was at Street Level Health Project to help her sister get her migraines treated. She said she had no idea how \"Covered California\" would translate to Mongolian.\u003c/p>\n\u003cp>More importantly, advocates want Covered California to launch an inclusive marketing and outreach campaign in a place where a majority of the population is not white and nearly 7 million residents speak limited English.\u003c/p>\n\u003cp>\"'Covered California' translates to 'California Cubierto' in Spanish -- but what exactly does it mean?\" said Laura Lopez, Street Level Health Project's executive director, who immigrated to the United States from Peru years ago. \"It's not just providing a piece of paper that says this is what is covered. It's really having people on the ground talking with the community.\"\u003c/p>\n\u003cp>California's exchange isn't shying away from the challenges.\u003c/p>\n\u003cp>Its executive director, Peter Lee, recently announced that new federal funding will be used to support a multi-language campaign, build a network of community-based assistants who can guide people to the right health plan and multilingual call centers.\u003c/p>\n\u003cp>The exchange is making $43 million available for community-based organizations, faith-based groups, nonprofits and local governments to compete for outreach and education grants.\u003c/p>\n\u003cp>\"California is unique from every other state not only geographically because our population is spread out, but you have multiple ethnic populations that are traditionally hard to reach, and they need their own custom way to be reached,\" said Oscar Hidalgo, the exchange's communications director.\u003c/p>\n\u003cp>The exchange estimates that 5.6 million Californians are without health insurance, or 16 percent of the population under age 65. Of that number, 4.6 million are eligible for coverage under the Affordable Care Act, while the rest are not because of their immigration status.\u003c/p>\n\u003cp>\u003cstrong>Multi-lingual outreach\u003c/strong>\u003c/p>\n\u003cp>Advocates say California should refine its efforts to reach non-English speakers.\u003c/p>\n\u003cp>Doreena Wong, who promotes health access for immigrants at the Los Angeles-based Asian Pacific American Legal Center, is among those urging the exchange to build a website that is not just in English and Spanish, but to offer translations in other languages prevalent throughout the state: Arabic, Armenian, Chinese, Farsi (Persian), Hmong, Khmer (Cambodian), Korean, Russian, Tagalog and Vietnamese.\u003c/p>\n\u003cp>According to the U.S. Department of Health and Human Services Office for Civil Rights, organizations that receive federal funding have to provide written notices in English, Spanish and other languages spoken by 10 percent or more of the households in the area they serve.\u003c/p>\n\u003cp>Wong recently told the board that many people eligible for the exchange aren't proficient in English, have limited education or have never had health care insurance. Other groups have requested the exchange, at a minimum, add Chinese.\u003c/p>\n\u003cp>Hidalgo said the state's health exchange website, \u003ca href=\"http://www.coveredca.com/\">www.coveredca.com\u003c/a>, is being created so that more languages can be added later. He said the exchange first needs to launch an introductory website where consumers can learn about impending health care changes, such as federal subsidies for working families and tax credits for small businesses.\u003c/p>\n\u003cp>\"It's very challenging to put together a website that's consumer friendly in English, and then to do it in 13 languages is a very, very big task,\" he said. \"I think what's important for us is to take a step in English and Spanish and figure out what the feedback is. ... We don't have all the answers at this moment, but we're going to find them.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more: \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthycal.org/archives/11156\" target=\"_blank\">Months Ahead of ACA Sign-Up, Outreach Underway\u003c/a> (Healthy Cal)\u003c/p>\n\n",
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"excerpt": "OAKLAND, Calif. (AP) — Set on a gritty corner of Oakland's International Boulevard, the nonprofit Street Level Health Project offers free checkups to patients who speak a total of 22 languages, from recent Mongolian immigrants seeking a doctor to Burmese refugees in need of a basic dental exam.\r\n\r\nIt also provides a window into one of the challenges for state officials who are trying to implement the Affordable Care Act, President Barack Obama's sweeping health care overhaul.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Judy Lin, Associated Press\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/hard-enough-understanding-health-law-in-english-try-in-mongolian-khmer-or-even-spanish/screen-shot-2013-03-04-at-10-15-47-am/\" rel=\"attachment wp-att-10960\">\u003cimg class=\"alignleft size-full wp-image-10960\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-04-at-10.15.47-AM.png\" alt=\"Screen Shot 2013-03-04 at 10.15.47 AM\" width=\"295\" height=\"154\">\u003c/a>OAKLAND, Calif. (AP) — Set on a gritty corner of Oakland's International Boulevard, the nonprofit Street Level Health Project offers free checkups to patients who speak a total of 22 languages, from recent Mongolian immigrants seeking a doctor to Burmese refugees in need of a basic dental exam.\u003c/p>\n\u003cp>It also provides a window into one of the challenges for state officials who are trying to implement the Affordable Care Act, President Barack Obama's sweeping health care overhaul.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"'Covered California' translates to 'California Cubierto' in Spanish -- but what exactly does it mean?\"\u003c/aside>\n\u003cp>Understanding the law is a challenge even for governors, state lawmakers and agency officials, but delivering its message to non-English speakers who can benefit from it is shaping up as a special complication. That is especially true in California and other states with large and diverse immigrant populations.\u003c/p>\n\u003cp>California has the largest minority population of any state, about 22.3 million people. That's followed by Texas with 13.7 million, and New York with 8.1 million.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In California, two-thirds of the estimated 2.6 million adults who will be eligible for federal subsidies in the health care exchange will be people of color. Roughly 1 million of those eligible will speak English less than very well, according to\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/01/how-big-a-barrier-is-language-to-enrolling-in-health-exchange/\" target=\"_blank\"> a joint study\u003c/a> by the California Pan-Ethnic Health Network and the UCLA Center for Health Policy Research and the University of California, Berkeley Labor Center.\u003c/p>\n\u003cp>With such diversity in cultures and language, the report's authors said the success of health care reform \"hinges in large part on how well the state conducts culturally and linguistically competent outreach and enrollment efforts.\"\u003c/p>\n\u003cp>\"If the exchange did no targeted outreach, there could be 110,000 fewer limited-English proficient individuals enrolled,\" said Cary Sanders, director of policy analysis for CPEHN, an Oakland-based multicultural health advocacy group.\u003c/p>\n\u003cp>\u003cstrong>What's in a name?\u003c/strong>\u003c/p>\n\u003cp>Even the relatively mundane task of developing a brand for California's new health care exchange has prompted some angst.\u003c/p>\n\u003cp>The exchange's staff tried to come up with a name that signified health insurance and would translate well into Spanish, Chinese, Tagalog, Vietnamese and other languages commonly used in California.\u003c/p>\n\u003cp>The exchange's five-member board settled on \"Covered California\" and is currently testing tag lines to see which words resonate best in focus groups. Advocates disappointed by the name are hoping the board selects a tag line that will be simple to understand and translate.\u003c/p>\n\u003cp>Zaya Jaden, a 35-year-old immigrant from Mongolia, was at Street Level Health Project to help her sister get her migraines treated. She said she had no idea how \"Covered California\" would translate to Mongolian.\u003c/p>\n\u003cp>More importantly, advocates want Covered California to launch an inclusive marketing and outreach campaign in a place where a majority of the population is not white and nearly 7 million residents speak limited English.\u003c/p>\n\u003cp>\"'Covered California' translates to 'California Cubierto' in Spanish -- but what exactly does it mean?\" said Laura Lopez, Street Level Health Project's executive director, who immigrated to the United States from Peru years ago. \"It's not just providing a piece of paper that says this is what is covered. It's really having people on the ground talking with the community.\"\u003c/p>\n\u003cp>California's exchange isn't shying away from the challenges.\u003c/p>\n\u003cp>Its executive director, Peter Lee, recently announced that new federal funding will be used to support a multi-language campaign, build a network of community-based assistants who can guide people to the right health plan and multilingual call centers.\u003c/p>\n\u003cp>The exchange is making $43 million available for community-based organizations, faith-based groups, nonprofits and local governments to compete for outreach and education grants.\u003c/p>\n\u003cp>\"California is unique from every other state not only geographically because our population is spread out, but you have multiple ethnic populations that are traditionally hard to reach, and they need their own custom way to be reached,\" said Oscar Hidalgo, the exchange's communications director.\u003c/p>\n\u003cp>The exchange estimates that 5.6 million Californians are without health insurance, or 16 percent of the population under age 65. Of that number, 4.6 million are eligible for coverage under the Affordable Care Act, while the rest are not because of their immigration status.\u003c/p>\n\u003cp>\u003cstrong>Multi-lingual outreach\u003c/strong>\u003c/p>\n\u003cp>Advocates say California should refine its efforts to reach non-English speakers.\u003c/p>\n\u003cp>Doreena Wong, who promotes health access for immigrants at the Los Angeles-based Asian Pacific American Legal Center, is among those urging the exchange to build a website that is not just in English and Spanish, but to offer translations in other languages prevalent throughout the state: Arabic, Armenian, Chinese, Farsi (Persian), Hmong, Khmer (Cambodian), Korean, Russian, Tagalog and Vietnamese.\u003c/p>\n\u003cp>According to the U.S. Department of Health and Human Services Office for Civil Rights, organizations that receive federal funding have to provide written notices in English, Spanish and other languages spoken by 10 percent or more of the households in the area they serve.\u003c/p>\n\u003cp>Wong recently told the board that many people eligible for the exchange aren't proficient in English, have limited education or have never had health care insurance. Other groups have requested the exchange, at a minimum, add Chinese.\u003c/p>\n\u003cp>Hidalgo said the state's health exchange website, \u003ca href=\"http://www.coveredca.com/\">www.coveredca.com\u003c/a>, is being created so that more languages can be added later. He said the exchange first needs to launch an introductory website where consumers can learn about impending health care changes, such as federal subsidies for working families and tax credits for small businesses.\u003c/p>\n\u003cp>\"It's very challenging to put together a website that's consumer friendly in English, and then to do it in 13 languages is a very, very big task,\" he said. \"I think what's important for us is to take a step in English and Spanish and figure out what the feedback is. ... We don't have all the answers at this moment, but we're going to find them.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more: \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthycal.org/archives/11156\" target=\"_blank\">Months Ahead of ACA Sign-Up, Outreach Underway\u003c/a> (Healthy Cal)\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Empty Promise? Experts Question Doctor Supply to See California's Newly Insured Poor",
"title": "Empty Promise? Experts Question Doctor Supply to See California's Newly Insured Poor",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By Emily Bazar, \u003ca href=\"http://centerforhealthreporting.org/article/empty-promise-experts-question-doctor-supply-california%E2%80%99s-newly-insured-poor1073\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10916\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/empty-promise-experts-question-doctor-supply-to-see-californias-newly-insured-poor/screen-shot-2013-03-04-at-9-19-48-am/\" rel=\"attachment wp-att-10916\">\u003cimg class=\"size-medium wp-image-10916\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-04-at-9.19.48-AM-300x289.png\" alt=\"Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)\" width=\"300\" height=\"289\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)\u003c/figcaption>\u003c/figure>\n\u003cp>In less than one year -- Jan. 1, 2014 -- Obamacare’s promise to bring health care to perhaps 1 million more poor California residents will be tested. That's when \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/pages/default.aspx\">Medi-Cal\u003c/a>, the publicly funded health program for the poor and disabled, launches a huge statewide expansion.\u003c/p>\n\u003cp>But making a promise is one thing, and delivering is another.\u003c/p>\n\u003cp>In some places, it’s already tough for many poor California residents to find a doctor who is able –- or willing -- to see them when they need one.\u003c/p>\n\u003cp>From the sprawling Los Angeles basin to the sparsely populated rural north, many medical providers who currently see these patients say they are overwhelmed, a situation that could worsen when those newly covered by Medi-Cal arrive for care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The epicenter is California’s Central Valley, where high rates of uninsured residents,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/\" target=\"_blank\"> coupled with persistent doctor shortages\u003c/a>, create a potentially combustible brew that could thwart the success of the health care law.\u003c/p>\n\u003cp>“We’re not even talking about 2014,” said Carmen Burgos of the Greater Bakersfield Legal Assistance program. Burgos helps low-income Kern County residents access health care and dental services. “Good luck finding a doctor who takes Medi-Cal now.”\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Progam Expansion\u003c/strong>\u003c/p>\n\u003cp>More than 7 million Californians are currently covered under Medi-Cal, and expanding the program is a major piece of President Obama’s health care overhaul, called the Affordable Care Act.\u003c/p>\n\u003cfigure id=\"attachment_10920\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/empty-promise-experts-question-doctor-supply-to-see-californias-newly-insured-poor/medi-calexpansion/\" rel=\"attachment wp-att-10920\">\u003cimg class=\"size-medium wp-image-10920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Medi-CalExpansion--300x240.jpg\" alt=\"(Graphic: CHCF Center for Health Reporting)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Graphic: CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>Between 2014 and 2019, roughly 1 million to 1.4 million more Californians will enroll in Medi-Cal as a result, according to UCLA and UC Berkeley estimates.\u003c/p>\n\u003cp>The Medi-Cal expansion will broaden eligibility by allowing applicants with higher incomes and allowing those who were previously ineligible, such as childless adults, to get coverage.\u003c/p>\n\u003cp>State officials say that there’s sufficient access to Medi-Cal services and that they are constantly monitoring to ensure that recipients can get care.\u003c/p>\n\u003cp>“We do believe that the Medi-Cal provider network provides adequate access in California now,” said Norman Williams, spokesman for the state Department of Health Care Services, which administers Medi-Cal. The state also is “adequately preparing for 2014 and the expansion.”\u003c/p>\n\u003cp>But doctors and health care experts across California offer a starkly different portrait of access on the ground.\u003c/p>\n\u003cul>\n\u003cli>“We’re experiencing provider shortages right now,” said Alex Briscoe, director of the Health Care Services Agency in Alameda County, home to the cities of Oakland and Berkeley. He sees pressure points across the entire county, from less-populated areas to denser communities. “Patients often wait months to get access to care,” he said.\u003c/li>\n\u003cli>Desperate parents overwhelm phone lines at Riverwalk Pediatric Clinic, a private practice in Bakersfield, searching for doctors who accept Medi-Cal, said pediatrician Hasmukh Amin. About half of the practice’s 20,000 patients already have Medi-Cal. “We say no to 25 to 30 callers per day,” Amin said. “We cannot handle any more volume. We are maxed out.”\u003c/li>\n\u003cli>In Los Angeles County, more than 1 million people –- about one-third of them on Medi-Cal –- were seen at 174 health clinics in 2011, said Louise McCarthy, president of the Community Clinic Association of Los Angeles County. When asked whether there will be enough doctors to serve the growing population of Medi-Cal patients, she replied simply, “No.”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Low Rates\u003c/strong>\u003c/p>\n\u003cp>Medi-Cal is California’s version of the federal Medicaid program, and the Golden State ranks poorly in doctor participation compared with other states.\u003c/p>\n\u003cp>Two studies, including \u003ca href=\"http://content.healthaffairs.org/content/31/8/1673.abstract\" target=\"_blank\">one published \u003c/a>in \u003cem>Health Affairs\u003c/em> in August, show that 57 percent of California doctors accept new Medi-Cal patients. That’s the second-lowest rate in the nation after New Jersey. California’s neighbors, Nevada and Oregon, accept 75 percent and 80 percent, respectively.\u003c/p>\n\u003cp>The primary reason doctors don’t participate is financial, doctors themselves say. California has one of the nation’s lowest payment rates, ranking 47th of 50.\u003c/p>\n\u003cp>Ted Mazer, an ear, nose and throat specialist in San Diego, chairs the \u003ca href=\"http://www.cmanet.org/\">California Medical Association\u003c/a>’s committee that focuses on Medi-Cal policy. He said doctors lose money providing care under Medi-Cal. For example, he said, Medicare, the federal health insurance program for people 65 and older, pays doctors about $76 for a regular office visit. One private insurance company pays about $71.\u003c/p>\n\u003cp>Medi-Cal? It pays $24, he said.\u003c/p>\n\u003cp>About six years ago, Mazer began limiting his participation in the program.\u003c/p>\n\u003cp>These low Medi-Cal rates are being addressed — temporarily at least — by Obamacare.\u003c/p>\n\u003cp>Starting this past January and lasting two years, reimbursement rates for many primary care services in Medi-Cal will jump to Medicare levels, funded by the federal government. In California, the change is dramatic. On average, fees will increase by 136 percent, according to the \u003ca href=\"http://www.kff.org/medicaid/upload/8398.pdf\">Kaiser Commission on Medicaid and the Uninsured\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The payment increase is a significant incentive that we anticipate will help attract new primary care physicians to the Medi-Cal provider network,” said Williams of the Department of Health Care Services.\u003c/p>\n\n",
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"excerpt": "In less than one year -- Jan. 1, 2014 -- Obamacare’s promise to bring health care to perhaps 1 million more poor California residents will be tested. That's when Medi-Cal, the publicly funded health program for the poor and disabled, launches a huge statewide expansion.\r\n\r\nBut making a promise is one thing, and delivering is another.\r\n\r\nIn some places, it’s already tough for many poor California residents to find a doctor who is able –- or willing -- to see them when they need one.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Emily Bazar, \u003ca href=\"http://centerforhealthreporting.org/article/empty-promise-experts-question-doctor-supply-california%E2%80%99s-newly-insured-poor1073\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10916\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/empty-promise-experts-question-doctor-supply-to-see-californias-newly-insured-poor/screen-shot-2013-03-04-at-9-19-48-am/\" rel=\"attachment wp-att-10916\">\u003cimg class=\"size-medium wp-image-10916\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-04-at-9.19.48-AM-300x289.png\" alt=\"Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)\" width=\"300\" height=\"289\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)\u003c/figcaption>\u003c/figure>\n\u003cp>In less than one year -- Jan. 1, 2014 -- Obamacare’s promise to bring health care to perhaps 1 million more poor California residents will be tested. That's when \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/pages/default.aspx\">Medi-Cal\u003c/a>, the publicly funded health program for the poor and disabled, launches a huge statewide expansion.\u003c/p>\n\u003cp>But making a promise is one thing, and delivering is another.\u003c/p>\n\u003cp>In some places, it’s already tough for many poor California residents to find a doctor who is able –- or willing -- to see them when they need one.\u003c/p>\n\u003cp>From the sprawling Los Angeles basin to the sparsely populated rural north, many medical providers who currently see these patients say they are overwhelmed, a situation that could worsen when those newly covered by Medi-Cal arrive for care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The epicenter is California’s Central Valley, where high rates of uninsured residents,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/\" target=\"_blank\"> coupled with persistent doctor shortages\u003c/a>, create a potentially combustible brew that could thwart the success of the health care law.\u003c/p>\n\u003cp>“We’re not even talking about 2014,” said Carmen Burgos of the Greater Bakersfield Legal Assistance program. Burgos helps low-income Kern County residents access health care and dental services. “Good luck finding a doctor who takes Medi-Cal now.”\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Progam Expansion\u003c/strong>\u003c/p>\n\u003cp>More than 7 million Californians are currently covered under Medi-Cal, and expanding the program is a major piece of President Obama’s health care overhaul, called the Affordable Care Act.\u003c/p>\n\u003cfigure id=\"attachment_10920\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/empty-promise-experts-question-doctor-supply-to-see-californias-newly-insured-poor/medi-calexpansion/\" rel=\"attachment wp-att-10920\">\u003cimg class=\"size-medium wp-image-10920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Medi-CalExpansion--300x240.jpg\" alt=\"(Graphic: CHCF Center for Health Reporting)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Graphic: CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>Between 2014 and 2019, roughly 1 million to 1.4 million more Californians will enroll in Medi-Cal as a result, according to UCLA and UC Berkeley estimates.\u003c/p>\n\u003cp>The Medi-Cal expansion will broaden eligibility by allowing applicants with higher incomes and allowing those who were previously ineligible, such as childless adults, to get coverage.\u003c/p>\n\u003cp>State officials say that there’s sufficient access to Medi-Cal services and that they are constantly monitoring to ensure that recipients can get care.\u003c/p>\n\u003cp>“We do believe that the Medi-Cal provider network provides adequate access in California now,” said Norman Williams, spokesman for the state Department of Health Care Services, which administers Medi-Cal. The state also is “adequately preparing for 2014 and the expansion.”\u003c/p>\n\u003cp>But doctors and health care experts across California offer a starkly different portrait of access on the ground.\u003c/p>\n\u003cul>\n\u003cli>“We’re experiencing provider shortages right now,” said Alex Briscoe, director of the Health Care Services Agency in Alameda County, home to the cities of Oakland and Berkeley. He sees pressure points across the entire county, from less-populated areas to denser communities. “Patients often wait months to get access to care,” he said.\u003c/li>\n\u003cli>Desperate parents overwhelm phone lines at Riverwalk Pediatric Clinic, a private practice in Bakersfield, searching for doctors who accept Medi-Cal, said pediatrician Hasmukh Amin. About half of the practice’s 20,000 patients already have Medi-Cal. “We say no to 25 to 30 callers per day,” Amin said. “We cannot handle any more volume. We are maxed out.”\u003c/li>\n\u003cli>In Los Angeles County, more than 1 million people –- about one-third of them on Medi-Cal –- were seen at 174 health clinics in 2011, said Louise McCarthy, president of the Community Clinic Association of Los Angeles County. When asked whether there will be enough doctors to serve the growing population of Medi-Cal patients, she replied simply, “No.”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Low Rates\u003c/strong>\u003c/p>\n\u003cp>Medi-Cal is California’s version of the federal Medicaid program, and the Golden State ranks poorly in doctor participation compared with other states.\u003c/p>\n\u003cp>Two studies, including \u003ca href=\"http://content.healthaffairs.org/content/31/8/1673.abstract\" target=\"_blank\">one published \u003c/a>in \u003cem>Health Affairs\u003c/em> in August, show that 57 percent of California doctors accept new Medi-Cal patients. That’s the second-lowest rate in the nation after New Jersey. California’s neighbors, Nevada and Oregon, accept 75 percent and 80 percent, respectively.\u003c/p>\n\u003cp>The primary reason doctors don’t participate is financial, doctors themselves say. California has one of the nation’s lowest payment rates, ranking 47th of 50.\u003c/p>\n\u003cp>Ted Mazer, an ear, nose and throat specialist in San Diego, chairs the \u003ca href=\"http://www.cmanet.org/\">California Medical Association\u003c/a>’s committee that focuses on Medi-Cal policy. He said doctors lose money providing care under Medi-Cal. For example, he said, Medicare, the federal health insurance program for people 65 and older, pays doctors about $76 for a regular office visit. One private insurance company pays about $71.\u003c/p>\n\u003cp>Medi-Cal? It pays $24, he said.\u003c/p>\n\u003cp>About six years ago, Mazer began limiting his participation in the program.\u003c/p>\n\u003cp>These low Medi-Cal rates are being addressed — temporarily at least — by Obamacare.\u003c/p>\n\u003cp>Starting this past January and lasting two years, reimbursement rates for many primary care services in Medi-Cal will jump to Medicare levels, funded by the federal government. In California, the change is dramatic. On average, fees will increase by 136 percent, according to the \u003ca href=\"http://www.kff.org/medicaid/upload/8398.pdf\">Kaiser Commission on Medicaid and the Uninsured\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The payment increase is a significant incentive that we anticipate will help attract new primary care physicians to the Medi-Cal provider network,” said Williams of the Department of Health Care Services.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Care Overhaul's Consumer Protections Pass California Legislature",
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"content": "\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/sacramento_capital_seliaymiwell_flickr/\" rel=\"attachment wp-att-9250\">\u003cimg class=\"size-medium wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Reforms to the individual health insurance market passed out of the Assembly and Senate in Sacramento on Thursday. Included in the bills were popular consumer provisions including: guaranteed issue, requiring insurers to cover all who apply; and rate setting rules that will make it illegal to charge people with pre-existing conditions more than anyone else or redline those conditions.\u003c/p>\n\u003cp>From here, the Assembly bill, \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0001-0050/abx1_2_bill_20130129_introduced.htm\" target=\"_blank\">AB 1X 2\u003c/a>, will be heard in the Senate. The Senate's bill, \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0001-0050/sbx1_2_bill_20130128_introduced.htm\" target=\"_blank\">SB 1X 2\u003c/a>, heads to the Assembly.\u003c/p>\n\u003cp>The bills are moving through a special session of the legislature. The Legislature is working to pass bills to bring the state in line with the requirements of the federal health care overhaul, the Affordable Care Act.\u003c/p>\n\u003cp>Assemblymember Richard Pan (D-Sacramento), chair of the Assembly Health committee, authored AB 1X 2. \"I'm certainly happy it passed,\" Pan said in an interview. \"It showed the legislature understands the nature of these historic reforms that we're putting place for California.\"\u003c!--more-->\u003c/p>\n\u003cp>The ACA permits rate setting on four factors: family size, age, geographic region and tobacco use. But in Pan's bill tobacco use cannot be a factor in rate setting. Federal rules would have allowed smokers to be charged premiums up to 50 percent higher than others.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Pan opposes this provision. He believes allowing smokers to be charged more would make insurance unaffordable to them and leave smokers uninsured. \"Certainly inability to have health insurance is not going to get them to stop smoking,\" Pan said. \"The way to get them to quit is to get them covered and get them smoking cessation treatment.\"\u003c/p>\n\u003cp>Nicole Evans, with the California Association of Health Plans, is cautious about the bills. The legislation does not \"tie back\" directly to the ACA, she says. Without this protection, insurance companies worry that if the federal government makes changes in the ACA's individual mandate requirement, healthy people would be more likely to go without insurance, leaving insurance companies required to insurance the sickest people remaining. Under this scenario, Evans says, insurance premiums would skyrocket.\u003c/p>\n\u003cp>\"Our position is: 'oppose unless amended,'\" Evans said.\u003c/p>\n\u003cp>Gov. Brown \u003ca href=\"http://www.californiahealthline.org/articles/2012/10/2/gov-brown-signs-vetoes-health-care-reform-related-measures.aspx\" target=\"_blank\">vetoed a similar bill \u003c/a>on consumer protections last fall because he did not feel the connection to the ACA was sufficient. Brian O'Hara, a staffer with Assemblymember Pan, says this question is currently \"in negotiation.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The two bills also set just six geographic regions for pricing insurance in the individual market in California. But reforms passed last year to the small group market called for 19 regions. The CoveredCA health exchange also is using 19 regional areas. Evans says it could create tremendous confusion, possibly delaying the timeline to the January 1st rollout of the ACA, if all insurance markets do not use the same number of regions and the same regional lines.\u003c/p>\n\n",
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"excerpt": "Reforms to the individual health insurance market passed out of the Assembly and Senate in Sacramento on Thursday. Included in the bills were popular consumer provisions including: guaranteed issue, requiring insurers to cover all who apply; and rate setting rules that will make it illegal to charge people with pre-existing conditions more than anyone else or redline those conditions.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/sacramento_capital_seliaymiwell_flickr/\" rel=\"attachment wp-att-9250\">\u003cimg class=\"size-medium wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Reforms to the individual health insurance market passed out of the Assembly and Senate in Sacramento on Thursday. Included in the bills were popular consumer provisions including: guaranteed issue, requiring insurers to cover all who apply; and rate setting rules that will make it illegal to charge people with pre-existing conditions more than anyone else or redline those conditions.\u003c/p>\n\u003cp>From here, the Assembly bill, \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0001-0050/abx1_2_bill_20130129_introduced.htm\" target=\"_blank\">AB 1X 2\u003c/a>, will be heard in the Senate. The Senate's bill, \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0001-0050/sbx1_2_bill_20130128_introduced.htm\" target=\"_blank\">SB 1X 2\u003c/a>, heads to the Assembly.\u003c/p>\n\u003cp>The bills are moving through a special session of the legislature. The Legislature is working to pass bills to bring the state in line with the requirements of the federal health care overhaul, the Affordable Care Act.\u003c/p>\n\u003cp>Assemblymember Richard Pan (D-Sacramento), chair of the Assembly Health committee, authored AB 1X 2. \"I'm certainly happy it passed,\" Pan said in an interview. \"It showed the legislature understands the nature of these historic reforms that we're putting place for California.\"\u003c!--more-->\u003c/p>\n\u003cp>The ACA permits rate setting on four factors: family size, age, geographic region and tobacco use. But in Pan's bill tobacco use cannot be a factor in rate setting. Federal rules would have allowed smokers to be charged premiums up to 50 percent higher than others.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Pan opposes this provision. He believes allowing smokers to be charged more would make insurance unaffordable to them and leave smokers uninsured. \"Certainly inability to have health insurance is not going to get them to stop smoking,\" Pan said. \"The way to get them to quit is to get them covered and get them smoking cessation treatment.\"\u003c/p>\n\u003cp>Nicole Evans, with the California Association of Health Plans, is cautious about the bills. The legislation does not \"tie back\" directly to the ACA, she says. Without this protection, insurance companies worry that if the federal government makes changes in the ACA's individual mandate requirement, healthy people would be more likely to go without insurance, leaving insurance companies required to insurance the sickest people remaining. Under this scenario, Evans says, insurance premiums would skyrocket.\u003c/p>\n\u003cp>\"Our position is: 'oppose unless amended,'\" Evans said.\u003c/p>\n\u003cp>Gov. Brown \u003ca href=\"http://www.californiahealthline.org/articles/2012/10/2/gov-brown-signs-vetoes-health-care-reform-related-measures.aspx\" target=\"_blank\">vetoed a similar bill \u003c/a>on consumer protections last fall because he did not feel the connection to the ACA was sufficient. Brian O'Hara, a staffer with Assemblymember Pan, says this question is currently \"in negotiation.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The two bills also set just six geographic regions for pricing insurance in the individual market in California. But reforms passed last year to the small group market called for 19 regions. The CoveredCA health exchange also is using 19 regional areas. Evans says it could create tremendous confusion, possibly delaying the timeline to the January 1st rollout of the ACA, if all insurance markets do not use the same number of regions and the same regional lines.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Obama Administration Files Brief in Support of Medi-Cal Provider Cuts",
"title": "Obama Administration Files Brief in Support of Medi-Cal Provider Cuts",
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"content": "\u003cp>In a move that is expected to have repercussions across the country, the Obama Administration on Monday filed a brief in the Ninth Circuit Court in support of Gov. Jerry Brown's proposed 10 percent payment cuts to Medi-Cal providers.\u003c/p>\n\u003cp>Some background: The provider cuts \u003ca href=\"http://www.dhcs.ca.gov/formsandpubs/publications/opa/Documents/11-06%20SPA%20Approvals.pdf\" target=\"_blank\">were approved\u003c/a> by CMS back in 2011, but then \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/14/federal-appeals-court-approves-cuts-to-medi-cal-providers/\" target=\"_blank\">immediately challenged \u003c/a>by the California Medical Association (and others) in federal court. A federal judge blocked the cuts. The state of California appealed to the Ninth Circuit. A three-judge panel approved the cuts. The CMA asked for an \u003cem>en banc\u003c/em> review by all of the judges.\u003c/p>\n\u003cp>And that's where we are today, with the Obama Administration's brief.\u003c/p>\n\u003cp>The timing is interesting, as it comes when the National Governors Association is meeting in Washington, and the Obama Administration is trying to convince states to implement the Medicaid expansion portion of the health care overhaul. As the\u003ca href=\"http://www.nytimes.com/2013/02/26/us/politics/states-can-cut-back-on-medicaid-payments-administration-says.html?_r=0\" target=\"_blank\">\u003cem> New York Times\u003c/em>\u003c/a> reports, the Administration seems to be in support of giving states flexibility:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>In court papers, the Obama administration said, “It is entirely appropriate for a state to review its Medicaid plan to determine whether it can continue to satisfy its statutory obligations at lower payment rates.” Indeed, the administration said, states should conduct such reviews “to avoid the perpetuation of payment rates that are unnecessarily high.” ...\u003c/p>\n\u003cp>Moreover, the administration said, Congress gave states “wide discretion” to set Medicaid rates, and courts should not second-guess decisions by Secretary Sebelius on the adequacy of rates.\u003c/p>\u003c/blockquote>\n\u003cp>Meanwhile, advocates for the poor -- as well as health care providers -- were \"infuriated,\" says the \u003cem>Times:\u003c/em>\u003c/p>\n\u003cblockquote>\u003cp>But it may encourage wavering Republican governors to go along with the [Medicaid] expansion because it gives them a tool to help control costs.\u003c/p>\n\u003cp>Byron J. Gross, a lawyer at the \u003ca title=\"group’s Web site.\" href=\"http://www.healthlaw.org/\">National Health Law Program\u003c/a>, an advocacy group for low-income people, said: “The federal government is trying to bend over backward to show flexibility and accommodate states as much as it can. California is an example of that.”\u003c/p>\u003c/blockquote>\n\u003cp>Gov. Brown insists that the provider cuts are a necessary part of restoring California's budgetary health. He has also expressed concern about the unknown costs associated with the health bill's expansion of Medicaid and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/10/governors-proposals-for-medicaid-expansion/\" target=\"_blank\">declared the state must move \"cautiously.\"\u003c/a>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We like the president’s commitment to extend health care to as many Americans as possible, and we can be powerful partners,” Gov. Brown told the \u003cem>Times\u003c/em>. “But we need more authority than we now have. I want to emphasize that — more authority than we have now to manage the \u003ca title=\"HHS Web site.\" href=\"http://www.healthcare.gov/law/\">Affordable Care Act\u003c/a> and the expansion of Medicaid.”\u003c/p>\n\n",
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"excerpt": "In a move that is expected to have repercussions across the country, the Obama Administration on Monday filed a brief in the Ninth Circuit Court in support of Gov. Jerry Brown's proposed 10 percent payment cuts to Medi-Cal providers.\r\n\r\nSome background: The provider cuts were approved by CMS in 2011, but then immediately challenged by the California Medical Association (and others) in federal court. A federal judge blocked the cuts. The state of California appealed to the Ninth Circuit. A three-judge panel approved the cuts. The CMA asked for an en banc review by all the judges.\r\n\r\nAnd that's where we are today, with the Obama Administration's brief.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a move that is expected to have repercussions across the country, the Obama Administration on Monday filed a brief in the Ninth Circuit Court in support of Gov. Jerry Brown's proposed 10 percent payment cuts to Medi-Cal providers.\u003c/p>\n\u003cp>Some background: The provider cuts \u003ca href=\"http://www.dhcs.ca.gov/formsandpubs/publications/opa/Documents/11-06%20SPA%20Approvals.pdf\" target=\"_blank\">were approved\u003c/a> by CMS back in 2011, but then \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/14/federal-appeals-court-approves-cuts-to-medi-cal-providers/\" target=\"_blank\">immediately challenged \u003c/a>by the California Medical Association (and others) in federal court. A federal judge blocked the cuts. The state of California appealed to the Ninth Circuit. A three-judge panel approved the cuts. The CMA asked for an \u003cem>en banc\u003c/em> review by all of the judges.\u003c/p>\n\u003cp>And that's where we are today, with the Obama Administration's brief.\u003c/p>\n\u003cp>The timing is interesting, as it comes when the National Governors Association is meeting in Washington, and the Obama Administration is trying to convince states to implement the Medicaid expansion portion of the health care overhaul. As the\u003ca href=\"http://www.nytimes.com/2013/02/26/us/politics/states-can-cut-back-on-medicaid-payments-administration-says.html?_r=0\" target=\"_blank\">\u003cem> New York Times\u003c/em>\u003c/a> reports, the Administration seems to be in support of giving states flexibility:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>In court papers, the Obama administration said, “It is entirely appropriate for a state to review its Medicaid plan to determine whether it can continue to satisfy its statutory obligations at lower payment rates.” Indeed, the administration said, states should conduct such reviews “to avoid the perpetuation of payment rates that are unnecessarily high.” ...\u003c/p>\n\u003cp>Moreover, the administration said, Congress gave states “wide discretion” to set Medicaid rates, and courts should not second-guess decisions by Secretary Sebelius on the adequacy of rates.\u003c/p>\u003c/blockquote>\n\u003cp>Meanwhile, advocates for the poor -- as well as health care providers -- were \"infuriated,\" says the \u003cem>Times:\u003c/em>\u003c/p>\n\u003cblockquote>\u003cp>But it may encourage wavering Republican governors to go along with the [Medicaid] expansion because it gives them a tool to help control costs.\u003c/p>\n\u003cp>Byron J. Gross, a lawyer at the \u003ca title=\"group’s Web site.\" href=\"http://www.healthlaw.org/\">National Health Law Program\u003c/a>, an advocacy group for low-income people, said: “The federal government is trying to bend over backward to show flexibility and accommodate states as much as it can. California is an example of that.”\u003c/p>\u003c/blockquote>\n\u003cp>Gov. Brown insists that the provider cuts are a necessary part of restoring California's budgetary health. He has also expressed concern about the unknown costs associated with the health bill's expansion of Medicaid and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/10/governors-proposals-for-medicaid-expansion/\" target=\"_blank\">declared the state must move \"cautiously.\"\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We like the president’s commitment to extend health care to as many Americans as possible, and we can be powerful partners,” Gov. Brown told the \u003cem>Times\u003c/em>. “But we need more authority than we now have. I want to emphasize that — more authority than we have now to manage the \u003ca title=\"HHS Web site.\" href=\"http://www.healthcare.gov/law/\">Affordable Care Act\u003c/a> and the expansion of Medicaid.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Systems Can Work: Rooting Out Variation and Saving Millions in San Diego ",
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"content": "\u003cp>By Russ Mitchell, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/February/14/chris-van-gorder-scripps-health-costs-solutions.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10588\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/14/systems-can-work-rooting-out-variation-and-saving-millions-in-san-diego/emergencyroomsign_anname-taber-andrew-bain/\" rel=\"attachment wp-att-10588\">\u003cimg class=\"size-medium wp-image-10588\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/EmergencyRoomSign_anName-Taber-Andrew-Bain--300x198.jpg\" alt=\"Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A hundred managers at Scripps Health jam shoulder-to-shoulder into a break room in San Diego. CEO Chris Van Gorder goes at them like a football coach down by 3 at halftime.\u003c/p>\n\u003cp>\"What are we trying to do in our health care system?\"\u003c/p>\n\u003cp>\"Reduce costs!\"\u003c/p>\n\u003cp>\"Why?\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Health care is too expensive.\"\u003c/p>\n\u003cp>\"The solution is going to come from Washington D.C., right?\"\u003c/p>\n\u003caside class=\"pullquote alignright\">There was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures.\u003c/aside>\n\u003cp>\"Ha ha ha ha.\"\u003c/p>\n\u003cp>\"Sacramento then, right?\"\u003c/p>\n\u003cp>\"Ha.\"\u003c/p>\n\u003cp>\"The solution,\" says Van Gorder, pumping an index figure toward his team, \"is going to come from right here.\"\u003c/p>\n\u003cp>Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.\u003c/p>\n\u003cp>Just this week, we've seen how lack of standardization leads to a nearly-inexplicable price range of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/11/how-much-for-a-hip-replacement-good-luck-trying-to-find-out/\" target=\"_blank\">$11,000 to $125,000 for a standard hip replacement\u003c/a> across the country.\u003c!--more-->\u003c/p>\n\u003cp>Price variation among hospitals within the same system is even harder to explain. At Scripps, there was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures, using the same protocol, even with the same surgeon.\u003c/p>\n\u003cp>And that's standard: Most health care systems still manage each hospital or clinic as its own silo -- each with different management, operations and clinical procedures.\u003c/p>\n\u003cp>Van Gorder, 60, tells his staff that major change is inevitable. Political leaders, employers and patients themselves are fed up with health care costs. Given federal budget deficits and the calls for entitlement reform, Medicare margins will continue to be under pressure. Politicians fearing a backlash from cutting benefits to consumers will take aim at hospitals and other providers. The Advisory Board Company predicts the typical hospital will see its margins collapse by as much as 20 percent over the next 10 years as reimbursements drop.\u003c/p>\n\u003cp>\"Hospitals that can't find a way to deliver their product less expensively and with better quality are going to go out of business,\" Van Gorder says. \"It's as simple as that.\"\u003c/p>\n\u003cp>\u003cstrong>The $6,000 Cost Difference\u003c/strong>\u003c/p>\n\u003cp>Consider the $6,000 cost difference for the cardiac valve and coronary artery bypass graft procedures. No one paid attention to it, because there was no incentive to do so. When a cross-system team dissected hospital-to-hospital variations in 2010, they found that the Scripps Memorial Hospital in La Jolla required that nitric oxide be administered to the patient, ostensibly to boost oxygen intake in the blood.\u003c/p>\n\u003cp>Fourteen miles away, at Mercy Hospital in downtown San Diego, such patients received no nitric oxide. A look at the data showed the outcomes were the same. Today, a doctor at any hospital in the Scripps system can still order up nitric oxide, but it’s no longer required. Savings: $400,000 per year.\u003c/p>\n\u003cp>Some of the other savings that netted $150 million in the first year:\u003c/p>\n\u003cul>\n\u003cli>The ER: Once, the wait could be as long as eight hours. Now, it averages 30 minutes. Scripps requires doctors and nurses to see patients at the same time, early in the process, instead of forcing them through a gauntlet of information-takers, where they’d repeat the same complaints over and over. Fewer handoffs mean better communications, fewer errors and more patients seen for a $29 million revenue boost.\u003c/li>\n\u003cli>Radiology: For imaging tests, each hospital stocked its radiologist's own favorite contrast agents -- the iodine, barium, gadolinium and other chemicals used to highlight structures and fluids in a patient's body. After doctors agreed to use a few brands, volume discounts saved $1.5 million a year.\u003c/li>\n\u003cli>Surgery: OneScripps focused on three cardiac surgeons at one hospital and studied their work habits for needless variation. Voluntary best-practice protocols were established which have decreased length of hospital stay by almost a day and saved the system $3.6 million a year.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>A Story With Twists And Turns\u003c/strong>\u003c/p>\n\u003cp>Van Gorder's campaign has not been without challenges. Historically, doctors have felt threatened by changes imposed from outside the profession, which they fear will undermine their autonomy and income. \"You can’t force feed doctors,\" says Brent Eastman, recently retired chief of medicine at Scripps, now president-elect of the American College of Surgeons.\u003c/p>\n\u003cp>Sensitive to this culture, Van Gorder created what he called a Physician Leadership Cabinet \"to share the responsibility of running this company together.\" The board includes the medical staff and physician members elected by their peers because \"We don't want 'yes people' sitting on the group.\" The key to cooperation, says Van Gorder, is transparency -- sharing all information.\u003c/p>\n\u003cp>Early on he was tested. The doctors demanded $4 million to pay for on-call doctors for the emergency rooms. Van Gorder said he couldn’t afford it, and laid out the numbers. The doctors cut the demand in half.\u003c/p>\n\u003cp>Van Gorder trusts that sharing financial information, especially on costs, along with data on treatment and outcomes, will usually lead doctors to the best-outcome-at-lowest-cost decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So far, that strategy has inspired buy-in. \"Probably only once every hundred years will there be a generation that can truly change the way health care is delivered,\" says Eastman, the physician. \"We are that generation.\"\u003c/p>\n\n",
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"excerpt": "Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.\r\n\r\nJust this week, we've seen how lack of standardization leads to a nearly-inexplicable price range of $11,000 to $125,000 for a standard hip replacement across the country.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Russ Mitchell, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/February/14/chris-van-gorder-scripps-health-costs-solutions.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10588\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/14/systems-can-work-rooting-out-variation-and-saving-millions-in-san-diego/emergencyroomsign_anname-taber-andrew-bain/\" rel=\"attachment wp-att-10588\">\u003cimg class=\"size-medium wp-image-10588\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/EmergencyRoomSign_anName-Taber-Andrew-Bain--300x198.jpg\" alt=\"Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A hundred managers at Scripps Health jam shoulder-to-shoulder into a break room in San Diego. CEO Chris Van Gorder goes at them like a football coach down by 3 at halftime.\u003c/p>\n\u003cp>\"What are we trying to do in our health care system?\"\u003c/p>\n\u003cp>\"Reduce costs!\"\u003c/p>\n\u003cp>\"Why?\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Health care is too expensive.\"\u003c/p>\n\u003cp>\"The solution is going to come from Washington D.C., right?\"\u003c/p>\n\u003caside class=\"pullquote alignright\">There was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures.\u003c/aside>\n\u003cp>\"Ha ha ha ha.\"\u003c/p>\n\u003cp>\"Sacramento then, right?\"\u003c/p>\n\u003cp>\"Ha.\"\u003c/p>\n\u003cp>\"The solution,\" says Van Gorder, pumping an index figure toward his team, \"is going to come from right here.\"\u003c/p>\n\u003cp>Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.\u003c/p>\n\u003cp>Just this week, we've seen how lack of standardization leads to a nearly-inexplicable price range of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/11/how-much-for-a-hip-replacement-good-luck-trying-to-find-out/\" target=\"_blank\">$11,000 to $125,000 for a standard hip replacement\u003c/a> across the country.\u003c!--more-->\u003c/p>\n\u003cp>Price variation among hospitals within the same system is even harder to explain. At Scripps, there was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures, using the same protocol, even with the same surgeon.\u003c/p>\n\u003cp>And that's standard: Most health care systems still manage each hospital or clinic as its own silo -- each with different management, operations and clinical procedures.\u003c/p>\n\u003cp>Van Gorder, 60, tells his staff that major change is inevitable. Political leaders, employers and patients themselves are fed up with health care costs. Given federal budget deficits and the calls for entitlement reform, Medicare margins will continue to be under pressure. Politicians fearing a backlash from cutting benefits to consumers will take aim at hospitals and other providers. The Advisory Board Company predicts the typical hospital will see its margins collapse by as much as 20 percent over the next 10 years as reimbursements drop.\u003c/p>\n\u003cp>\"Hospitals that can't find a way to deliver their product less expensively and with better quality are going to go out of business,\" Van Gorder says. \"It's as simple as that.\"\u003c/p>\n\u003cp>\u003cstrong>The $6,000 Cost Difference\u003c/strong>\u003c/p>\n\u003cp>Consider the $6,000 cost difference for the cardiac valve and coronary artery bypass graft procedures. No one paid attention to it, because there was no incentive to do so. When a cross-system team dissected hospital-to-hospital variations in 2010, they found that the Scripps Memorial Hospital in La Jolla required that nitric oxide be administered to the patient, ostensibly to boost oxygen intake in the blood.\u003c/p>\n\u003cp>Fourteen miles away, at Mercy Hospital in downtown San Diego, such patients received no nitric oxide. A look at the data showed the outcomes were the same. Today, a doctor at any hospital in the Scripps system can still order up nitric oxide, but it’s no longer required. Savings: $400,000 per year.\u003c/p>\n\u003cp>Some of the other savings that netted $150 million in the first year:\u003c/p>\n\u003cul>\n\u003cli>The ER: Once, the wait could be as long as eight hours. Now, it averages 30 minutes. Scripps requires doctors and nurses to see patients at the same time, early in the process, instead of forcing them through a gauntlet of information-takers, where they’d repeat the same complaints over and over. Fewer handoffs mean better communications, fewer errors and more patients seen for a $29 million revenue boost.\u003c/li>\n\u003cli>Radiology: For imaging tests, each hospital stocked its radiologist's own favorite contrast agents -- the iodine, barium, gadolinium and other chemicals used to highlight structures and fluids in a patient's body. After doctors agreed to use a few brands, volume discounts saved $1.5 million a year.\u003c/li>\n\u003cli>Surgery: OneScripps focused on three cardiac surgeons at one hospital and studied their work habits for needless variation. Voluntary best-practice protocols were established which have decreased length of hospital stay by almost a day and saved the system $3.6 million a year.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>A Story With Twists And Turns\u003c/strong>\u003c/p>\n\u003cp>Van Gorder's campaign has not been without challenges. Historically, doctors have felt threatened by changes imposed from outside the profession, which they fear will undermine their autonomy and income. \"You can’t force feed doctors,\" says Brent Eastman, recently retired chief of medicine at Scripps, now president-elect of the American College of Surgeons.\u003c/p>\n\u003cp>Sensitive to this culture, Van Gorder created what he called a Physician Leadership Cabinet \"to share the responsibility of running this company together.\" The board includes the medical staff and physician members elected by their peers because \"We don't want 'yes people' sitting on the group.\" The key to cooperation, says Van Gorder, is transparency -- sharing all information.\u003c/p>\n\u003cp>Early on he was tested. The doctors demanded $4 million to pay for on-call doctors for the emergency rooms. Van Gorder said he couldn’t afford it, and laid out the numbers. The doctors cut the demand in half.\u003c/p>\n\u003cp>Van Gorder trusts that sharing financial information, especially on costs, along with data on treatment and outcomes, will usually lead doctors to the best-outcome-at-lowest-cost decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So far, that strategy has inspired buy-in. \"Probably only once every hundred years will there be a generation that can truly change the way health care is delivered,\" says Eastman, the physician. \"We are that generation.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "ACA Updates: Covered California Benefit Plans and Calculate Your Premium Online ",
"title": "ACA Updates: Covered California Benefit Plans and Calculate Your Premium Online ",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>California is first state to announce benefit plans including co-pays, deductibles\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8836\" class=\"wp-caption alignleft\" style=\"max-width: 290px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/11/12/%e2%80%98last-distraction%e2%80%99-removed-as-california-moves-ahead-on-health-reform/coveredcalifornia1/\" rel=\"attachment wp-att-8836\">\u003cimg class=\"size-full wp-image-8836\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CoveredCalifornia1.png\" alt=\"California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.\" width=\"290\" height=\"302\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/11/CoveredCalifornia1.png 290w, https://ww2.kqed.org/app/uploads/sites/27/2012/11/CoveredCalifornia1-32x32.png 32w\" sizes=\"(max-width: 290px) 100vw, 290px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.\u003c/figcaption>\u003c/figure>\n\u003cp>Calling today a \"game changer for California and a game changer for the nation,\" Peter Lee, executive director of Covered California, the state's marketplace for health insurance, announced benefit plans that will be featured in the exchange.\u003c/p>\n\u003cp>He also unveiled \u003ca href=\"http://www.coveredca.com\" target=\"_blank\">its updated website\u003c/a> (in English and \u003ca href=\"http://www.coveredca.com/es/\" target=\"_blank\">Spanish\u003c/a>) where consumers can access what is sure to be a very popular \u003ca href=\"http://www.coveredca.com/resources/calculating-the-cost/\" target=\"_blank\">premium calculator\u003c/a>. People with incomes up to 400 percent of poverty are eligible for subsidies from the federal government to help purchase insurance. The calculator gives an estimate of what you will pay after the subsidy.\u003c/p>\n\u003cp>\u003cstrong>[Update September, 2013: Covered California has new\u003c/strong> \u003ca href=\"http://www.coveredca.com/shopandcompare/\" target=\"_blank\">Shop and Compare Tool\u003c/a>]\u003c/p>\n\u003cp>An estimated 2.6 million Californians are expected to qualify for the subsidy. People who receive Medi-Cal or employer-based health insurance are not eligible and will continue to receive health insurance through their current plans.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\u003ca href=\"http://kff.org/interactive/subsidy-calculator/\" target=\"_blank\">Calculate your monthly premium here\u003c/a>. \u003c/aside>\n\u003cp>California is the first state in the nation to release benefit packages for the public to review. \"The most important aspect of these plans is that they’re standardized. ... Consumers will be able to make apples-to-apples comparisons that they haven’t been able to make in the past,\" Lee said in a press conference.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As called for in the Affordable Care Act, there will be four tiers of coverage: platinum, gold, silver and bronze. The platinum plan will cover 90 percent of health care costs and have the highest premium. The gold plan will cover 80 percent; the silver 70 percent.\u003c/p>\n\u003cp>The bronze plan will have the lowest premium and cover 60 percent of costs, \"meaning a consumer would pay 40 percent out of pocket,\" said Ken Wood, senior advisor for Covered California. \"That’s really a catastrophic plan that’s designed to protect someone from financial collapse if they had a severe illness. … So we are defining benefits across a wide range of richness and design and thus affordability.”\u003c/p>\n\u003cp style=\"text-align: center\">\u003cstrong>[Related Content: \u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">Obamacare Explained -- A Guide for Californians\u003c/a>]\u003c/strong>\u003c/p>\n\u003cp>In other words, pay a higher premium and more of your health care costs will be covered.\u003c/p>\n\u003cp>California goes beyond federal requirements by detailing what deductibles and co-pays consumers may be charged. Platinum and gold plans will have no deductible, and a doctor's office visit will be $25 (platinum) or $45 (gold). From there, silver plans will have $2,000 deductibles, a $45 doctor's office visit co-pay and an additional $500 deductible for medications. (See chart at end of post for more detail on deductibles and co-pays.)\u003c/p>\n\u003cp>While Wednesday's announcement detailed many aspects of costs, the premium prices are still estimated and will not be finalized until June.\u003c/p>\n\u003cp>These standardized deductibles and co-pays are rules which apply to plans sold in the exchange. While health insurers may still offer plans of other designs outside the exchange, consumers who qualify for the subsidy must purchase their plan on the exchange.\u003c/p>\n\u003cp>\u003cstrong>\"The HR department for the rest of us\"\u003c/strong>\u003cbr>\nCalling these announcements a \"bold, big step forward,\" Anthony Wright, executive director of the advocacy group Health Access said, \"Consumers will get good and simple information about what the plan covers, and what it doesn't. It will remove the guesswork so many consumers go through trying to figure out the differences between plans. ... For individuals and families who don't work for large employers with significant purchasing power, Covered California will serve as the HR department for the rest of us.\"\u003c/p>\n\u003cp>Consumers can calculate their subsidies, but they should be sure to read the disclaimers -- especially noting that the subsidy is based on the \"silver\" tier of coverage.\u003c/p>\n\u003cp>Patrick Johnston, president of the California Association of Health Plans sounded a cautionary note, saying that the standardization of plans may reduce confusion, but might also increase premiums, then pointed to some of the requirements of the Affordable Care Act not addressed in Wednesday's news.\u003c/p>\n\u003cp>\"New taxes, limits on geography-based pricing and age rating restrictions are all part of the Affordable Care Act that will drive up the cost of coverage for millions of consumers and employers,\" Johnston said. \"We will see in the coming months whether the standardized benefit designs adversely impact premiums or not.\"\u003c/p>\n\u003cp>The benefit plans also feature out-of-pocket maximums: $6,400 for individuals and $12,800 for a family. In other words, if you get very sick or injured, that is the maximum amount you will have to pay outside of your premium.\u003c/p>\n\u003cp>“That’s a lot of money, let’s face it,\" said Ken Wood. \"But when people can have hospital bills at $500,000 or $1,000,000, can find they’re in a bankruptcy situation because of that type of tragedy, having their exposure limited to $12,000 is a bit is a breakthrough.”\u003c/p>\n\u003cp style=\"text-align: center\">\u003cstrong>[Related: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/25/some-say-obamacares-affordable-coverage-isnt-so-affordable/\" target=\"_blank\">Some Say Obamacare's \"Affordable\" Coverage Isn't So Affordable]\u003c/a>\u003c/strong>\u003c/p>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_10575\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/13/aca-updates-covered-california-benefit-plans-and-calculate-your-subsidy-online/print/\" rel=\"attachment wp-att-10575\">\u003cimg class=\"size-large wp-image-10575\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/CC-Standard-Individual-Benefit-Plans-620x348.jpg\" alt=\"(Chart: Covered California)\" width=\"620\" height=\"348\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Chart: Covered California)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: This post has been updated to reflect that the CaliforniaCovered website includes a calculator for insurance costs, not the subsidy from the federal government. \u003c/em>\u003c/p>\n\n",
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"excerpt": "Calling today a \"game changer for California and a game changer for the nation,\" Peter Lee, executive director of Covered California, announced health insurance benefit designs that will be featured in the insurance exchange. He also revealed launch of its new website (in English and Spanish) where consumers can access what is sure to be a very popular premium subsidy calculator. California is the first state in the nation to release benefit packages for the public to review.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>California is first state to announce benefit plans including co-pays, deductibles\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8836\" class=\"wp-caption alignleft\" style=\"max-width: 290px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/11/12/%e2%80%98last-distraction%e2%80%99-removed-as-california-moves-ahead-on-health-reform/coveredcalifornia1/\" rel=\"attachment wp-att-8836\">\u003cimg class=\"size-full wp-image-8836\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CoveredCalifornia1.png\" alt=\"California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.\" width=\"290\" height=\"302\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/11/CoveredCalifornia1.png 290w, https://ww2.kqed.org/app/uploads/sites/27/2012/11/CoveredCalifornia1-32x32.png 32w\" sizes=\"(max-width: 290px) 100vw, 290px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.\u003c/figcaption>\u003c/figure>\n\u003cp>Calling today a \"game changer for California and a game changer for the nation,\" Peter Lee, executive director of Covered California, the state's marketplace for health insurance, announced benefit plans that will be featured in the exchange.\u003c/p>\n\u003cp>He also unveiled \u003ca href=\"http://www.coveredca.com\" target=\"_blank\">its updated website\u003c/a> (in English and \u003ca href=\"http://www.coveredca.com/es/\" target=\"_blank\">Spanish\u003c/a>) where consumers can access what is sure to be a very popular \u003ca href=\"http://www.coveredca.com/resources/calculating-the-cost/\" target=\"_blank\">premium calculator\u003c/a>. People with incomes up to 400 percent of poverty are eligible for subsidies from the federal government to help purchase insurance. The calculator gives an estimate of what you will pay after the subsidy.\u003c/p>\n\u003cp>\u003cstrong>[Update September, 2013: Covered California has new\u003c/strong> \u003ca href=\"http://www.coveredca.com/shopandcompare/\" target=\"_blank\">Shop and Compare Tool\u003c/a>]\u003c/p>\n\u003cp>An estimated 2.6 million Californians are expected to qualify for the subsidy. People who receive Medi-Cal or employer-based health insurance are not eligible and will continue to receive health insurance through their current plans.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\u003ca href=\"http://kff.org/interactive/subsidy-calculator/\" target=\"_blank\">Calculate your monthly premium here\u003c/a>. \u003c/aside>\n\u003cp>California is the first state in the nation to release benefit packages for the public to review. \"The most important aspect of these plans is that they’re standardized. ... Consumers will be able to make apples-to-apples comparisons that they haven’t been able to make in the past,\" Lee said in a press conference.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As called for in the Affordable Care Act, there will be four tiers of coverage: platinum, gold, silver and bronze. The platinum plan will cover 90 percent of health care costs and have the highest premium. The gold plan will cover 80 percent; the silver 70 percent.\u003c/p>\n\u003cp>The bronze plan will have the lowest premium and cover 60 percent of costs, \"meaning a consumer would pay 40 percent out of pocket,\" said Ken Wood, senior advisor for Covered California. \"That’s really a catastrophic plan that’s designed to protect someone from financial collapse if they had a severe illness. … So we are defining benefits across a wide range of richness and design and thus affordability.”\u003c/p>\n\u003cp style=\"text-align: center\">\u003cstrong>[Related Content: \u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">Obamacare Explained -- A Guide for Californians\u003c/a>]\u003c/strong>\u003c/p>\n\u003cp>In other words, pay a higher premium and more of your health care costs will be covered.\u003c/p>\n\u003cp>California goes beyond federal requirements by detailing what deductibles and co-pays consumers may be charged. Platinum and gold plans will have no deductible, and a doctor's office visit will be $25 (platinum) or $45 (gold). From there, silver plans will have $2,000 deductibles, a $45 doctor's office visit co-pay and an additional $500 deductible for medications. (See chart at end of post for more detail on deductibles and co-pays.)\u003c/p>\n\u003cp>While Wednesday's announcement detailed many aspects of costs, the premium prices are still estimated and will not be finalized until June.\u003c/p>\n\u003cp>These standardized deductibles and co-pays are rules which apply to plans sold in the exchange. While health insurers may still offer plans of other designs outside the exchange, consumers who qualify for the subsidy must purchase their plan on the exchange.\u003c/p>\n\u003cp>\u003cstrong>\"The HR department for the rest of us\"\u003c/strong>\u003cbr>\nCalling these announcements a \"bold, big step forward,\" Anthony Wright, executive director of the advocacy group Health Access said, \"Consumers will get good and simple information about what the plan covers, and what it doesn't. It will remove the guesswork so many consumers go through trying to figure out the differences between plans. ... For individuals and families who don't work for large employers with significant purchasing power, Covered California will serve as the HR department for the rest of us.\"\u003c/p>\n\u003cp>Consumers can calculate their subsidies, but they should be sure to read the disclaimers -- especially noting that the subsidy is based on the \"silver\" tier of coverage.\u003c/p>\n\u003cp>Patrick Johnston, president of the California Association of Health Plans sounded a cautionary note, saying that the standardization of plans may reduce confusion, but might also increase premiums, then pointed to some of the requirements of the Affordable Care Act not addressed in Wednesday's news.\u003c/p>\n\u003cp>\"New taxes, limits on geography-based pricing and age rating restrictions are all part of the Affordable Care Act that will drive up the cost of coverage for millions of consumers and employers,\" Johnston said. \"We will see in the coming months whether the standardized benefit designs adversely impact premiums or not.\"\u003c/p>\n\u003cp>The benefit plans also feature out-of-pocket maximums: $6,400 for individuals and $12,800 for a family. In other words, if you get very sick or injured, that is the maximum amount you will have to pay outside of your premium.\u003c/p>\n\u003cp>“That’s a lot of money, let’s face it,\" said Ken Wood. \"But when people can have hospital bills at $500,000 or $1,000,000, can find they’re in a bankruptcy situation because of that type of tragedy, having their exposure limited to $12,000 is a bit is a breakthrough.”\u003c/p>\n\u003cp style=\"text-align: center\">\u003cstrong>[Related: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/25/some-say-obamacares-affordable-coverage-isnt-so-affordable/\" target=\"_blank\">Some Say Obamacare's \"Affordable\" Coverage Isn't So Affordable]\u003c/a>\u003c/strong>\u003c/p>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_10575\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/13/aca-updates-covered-california-benefit-plans-and-calculate-your-subsidy-online/print/\" rel=\"attachment wp-att-10575\">\u003cimg class=\"size-large wp-image-10575\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/CC-Standard-Individual-Benefit-Plans-620x348.jpg\" alt=\"(Chart: Covered California)\" width=\"620\" height=\"348\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Chart: Covered California)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: This post has been updated to reflect that the CaliforniaCovered website includes a calculator for insurance costs, not the subsidy from the federal government. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/12/the-5-health-figures-on-the-guest-list-at-tonights-state-of-the-union/screen-shot-2013-02-12-at-1-14-38-pm/\" rel=\"attachment wp-att-10531\">\u003cimg class=\"alignleft size-medium wp-image-10531\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/Screen-Shot-2013-02-12-at-1.14.38-PM-300x212.png\" alt=\"The 2012 State of the Union address. (Photo: The White House)\" width=\"300\" height=\"212\">\u003c/a>Five of the 24 people invited to sit near First Lady Michelle Obama at tonight’s State of the Union have strong health care connections. They include a governor, a business owner and a beneficiary of the health law provision that prevents health plans from denying coverage because of pre-existing conditions.\u003c/p>\n\u003cp>Typically, the invited guests at the joint session of Congress help the president highlight a new initiative or show how administration policy is working.\u003c/p>\n\u003cp>Here are the biographies furnished by The White House:\u003c/p>\n\u003col>\n\u003cli>\u003cstrong>Peter Hudson of Evergreen, CO: Co-Founder and CEO, iTriage \u003c/strong>Hudson is a physician and entrepreneur with more than 15 years of experience founding and growing healthcare-related businesses. Using open government data, he launched iTriage in 2009 to help consumers engage in their own healthcare. Through an app, smartphone users can locate nearby providers based on their symptoms, make appointments, store their personal health records, save medication refill reminders, and learn about thousands of medications, diseases and procedures.\u003c!--more-->\u003c/li>\n\u003cli>\u003cstrong>Gov. John Kitzhaber, D-Oregon: \u003c/strong>A former emergency room doctor, Kitzhaber has made major changes to Oregon’s Medicaid program. Now in his third term, he is working with the Obama administration to scale up innovative models that improve health outcomes and achieve greater efficiency.\u003c/li>\n\u003cli>\u003cstrong>Menchu Sanchez, Registered Nurse, NYU Langone Medical Center: \u003c/strong>When Hurricane Sandy cut the power at NYU Langone Medical Center in Manhattan, Sanchez devised a plan to transport 20 at-risk infants to intensive care units around the city. She organized the nurses and doctors to carry the babies down eight flights of stairs with only cell phones to light the way. Menchu was born, raised, and educated in the Philippines and she immigrated to the United States in the 1980s. She has worked as a nurse in New York for more than 25 years and has been at NYU since 2010.\u003c/li>\n\u003cli>\u003cstrong>Abby Schanfield of Minneapolis, MN: \u003c/strong>Prior to passage of the Affordable Care Act, Abby would have lost coverage upon turning 21 and would have been unable to obtain insurance due to several pre-existing conditions. She was born with toxoplasmosis, a parasitic infection that her mother unwittingly passed on during pregnancy and which set the stage for lifelong medical problems. Abby is a member of TakeAction Minnesota’s health care team, a grassroots organization that advocates for progressive policies ranging from health care to economic reform.\u003c/li>\n\u003cli>\u003cstrong>Haile Thomas of Tucson, AZ Youth Advocate: \u003c/strong>Haile Thomas is a 12 year-old co-founder/director of the \u003ca href=\"http://www.dosomething.org/project/happy-organization-inc\" target=\"_blank\">HAPPY Organization\u003c/a>, an Arizona nonprofit dedicated to improving the health and wellness of youth through education, outreach, and advocacy about proper nutrition and healthy lifestyle choices. She hosts an annual H.E.A.L. (healthy eating, active lifestyle) Festival on Global Youth Service Day in Tucson. She created the \u003ca href=\"http://www.hgaclub.com\" target=\"_blank\">Healthy Girl Adventures Club\u003c/a> to inspire girls to embrace healthy habits, and produces online cooking videos aimed at kids.\u003c/li>\n\u003c/ol>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/12/the-5-health-figures-on-the-guest-list-at-tonights-state-of-the-union/screen-shot-2013-02-12-at-1-14-38-pm/\" rel=\"attachment wp-att-10531\">\u003cimg class=\"alignleft size-medium wp-image-10531\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/Screen-Shot-2013-02-12-at-1.14.38-PM-300x212.png\" alt=\"The 2012 State of the Union address. (Photo: The White House)\" width=\"300\" height=\"212\">\u003c/a>Five of the 24 people invited to sit near First Lady Michelle Obama at tonight’s State of the Union have strong health care connections. They include a governor, a business owner and a beneficiary of the health law provision that prevents health plans from denying coverage because of pre-existing conditions.\u003c/p>\n\u003cp>Typically, the invited guests at the joint session of Congress help the president highlight a new initiative or show how administration policy is working.\u003c/p>\n\u003cp>Here are the biographies furnished by The White House:\u003c/p>\n\u003col>\n\u003cli>\u003cstrong>Peter Hudson of Evergreen, CO: Co-Founder and CEO, iTriage \u003c/strong>Hudson is a physician and entrepreneur with more than 15 years of experience founding and growing healthcare-related businesses. Using open government data, he launched iTriage in 2009 to help consumers engage in their own healthcare. Through an app, smartphone users can locate nearby providers based on their symptoms, make appointments, store their personal health records, save medication refill reminders, and learn about thousands of medications, diseases and procedures.\u003c!--more-->\u003c/li>\n\u003cli>\u003cstrong>Gov. John Kitzhaber, D-Oregon: \u003c/strong>A former emergency room doctor, Kitzhaber has made major changes to Oregon’s Medicaid program. Now in his third term, he is working with the Obama administration to scale up innovative models that improve health outcomes and achieve greater efficiency.\u003c/li>\n\u003cli>\u003cstrong>Menchu Sanchez, Registered Nurse, NYU Langone Medical Center: \u003c/strong>When Hurricane Sandy cut the power at NYU Langone Medical Center in Manhattan, Sanchez devised a plan to transport 20 at-risk infants to intensive care units around the city. She organized the nurses and doctors to carry the babies down eight flights of stairs with only cell phones to light the way. Menchu was born, raised, and educated in the Philippines and she immigrated to the United States in the 1980s. She has worked as a nurse in New York for more than 25 years and has been at NYU since 2010.\u003c/li>\n\u003cli>\u003cstrong>Abby Schanfield of Minneapolis, MN: \u003c/strong>Prior to passage of the Affordable Care Act, Abby would have lost coverage upon turning 21 and would have been unable to obtain insurance due to several pre-existing conditions. She was born with toxoplasmosis, a parasitic infection that her mother unwittingly passed on during pregnancy and which set the stage for lifelong medical problems. Abby is a member of TakeAction Minnesota’s health care team, a grassroots organization that advocates for progressive policies ranging from health care to economic reform.\u003c/li>\n\u003cli>\u003cstrong>Haile Thomas of Tucson, AZ Youth Advocate: \u003c/strong>Haile Thomas is a 12 year-old co-founder/director of the \u003ca href=\"http://www.dosomething.org/project/happy-organization-inc\" target=\"_blank\">HAPPY Organization\u003c/a>, an Arizona nonprofit dedicated to improving the health and wellness of youth through education, outreach, and advocacy about proper nutrition and healthy lifestyle choices. She hosts an annual H.E.A.L. (healthy eating, active lifestyle) Festival on Global Youth Service Day in Tucson. She created the \u003ca href=\"http://www.hgaclub.com\" target=\"_blank\">Healthy Girl Adventures Club\u003c/a> to inspire girls to embrace healthy habits, and produces online cooking videos aimed at kids.\u003c/li>\n\u003c/ol>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>You're likely familiar with rehabilitation -- physical therapy after an injury would fall into this category. But parents with chronically ill children are all too familiar with a different type of service -- habilitation service -- as Elaine Korry detailed Monday morning for \u003cem>The California Report. \u003c/em> From her story:\u003c/p>\n\u003cblockquote>\u003cp>\"Habilitative services are really just making sure that a child can thrive in the world that they’re living in, so, for example, hearing aids are a habilitative service,\" says Kelly Hardy, director of health policy at Children Now, a statewide advocacy group. ...\u003c/p>\n\u003cp>Dr. Thomas Long, a health financing expert with the American Academy of Pediatrics, says it helps young patients, like deaf kids, attain health in the first place.\u003c/p>\n\u003cp>\"Habilitation implies skills that have not yet been developed,\" Long says. \"For example, speech therapy. It’s terribly important for children to learn to speak well.\u003c/p>\n\u003cp>Habilitation is also important for kids with a chronic disease, such as asthma or diabetes.\u003c/p>\u003c/blockquote>\n\u003cp>California's implementation of the Affordable Care Act is in full swing. It takes effect next Jan. 1. The federal health bill left it to states to determine their own benchmark health insurance plan that would be offered in the health benefit exchange -- as long as that plan offered benefits across the \u003ca href=\"http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html\" target=\"_blank\">10 categories\u003c/a> required by the ACA.\u003c/p>\n\u003cp>[\u003cstrong>Related:\u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/13/people-with-disabilities-who-need-habilitative-services-face-complex-choices-under-obamacare/\" target=\"_blank\"> People with Disabilities Who Need Habilitative Services Face Complex Choices Under Obamacare\u003c/a>]\u003c/p>\n\u003cp>One hitch is that the federal government did not define exactly what was meant by \"habilitative services,\" so California legislators stepped in when they passed \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/asm/ab_1451-1500/ab_1453_bill_20120930_chaptered.pdf\" target=\"_blank\">AB 1453\u003c/a> last fall. That bill defined the benchmark plan in California, and legislators defined 'habilitative services' this way:\u003c/p>\n\u003cblockquote>\u003cp>“Habilitative services” means medically necessary health care services and health care devices that assist an individual in partially or fully acquiring or improving skills and functioning and that are necessary to address a health condition, to the maximum extent practical.\u003c/p>\n\u003cp>These services address the skills and abilities needed for functioning in interaction with an individual’s environment.\u003c/p>\n\u003cp>Examples of health care services that are not habilitative services include, but are not limited to, respite care, day care, recreational care, residential treatment, social services, custodial care, or education services of any kind, including, but not limited to, vocational training. Habilitative services shall be covered under the same terms and conditions applied to rehabilitative services under the plan contract.\u003c/p>\u003c/blockquote>\n\u003cp>Did you catch that? The passage lists not only what\u003cem> is\u003c/em> included and but also what's \u003cem>not\u003c/em> included. In Korry's piece, she interviewed the family of a teenage girl who has Type 1 diabetes. The entire family has learned a lot about managing the disease in a diabetes camp, a retreat sponsored by the Diabetic Youth Foundation. From Korry's report:\u003c/p>\n\u003cblockquote>\u003cp>It’s a place where kids with a life-threatening disease, like 15-year-old Taylor Gaydon, can have fun while learning to manage their disease.\u003c/p>\n\u003cp>\"I usually check my sugar 8 to 10 times a day,\" Gaydon says, \"and I don’t think I’d be as good taking care of my diabetes without camp. It really helped. ...\u003c/p>\n\u003cp>Fun activities such as zipline plunges and scavenger hunts are just a small part of the weekend’s events. Program director Janet Kramchuster says most of the time is devoted to education.\u003c/p>\n\u003cp>\"We talk about carbohydrate counting, we talk about insulin adjustments,\" Kramchuster says. \"We talk about how the family is functioning as a unit. We really delve into intensive education that cannot be covered in a 15-minute doctor’s appointment.\"\u003c/p>\n\u003cp>The Diabetic Youth Foundation subsidizes most of the cost of running this camp. Families pay the remainder, usually out of pocket. Those with chronically ill children often face expenses for vital services their insurers don’t cover. But children’s advocates say that under the Affordable Care Act, support services must be covered by insurance, if they fall into habilitative services category.\u003c/p>\u003c/blockquote>\n\u003cp>So, is a diabetes camp a habilitative service? Maybe, maybe not. It depends how individual health plans are written. Charles Bacchi with the California Association of Health Plans says the challenge will be in finding a balance. The more generous a benefit package, the higher the premiums. From Korry's report:\u003c/p>\n\u003cblockquote>\u003cp>\"We’ve got to look at things that are medical,\" Bacchi says, \"provided by licensed providers -- and not try and shift social and educational costs into the health care premium dollar, because that will inordinately increase premiums and make health care unaffordable for millions of Californians.\"\u003c/p>\n\u003cp>That’s one argument. On the other side, advocates for kids with chronic illnesses say a broad array of service, including social supports and education, arm patients with vital knowledge. Again, Diabetic Youth Foundation’s Janet Kramchuster.\u003c/p>\n\u003cp>\"That knowledge prevents the ER visits, and it helps reduce complications down the road,\" says the Diabetic Youth Foundation's Kramchuster. \"Talk about a savings for insurance companies.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cem>Support for Elaine Korry's reporting comes from \u003ca href=\"http://www.reportingonhealth.org/fellowships/seminars/lucile-packard-foundation-childrens-health-journalism-fund\" target=\"_blank\">Lucile Packard Foundation for Children's Health Journalism Fund\u003c/a> at USC Annenberg School for Communication and Journalism.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You're likely familiar with rehabilitation -- physical therapy after an injury would fall into this category. But parents with chronically ill children are all too familiar with a different type of service -- habilitation service -- as Elaine Korry detailed Monday morning for \u003cem>The California Report. \u003c/em> From her story:\u003c/p>\n\u003cblockquote>\u003cp>\"Habilitative services are really just making sure that a child can thrive in the world that they’re living in, so, for example, hearing aids are a habilitative service,\" says Kelly Hardy, director of health policy at Children Now, a statewide advocacy group. ...\u003c/p>\n\u003cp>Dr. Thomas Long, a health financing expert with the American Academy of Pediatrics, says it helps young patients, like deaf kids, attain health in the first place.\u003c/p>\n\u003cp>\"Habilitation implies skills that have not yet been developed,\" Long says. \"For example, speech therapy. It’s terribly important for children to learn to speak well.\u003c/p>\n\u003cp>Habilitation is also important for kids with a chronic disease, such as asthma or diabetes.\u003c/p>\u003c/blockquote>\n\u003cp>California's implementation of the Affordable Care Act is in full swing. It takes effect next Jan. 1. The federal health bill left it to states to determine their own benchmark health insurance plan that would be offered in the health benefit exchange -- as long as that plan offered benefits across the \u003ca href=\"http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html\" target=\"_blank\">10 categories\u003c/a> required by the ACA.\u003c/p>\n\u003cp>[\u003cstrong>Related:\u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/13/people-with-disabilities-who-need-habilitative-services-face-complex-choices-under-obamacare/\" target=\"_blank\"> People with Disabilities Who Need Habilitative Services Face Complex Choices Under Obamacare\u003c/a>]\u003c/p>\n\u003cp>One hitch is that the federal government did not define exactly what was meant by \"habilitative services,\" so California legislators stepped in when they passed \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/asm/ab_1451-1500/ab_1453_bill_20120930_chaptered.pdf\" target=\"_blank\">AB 1453\u003c/a> last fall. That bill defined the benchmark plan in California, and legislators defined 'habilitative services' this way:\u003c/p>\n\u003cblockquote>\u003cp>“Habilitative services” means medically necessary health care services and health care devices that assist an individual in partially or fully acquiring or improving skills and functioning and that are necessary to address a health condition, to the maximum extent practical.\u003c/p>\n\u003cp>These services address the skills and abilities needed for functioning in interaction with an individual’s environment.\u003c/p>\n\u003cp>Examples of health care services that are not habilitative services include, but are not limited to, respite care, day care, recreational care, residential treatment, social services, custodial care, or education services of any kind, including, but not limited to, vocational training. Habilitative services shall be covered under the same terms and conditions applied to rehabilitative services under the plan contract.\u003c/p>\u003c/blockquote>\n\u003cp>Did you catch that? The passage lists not only what\u003cem> is\u003c/em> included and but also what's \u003cem>not\u003c/em> included. In Korry's piece, she interviewed the family of a teenage girl who has Type 1 diabetes. The entire family has learned a lot about managing the disease in a diabetes camp, a retreat sponsored by the Diabetic Youth Foundation. From Korry's report:\u003c/p>\n\u003cblockquote>\u003cp>It’s a place where kids with a life-threatening disease, like 15-year-old Taylor Gaydon, can have fun while learning to manage their disease.\u003c/p>\n\u003cp>\"I usually check my sugar 8 to 10 times a day,\" Gaydon says, \"and I don’t think I’d be as good taking care of my diabetes without camp. It really helped. ...\u003c/p>\n\u003cp>Fun activities such as zipline plunges and scavenger hunts are just a small part of the weekend’s events. Program director Janet Kramchuster says most of the time is devoted to education.\u003c/p>\n\u003cp>\"We talk about carbohydrate counting, we talk about insulin adjustments,\" Kramchuster says. \"We talk about how the family is functioning as a unit. We really delve into intensive education that cannot be covered in a 15-minute doctor’s appointment.\"\u003c/p>\n\u003cp>The Diabetic Youth Foundation subsidizes most of the cost of running this camp. Families pay the remainder, usually out of pocket. Those with chronically ill children often face expenses for vital services their insurers don’t cover. But children’s advocates say that under the Affordable Care Act, support services must be covered by insurance, if they fall into habilitative services category.\u003c/p>\u003c/blockquote>\n\u003cp>So, is a diabetes camp a habilitative service? Maybe, maybe not. It depends how individual health plans are written. Charles Bacchi with the California Association of Health Plans says the challenge will be in finding a balance. The more generous a benefit package, the higher the premiums. From Korry's report:\u003c/p>\n\u003cblockquote>\u003cp>\"We’ve got to look at things that are medical,\" Bacchi says, \"provided by licensed providers -- and not try and shift social and educational costs into the health care premium dollar, because that will inordinately increase premiums and make health care unaffordable for millions of Californians.\"\u003c/p>\n\u003cp>That’s one argument. On the other side, advocates for kids with chronic illnesses say a broad array of service, including social supports and education, arm patients with vital knowledge. 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"content": "\u003cfigure id=\"attachment_10256\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/30/uc-student-health-plan-slips-through-loophole-in-affordable-care-act/calcampus120626/\" rel=\"attachment wp-att-10256\">\u003cimg class=\"size-medium wp-image-10256\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/CalCampus120626-300x198.jpg\" alt=\"A UC Berkeley student discovered the limits of his UC student health coverage after a cancer diagnosis.(Studio H (Chris)/Flickr)\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A UC Berkeley student discovered the limits of his UC student health coverage after a cancer diagnosis.(Studio H (Chris)/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>If you are a student at any of the UC campuses -- or a family member of one -- you might want to pay close attention to the case of Kenya Wheeler at UC Berkeley. A year ago he was \"healthy as a horse,\" the San Francisco Chronicle reports and biked to school every day.\u003c/p>\n\u003cp>But everything changed when he was diagnosed with cancer. He had health insurance through the UC Student Health Plan. But as medical bills mounted, he closed in on the $400,000 lifetime cap of the policy -- caps that were made illegal under the Affordable Care Act.\u003c/p>\n\u003cp>Illegal, that is, except for self-funded college health insurance plans, such as the one UC has. In its self-funded plan, UC bears the financial risk of medical coverage. From\u003ca href=\"http://www.sfgate.com/health/article/Obamacare-loophole-threatens-UC-students-4234269.php#page-1\" target=\"_blank\"> the Chronicle\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Universities have long offered student health coverage to make sure their students have access to health care. Most college health plans purchase a group policy from a health insurance company and must adhere to the new federal requirements.\u003c!--more-->\u003c/p>\n\u003cp>But some large universities - an estimated 30 universities and systems covering some 300,000 students nationwide - prefer self-funded health plans because they provide more control over policy terms, offer lower taxes and let schools keep funds until it's time to pay a claim. Similar self-funded plans are offered by corporations and other large businesses, but they are subject to the new federal regulations.\u003c/p>\n\u003cp>It's not clear why self-funded student policies were left out of the law, but federal health officials indicated last year they did not believe they had the legal authority to regulate this type of plan.\u003c/p>\n\u003cp>Nonetheless, starting Jan. 1, the federal law will require Americans - including students - to have health insurance that meets certain minimum requirements or face penalties.\u003c/p>\n\u003cp>Meanwhile, UC and other universities, including Harvard, have asked federal health officials to add self-funded student health plans to the new law, in which case UC would be required to lift the caps, said \u003ca href=\"http://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Grace+Crickette%22\">Grace Crickette\u003c/a>, UC's chief risk officer. Asked why, Crickette said it was to benefit students, who might otherwise suffer tax penalties\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>\u003c/strong>\"We don't know if we'll get in,\" she said. \"We might be rejected.\"\u003c/p>\u003c/blockquote>\n\u003cp>UC students have started a petition drive, demanding that UC lift the lifetime cap immediately, the Chronicle says:\u003c/p>\n\u003cblockquote>\u003cp>UC officials say they're weighing their options but are hesitant to voluntarily lift the caps until they know what it would cost - and how much they'd have to raise the price of student health care to pay for it.\u003c/p>\n\u003cp>\"It's a front-burner issue,\" said \u003ca href=\"http://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Peter+Taylor%22\">Peter Taylor\u003c/a>, UC's chief financial officer, who became aware of the problem last summer. \"We're not making a profit on (student health care) - but I can't afford to lose money, either.\"\u003c/p>\u003c/blockquote>\n\u003cp>Kenya Wheeler did hit his lifetime cap, was turned down for Medi-Cal but then married his girlfriend so he could continue receiving insurance through her plan. The Chronicle reports his cancer is now in remission.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "If you are a student at any of the UC campuses -- or a family member of one -- you might want to pay close attention to the case of Kenya Wheeler at UC Berkeley. A year ago he was \"healthy as a horse,\" the San Francisco Chronicle reports and biked to school every day.\r\n\r\nBut everything changed when he was diagnosed with cancer. He had health insurance through the UC Student Health Plan. But as medical bills mounted, he closed in on the $400,000 lifetime cap of the policy -- caps that were made illegal under the Affordable Care Act.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_10256\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/30/uc-student-health-plan-slips-through-loophole-in-affordable-care-act/calcampus120626/\" rel=\"attachment wp-att-10256\">\u003cimg class=\"size-medium wp-image-10256\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/CalCampus120626-300x198.jpg\" alt=\"A UC Berkeley student discovered the limits of his UC student health coverage after a cancer diagnosis.(Studio H (Chris)/Flickr)\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A UC Berkeley student discovered the limits of his UC student health coverage after a cancer diagnosis.(Studio H (Chris)/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>If you are a student at any of the UC campuses -- or a family member of one -- you might want to pay close attention to the case of Kenya Wheeler at UC Berkeley. A year ago he was \"healthy as a horse,\" the San Francisco Chronicle reports and biked to school every day.\u003c/p>\n\u003cp>But everything changed when he was diagnosed with cancer. He had health insurance through the UC Student Health Plan. But as medical bills mounted, he closed in on the $400,000 lifetime cap of the policy -- caps that were made illegal under the Affordable Care Act.\u003c/p>\n\u003cp>Illegal, that is, except for self-funded college health insurance plans, such as the one UC has. In its self-funded plan, UC bears the financial risk of medical coverage. From\u003ca href=\"http://www.sfgate.com/health/article/Obamacare-loophole-threatens-UC-students-4234269.php#page-1\" target=\"_blank\"> the Chronicle\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Universities have long offered student health coverage to make sure their students have access to health care. Most college health plans purchase a group policy from a health insurance company and must adhere to the new federal requirements.\u003c!--more-->\u003c/p>\n\u003cp>But some large universities - an estimated 30 universities and systems covering some 300,000 students nationwide - prefer self-funded health plans because they provide more control over policy terms, offer lower taxes and let schools keep funds until it's time to pay a claim. Similar self-funded plans are offered by corporations and other large businesses, but they are subject to the new federal regulations.\u003c/p>\n\u003cp>It's not clear why self-funded student policies were left out of the law, but federal health officials indicated last year they did not believe they had the legal authority to regulate this type of plan.\u003c/p>\n\u003cp>Nonetheless, starting Jan. 1, the federal law will require Americans - including students - to have health insurance that meets certain minimum requirements or face penalties.\u003c/p>\n\u003cp>Meanwhile, UC and other universities, including Harvard, have asked federal health officials to add self-funded student health plans to the new law, in which case UC would be required to lift the caps, said \u003ca href=\"http://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Grace+Crickette%22\">Grace Crickette\u003c/a>, UC's chief risk officer. Asked why, Crickette said it was to benefit students, who might otherwise suffer tax penalties\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>\u003c/strong>\"We don't know if we'll get in,\" she said. \"We might be rejected.\"\u003c/p>\u003c/blockquote>\n\u003cp>UC students have started a petition drive, demanding that UC lift the lifetime cap immediately, the Chronicle says:\u003c/p>\n\u003cblockquote>\u003cp>UC officials say they're weighing their options but are hesitant to voluntarily lift the caps until they know what it would cost - and how much they'd have to raise the price of student health care to pay for it.\u003c/p>\n\u003cp>\"It's a front-burner issue,\" said \u003ca href=\"http://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Peter+Taylor%22\">Peter Taylor\u003c/a>, UC's chief financial officer, who became aware of the problem last summer. \"We're not making a profit on (student health care) - but I can't afford to lose money, either.\"\u003c/p>\u003c/blockquote>\n\u003cp>Kenya Wheeler did hit his lifetime cap, was turned down for Medi-Cal but then married his girlfriend so he could continue receiving insurance through her plan. The Chronicle reports his cancer is now in remission.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Are There Enough Medi-Cal Doctors in Kern County? How About Statewide? Who Knows?",
"title": "Are There Enough Medi-Cal Doctors in Kern County? How About Statewide? Who Knows?",
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"content": "\u003cfigure id=\"attachment_10232\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/29/are-there-enough-medi-cal-doctors-in-kern-county-how-about-statewide-who-knows/clinica/\" rel=\"attachment wp-att-10232\">\u003cimg class=\"size-medium wp-image-10232\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/clinica_3-300x231.jpg\" alt=\"People wait in line at Clinica Sierra Vista at the East Bakersfield Community Health Center. Some were waiting before they opened at 7:30am. (Casey Christie / The Californian)\" width=\"300\" height=\"231\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">People wait in line at Clinica Sierra Vista at the East Bakersfield Community Health Center. Some were waiting before they opened at 7:30am. (Casey Christie / The Californian)\u003c/figcaption>\u003c/figure>\n\u003cp>Once Obamacare is fully implemented in January, hundreds of thousands of Californians will move from the ranks of the uninsured to the insured. That's the good news. The downside: many California counties already face \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/11/29/california-faces-shortage-of-primary-care-doctors/\" target=\"_blank\">a shortage of primary care doctors\u003c/a> -- a shortage that is especially\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/\" target=\"_blank\"> acute in the Central Valley\u003c/a>.\u003c/p>\n\u003cp>How those newly insured -- especially those who will be enrolled under Medi-Cal -- will access care is an especially pressing question in Kern County, as the CHCF Center for Health Reporting has been exploring under a series,\u003ca href=\"http://centerforhealthreporting.org/project/desperate-doctors-will-obamacare-deliver-access-physicians-poor-kern-residents\" target=\"_blank\"> Desperate for Doctors\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignright\">“It would be really helpful for policymakers to have an agreed upon set of facts.”\u003c/aside>\n\u003cp>A chief problem is not only the shortage of primary care doctors, but also the question of whether physicians accept Medi-Cal patients. If individuals and families hold Medi-Cal insurance, but can't find a doctor who will accept it, their new coverage isn't much help.\u003c!--more-->\u003c/p>\n\u003cp>A straightforward starting point would be to quantify how many doctors there are and how many accept Medi-Cal. But, in a \u003ca href=\"http://centerforhealthreporting.org/article/are-there-enough-medi-cal-doctors-kern-county-who-knows1050\" target=\"_blank\">great piece of reporting\u003c/a>, Emily Bazar found that there's little agreement on these two critical pieces of information -- within statewide agencies.\u003c/p>\n\u003cp>The state's Department of Health Care Services (DHCS) report there are 2,023 Kern County doctors who see Medi-Cal patients, Bazar writes. Starting point, yes? But this number was a surprise to people on the ground in Kern County. From Bazar's report:\u003c/p>\n\u003cblockquote>\u003cp>Here’s what Sandi Palumbo, executive director of the \u003ca href=\"http://www.kms.org/\" target=\"_blank\">Kern County Medical Society\u003c/a>, says:\u003c/p>\n\u003cp>“Whaaaattt!? I didn’t even know there were that many licensed physicians in Kern County.\"...\u003c/p>\n\u003cp>There aren’t.\u003c/p>\n\u003cp>The state \u003ca href=\"http://www.mbc.ca.gov/\" target=\"_blank\">Medical\u003c/a> and \u003ca href=\"http://www.ombc.ca.gov/\" target=\"_blank\">Osteopathic Medical\u003c/a> Boards, in charge of licensing doctors who practice in California, show about 1,200 physicians in Kern County, more than 800 fewer than the state’s statistic.\u003c/p>\u003c/blockquote>\n\u003cp>A DHCS spokeswoman told Bazar that the discrepancy could be accounted for by doctors who are licensed in other counties, but practice in Kern. Palumbo didn't buy it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Bazar reports that DHCS says there are 104,239 doctors statewide who are enrolled as Medi-Cal providers. But the California Medical Association doesn't buy that number, either. From Bazar's report:\u003c/p>\n\u003cblockquote>\u003cp>Lisa Folberg, vice president of medical and regulatory policy for the California Medical Association ... says the state’s number is “ridiculously overinflated.” ...\u003c/p>\n\u003cp>She points to the number of doctors licensed by the state with addresses in the state: About 107,000.\u003c/p>\n\u003cp>Folberg said there’s no way that almost every doctor in the state accepts Medi-Cal. “Every study across the nation shows that not all physicians participate in Medicaid,” she said.\u003c/p>\u003c/blockquote>\n\u003cp>State officials again had an explanation for these conflicting numbers: there is currently no expiration date on a doctor's enrollment in Medi-Cal. But starting this month, the Affordable Care Act requires that state's confirm a doctor's participation in the program every five years.\u003c/p>\n\u003cp>Perhaps that 104,000 number of doctors who accept Medi-Cal will decline.\u003c/p>\n\u003cp>“It would be really helpful for policymakers to have an agreed upon set of facts,” Andrew Bindman, director of the University of California-based California Medicaid Research Institute, told Bazar.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Staff writer Rachel Cook of \u003ca href=\"http://www.bakersfield.com/\" target=\"_blank\">The Bakersfield Californian\u003c/a> contributed to Emily Bazar's report.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Once Obamacare is fully implemented in January, hundreds of thousands of Californians will move from the ranks of the uninsured to the insured. But as we've reported, many California counties already face a shortage of primary care doctors -- a shortage that is especially acute in the Central Valley.\r\n\r\nHow those newly insured -- especially those who will be enrolled under Medi-Cal -- will access care is an especially pressing question in Kern County, as the CHCF Center for Health Reporting has been exploring under a series, Desperate for Doctors.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_10232\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/29/are-there-enough-medi-cal-doctors-in-kern-county-how-about-statewide-who-knows/clinica/\" rel=\"attachment wp-att-10232\">\u003cimg class=\"size-medium wp-image-10232\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/clinica_3-300x231.jpg\" alt=\"People wait in line at Clinica Sierra Vista at the East Bakersfield Community Health Center. Some were waiting before they opened at 7:30am. (Casey Christie / The Californian)\" width=\"300\" height=\"231\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">People wait in line at Clinica Sierra Vista at the East Bakersfield Community Health Center. Some were waiting before they opened at 7:30am. (Casey Christie / The Californian)\u003c/figcaption>\u003c/figure>\n\u003cp>Once Obamacare is fully implemented in January, hundreds of thousands of Californians will move from the ranks of the uninsured to the insured. That's the good news. The downside: many California counties already face \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/11/29/california-faces-shortage-of-primary-care-doctors/\" target=\"_blank\">a shortage of primary care doctors\u003c/a> -- a shortage that is especially\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/\" target=\"_blank\"> acute in the Central Valley\u003c/a>.\u003c/p>\n\u003cp>How those newly insured -- especially those who will be enrolled under Medi-Cal -- will access care is an especially pressing question in Kern County, as the CHCF Center for Health Reporting has been exploring under a series,\u003ca href=\"http://centerforhealthreporting.org/project/desperate-doctors-will-obamacare-deliver-access-physicians-poor-kern-residents\" target=\"_blank\"> Desperate for Doctors\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignright\">“It would be really helpful for policymakers to have an agreed upon set of facts.”\u003c/aside>\n\u003cp>A chief problem is not only the shortage of primary care doctors, but also the question of whether physicians accept Medi-Cal patients. If individuals and families hold Medi-Cal insurance, but can't find a doctor who will accept it, their new coverage isn't much help.\u003c!--more-->\u003c/p>\n\u003cp>A straightforward starting point would be to quantify how many doctors there are and how many accept Medi-Cal. But, in a \u003ca href=\"http://centerforhealthreporting.org/article/are-there-enough-medi-cal-doctors-kern-county-who-knows1050\" target=\"_blank\">great piece of reporting\u003c/a>, Emily Bazar found that there's little agreement on these two critical pieces of information -- within statewide agencies.\u003c/p>\n\u003cp>The state's Department of Health Care Services (DHCS) report there are 2,023 Kern County doctors who see Medi-Cal patients, Bazar writes. Starting point, yes? But this number was a surprise to people on the ground in Kern County. From Bazar's report:\u003c/p>\n\u003cblockquote>\u003cp>Here’s what Sandi Palumbo, executive director of the \u003ca href=\"http://www.kms.org/\" target=\"_blank\">Kern County Medical Society\u003c/a>, says:\u003c/p>\n\u003cp>“Whaaaattt!? I didn’t even know there were that many licensed physicians in Kern County.\"...\u003c/p>\n\u003cp>There aren’t.\u003c/p>\n\u003cp>The state \u003ca href=\"http://www.mbc.ca.gov/\" target=\"_blank\">Medical\u003c/a> and \u003ca href=\"http://www.ombc.ca.gov/\" target=\"_blank\">Osteopathic Medical\u003c/a> Boards, in charge of licensing doctors who practice in California, show about 1,200 physicians in Kern County, more than 800 fewer than the state’s statistic.\u003c/p>\u003c/blockquote>\n\u003cp>A DHCS spokeswoman told Bazar that the discrepancy could be accounted for by doctors who are licensed in other counties, but practice in Kern. Palumbo didn't buy it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Bazar reports that DHCS says there are 104,239 doctors statewide who are enrolled as Medi-Cal providers. But the California Medical Association doesn't buy that number, either. From Bazar's report:\u003c/p>\n\u003cblockquote>\u003cp>Lisa Folberg, vice president of medical and regulatory policy for the California Medical Association ... says the state’s number is “ridiculously overinflated.” ...\u003c/p>\n\u003cp>She points to the number of doctors licensed by the state with addresses in the state: About 107,000.\u003c/p>\n\u003cp>Folberg said there’s no way that almost every doctor in the state accepts Medi-Cal. “Every study across the nation shows that not all physicians participate in Medicaid,” she said.\u003c/p>\u003c/blockquote>\n\u003cp>State officials again had an explanation for these conflicting numbers: there is currently no expiration date on a doctor's enrollment in Medi-Cal. But starting this month, the Affordable Care Act requires that state's confirm a doctor's participation in the program every five years.\u003c/p>\n\u003cp>Perhaps that 104,000 number of doctors who accept Medi-Cal will decline.\u003c/p>\n\u003cp>“It would be really helpful for policymakers to have an agreed upon set of facts,” Andrew Bindman, director of the University of California-based California Medicaid Research Institute, told Bazar.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Staff writer Rachel Cook of \u003ca href=\"http://www.bakersfield.com/\" target=\"_blank\">The Bakersfield Californian\u003c/a> contributed to Emily Bazar's report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"soldout": {
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