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"content": "\u003cp>By Jay Hancock, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/November/07/obama-reelection-and-affordable-care-act.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/November/07/obama-reelection-and-affordable-care-act.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8803\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/obamaspeech20121106.jpg\">\u003cimg class=\"size-medium wp-image-8803\" title=\"(SAUL LOEB/AFP/Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/obamaspeech20121106-300x210.jpg\" alt=\"(SAUL LOEB/AFP/Getty Images)\" width=\"300\" height=\"210\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(SAUL LOEB/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>President Barack Obama’s victory cements the Affordable Care Act, expanding coverage to millions but leaving weighty questions about how to pay for it and other care to be delivered to an increasingly unhealthy, aging population.\u003c/p>\n\u003cp>\"The reelection of Obama and the Democrats holding the Senate will solidify the law in American history,\" said Len Nichols, a health economist at George Mason University who supports what both sides have come to call \"Obamacare.\"\u003c/p>\n\u003cp>\"By 2016 you’ll see the vast majority of states with operational [insurance] exchanges and the Medicaid expansion, and we’ll be on a pathway to a more humane system.\"\u003c/p>\n\u003cp>Republican presidential candidate Mitt Romney had promised to repeal the act and replace it with something that would loosen government’s involvement in health care. Conservatives portrayed the law’s survival as limiting the freedom of patient and doctor and adding to a federal debt that recently exceeded $16 trillion.\u003cbr>\n\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The law will have significant problems in implementation because so many of the American people object to so many of its provisions,\" said Grace-Marie Turner, president of the pro-markets Galen Institute, noting that voters in Alabama, Montana and Wyoming voted Tuesday to reject the law's requirement for individual coverage. \"You’re going to see almost civil disobedience. People are saying, 'I'm just not going to comply.'\"\u003c/p>\n\u003cp>The Republican-controlled House of Representatives could also prove an obstacle, using its purse-string power to press for delays or watering down the act as part of a deficit-reduction bargain.\u003cstrong>\u003c/strong>\u003c/p>\n\u003cp>Obama won despite criticism that he chose the middle of a financial catastrophe to seek the biggest change to health care in nearly half a century. Although aspects of the Affordable Care Act receive high marks, polls show the mandates for individuals and employers to buy coverage are still unpopular.\u003c/p>\n\u003cp>The president’s first term was about getting a bitterly divided Congress to approve the legislation and then defending it against unexpectedly vigorous legal challenges. His second term will be about bringing the law to life. He referred to the act in his acceptance speech early Wednesday, talking about an Ohio family with an 8-year-old daughter \"whose long battle with leukemia nearly cost the family everything, had it not been for health care reform passing just a few months before the insurance company was about to stop paying for her care.\"\u003c/p>\n\u003cp>Analysts forecast coverage for as many as 30 million previously uninsured Americans even as economic pressures lead to fewer choices and higher cost-sharing for those already covered by private insurers and Medicare.\u003c/p>\n\u003cp>\"It’s full-steam ahead with implementation,\" said Dan Mendelson, a consultant who ran the health portfolio in the Office of Management and Budget under President Bill Clinton. \"They will be aggressively working to make all the timelines that are articulated in the law. I don’t think it will benefit Obama at all in defining a legacy to let those timelines slip. He will push that hard.\"\u003c/p>\n\u003cp>The administration's immediate job is launching online insurance marketplaces, known as exchanges, and managing the law’s expansion of the state and federal Medicaid program for low-income patients even as a budgetary showdown looms.\u003c/p>\n\u003cp>Only \u003ca href=\"http://healthreform.kff.org/the-states.aspx\" target=\"_blank\">13 states and the District of Columbia\u003c/a> have said they’ll open exchanges offering subsidized coverage from private insurers. Republican governors in Texas, Louisiana and many other states halted exchange preparations before the election. Many also balked at the Medicaid expansion after the Supreme Court gave states the ability to opt out of that aspect of the health overhaul.\u003c/p>\n\u003cp>Romney's defeat, the promise of billions in federal subsidies and the prospect of federal regulators running exchanges in the absence of state leadership should push most governors into line, analysts said.\u003c/p>\n\u003cp>\"The states are not going to give up the money,\" said Gerard Anderson, professor of health policy at The Johns Hopkins University Bloomberg School of Public Health. \"There are just too many dollars. The hospitals and insurers, but mostly the hospitals, are going to say, 'Excuse me, we need the money.'\"\u003c/p>\n\u003cp>But that’s not to say everything will go according to schedule. Deficit-reduction talks triggered by the Jan. 1 \"fiscal cliff\" of tax-cut expirations and spending reductions could change significant parts of the health act. For example, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/October/31/health-law-obama-romney-election.aspx\" target=\"_blank\">Democrats might scale back\u003c/a> the act’s coverage and subsidies in return for revenue increases or other concessions from Republicans, analysts said.\u003c/p>\n\u003cp>If many state-run exchanges might not be ready by 2014, it’s also far from certain that the Department of Health and Human Services, which has delayed publishing exchange-related regulations, will be prepared to impose substitutes.\u003c/p>\n\u003cp>\"What is the state of readiness to implement both state insurance exchanges and the federal backup?\" said Paul Ginsburg, president of the Center for Studying Health System Change. \"The administration has been extremely silent about this.\"\u003c/p>\n\u003cp>Looming over everything are still-growing, economy-wide health expenses and the limited means of government and businesses to pay them. Deficit-reduction deals with a Republican House could modify not only the health act but Medicare, which Republicans would like to convert to a “premium support” program in which seniors would get coverage fixed amount of money to purchase private coverage or traditional Medicare, analysts said.\u003c/p>\n\u003cp>Expect more cost-control efforts such as higher deductibles in private insurance, managed-care Medicare plans for seniors and more restricted medical networks for patients, they said, as well as new pressure on reimbursements for doctors, hospitals and other providers.\u003c/p>\n\u003cp>Now that Obama has nailed down his signature accomplishment, the need to pay for it could generate more industry cuts than many expected from a second Obama term, analysts said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"Many policy changes that are not normally politically feasible become feasible in the context of significant deficit reduction — as we saw in 1982 and 1997,\" Ginsburg said. \"So if the time for deficit reduction is here, health care has to be an important part of that, because that’s where so much of the spending and so much of the growth in the spending in the future is.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jay Hancock, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/November/07/obama-reelection-and-affordable-care-act.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/November/07/obama-reelection-and-affordable-care-act.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8803\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/obamaspeech20121106.jpg\">\u003cimg class=\"size-medium wp-image-8803\" title=\"(SAUL LOEB/AFP/Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/obamaspeech20121106-300x210.jpg\" alt=\"(SAUL LOEB/AFP/Getty Images)\" width=\"300\" height=\"210\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(SAUL LOEB/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>President Barack Obama’s victory cements the Affordable Care Act, expanding coverage to millions but leaving weighty questions about how to pay for it and other care to be delivered to an increasingly unhealthy, aging population.\u003c/p>\n\u003cp>\"The reelection of Obama and the Democrats holding the Senate will solidify the law in American history,\" said Len Nichols, a health economist at George Mason University who supports what both sides have come to call \"Obamacare.\"\u003c/p>\n\u003cp>\"By 2016 you’ll see the vast majority of states with operational [insurance] exchanges and the Medicaid expansion, and we’ll be on a pathway to a more humane system.\"\u003c/p>\n\u003cp>Republican presidential candidate Mitt Romney had promised to repeal the act and replace it with something that would loosen government’s involvement in health care. Conservatives portrayed the law’s survival as limiting the freedom of patient and doctor and adding to a federal debt that recently exceeded $16 trillion.\u003cbr>\n\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The law will have significant problems in implementation because so many of the American people object to so many of its provisions,\" said Grace-Marie Turner, president of the pro-markets Galen Institute, noting that voters in Alabama, Montana and Wyoming voted Tuesday to reject the law's requirement for individual coverage. \"You’re going to see almost civil disobedience. People are saying, 'I'm just not going to comply.'\"\u003c/p>\n\u003cp>The Republican-controlled House of Representatives could also prove an obstacle, using its purse-string power to press for delays or watering down the act as part of a deficit-reduction bargain.\u003cstrong>\u003c/strong>\u003c/p>\n\u003cp>Obama won despite criticism that he chose the middle of a financial catastrophe to seek the biggest change to health care in nearly half a century. Although aspects of the Affordable Care Act receive high marks, polls show the mandates for individuals and employers to buy coverage are still unpopular.\u003c/p>\n\u003cp>The president’s first term was about getting a bitterly divided Congress to approve the legislation and then defending it against unexpectedly vigorous legal challenges. His second term will be about bringing the law to life. He referred to the act in his acceptance speech early Wednesday, talking about an Ohio family with an 8-year-old daughter \"whose long battle with leukemia nearly cost the family everything, had it not been for health care reform passing just a few months before the insurance company was about to stop paying for her care.\"\u003c/p>\n\u003cp>Analysts forecast coverage for as many as 30 million previously uninsured Americans even as economic pressures lead to fewer choices and higher cost-sharing for those already covered by private insurers and Medicare.\u003c/p>\n\u003cp>\"It’s full-steam ahead with implementation,\" said Dan Mendelson, a consultant who ran the health portfolio in the Office of Management and Budget under President Bill Clinton. \"They will be aggressively working to make all the timelines that are articulated in the law. I don’t think it will benefit Obama at all in defining a legacy to let those timelines slip. He will push that hard.\"\u003c/p>\n\u003cp>The administration's immediate job is launching online insurance marketplaces, known as exchanges, and managing the law’s expansion of the state and federal Medicaid program for low-income patients even as a budgetary showdown looms.\u003c/p>\n\u003cp>Only \u003ca href=\"http://healthreform.kff.org/the-states.aspx\" target=\"_blank\">13 states and the District of Columbia\u003c/a> have said they’ll open exchanges offering subsidized coverage from private insurers. Republican governors in Texas, Louisiana and many other states halted exchange preparations before the election. Many also balked at the Medicaid expansion after the Supreme Court gave states the ability to opt out of that aspect of the health overhaul.\u003c/p>\n\u003cp>Romney's defeat, the promise of billions in federal subsidies and the prospect of federal regulators running exchanges in the absence of state leadership should push most governors into line, analysts said.\u003c/p>\n\u003cp>\"The states are not going to give up the money,\" said Gerard Anderson, professor of health policy at The Johns Hopkins University Bloomberg School of Public Health. \"There are just too many dollars. The hospitals and insurers, but mostly the hospitals, are going to say, 'Excuse me, we need the money.'\"\u003c/p>\n\u003cp>But that’s not to say everything will go according to schedule. Deficit-reduction talks triggered by the Jan. 1 \"fiscal cliff\" of tax-cut expirations and spending reductions could change significant parts of the health act. For example, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/October/31/health-law-obama-romney-election.aspx\" target=\"_blank\">Democrats might scale back\u003c/a> the act’s coverage and subsidies in return for revenue increases or other concessions from Republicans, analysts said.\u003c/p>\n\u003cp>If many state-run exchanges might not be ready by 2014, it’s also far from certain that the Department of Health and Human Services, which has delayed publishing exchange-related regulations, will be prepared to impose substitutes.\u003c/p>\n\u003cp>\"What is the state of readiness to implement both state insurance exchanges and the federal backup?\" said Paul Ginsburg, president of the Center for Studying Health System Change. \"The administration has been extremely silent about this.\"\u003c/p>\n\u003cp>Looming over everything are still-growing, economy-wide health expenses and the limited means of government and businesses to pay them. Deficit-reduction deals with a Republican House could modify not only the health act but Medicare, which Republicans would like to convert to a “premium support” program in which seniors would get coverage fixed amount of money to purchase private coverage or traditional Medicare, analysts said.\u003c/p>\n\u003cp>Expect more cost-control efforts such as higher deductibles in private insurance, managed-care Medicare plans for seniors and more restricted medical networks for patients, they said, as well as new pressure on reimbursements for doctors, hospitals and other providers.\u003c/p>\n\u003cp>Now that Obama has nailed down his signature accomplishment, the need to pay for it could generate more industry cuts than many expected from a second Obama term, analysts said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Many policy changes that are not normally politically feasible become feasible in the context of significant deficit reduction — as we saw in 1982 and 1997,\" Ginsburg said. \"So if the time for deficit reduction is here, health care has to be an important part of that, because that’s where so much of the spending and so much of the growth in the spending in the future is.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>By Sarah Varney,\u003c/strong> \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/November/05/health-care-election-california.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/November/05/health-care-election-california.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8793\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/SupCt_Day2_taken03272012_MarkWilson_Getty.jpg\">\u003cimg class=\"size-medium wp-image-8793 \" title=\"President Obama's health care overhaul largely survived court challenges, but the presidential election poses another hurdle for its fate. (Mark Wilson: Getty)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/SupCt_Day2_taken03272012_MarkWilson_Getty-300x200.jpg\" alt=\"President Obama's health care overhaul largely survived court challenges, but the presidential election poses another hurdle for its fate. (Mark Wilson: Getty)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Obama's health care overhaul largely survived court challenges. The presidential election poses another hurdle. (Mark Wilson: Getty)\u003c/figcaption>\u003c/figure>\n\u003cp>If Caroline Cunningham wakes up in her Studio City home on Wednesday morning to a President-elect Mitt Romney, she knows the first thing she will do. \"I have to rush and get back surgery,\" she says.\u003c/p>\n\u003cp>Cunningham, a 62-year-old mental health therapist with spinal stenosis, has health insurance coverage through a temporary program established for people with pre-existing conditions under the Affordable Care Act. The pre-existing condition insurance plans, mandated in every state and subsidized by the federal government, offer coverage to those deemed uninsurable.\u003c/p>\n\u003cp>But the high risk pools, as they are known, have an expiration date. They are slated to shut down in January 2014 when, under the federal health law, people with pre-existing conditions can buy plans from private insurers through newly created insurance exchanges.\u003c/p>\n\u003cp>If Romney follows through with his pledge to dismantle President Barack Obama’s signature domestic legislation and Congress is unable to quickly enact a meaningful alternative, Cunningham worries she will, once again, be uninsured. \"I called the Romney campaign and asked them what they’re going to do,\" said Cunningham. \"I hope they wouldn’t dump us.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Medicaid Expansion\u003c/strong>\u003c/p>\n\u003cp>More than any other state, California has wagered heavily on the Affordable Care Act. It has moved quickly to erect an insurance exchange and establish the high risk pool. It has also put federal consumer protections into state law.\u003c!--more-->\u003c/p>\n\u003cp>In 2010, the state signed a $10 billion Medicaid waiver with the Obama administration that allowed counties from Democratic Los Angeles to Republican San Diego to enroll as many as 500,000 low-income adults into a 'Medicaid-lite' program -- years ahead of the Medicaid expansion required by the act. Similar to the high risk pool, 'Medicaid-lite' -- officially called the Low Income Health Plan -- is a temporary measure until January 2014. That’s when California would open up its Medicaid program to millions of poor people, an expansion paid for largely by the federal government.\u003c/p>\n\u003cp>But if a Romney Administration follows through with its vow to undo the health law, that deadline could come and go without an expanded Medicaid program or a health insurance exchange in place.\u003c/p>\n\u003cp>\"It’s the ballgame at stake,\" said Anthony Wright, executive director of Health Access California, an advocacy group. \"We go from the major reforms to a salvage operation.\"\u003c/p>\n\u003cp>The various provisions in the health law and California’s Medicaid waiver were all designed to work in concert. \"The fundamental design of health reform in California was a layering of stuff,\" said Peter Harbage, a policy analyst who has advised Republican and Democratic administrations on health issues. \"Phase one, phase two and phase three, and if one of the later phases doesn’t materialize, then people could be left without insurance.\"\u003c/p>\n\u003cp>\u003cstrong>California's health insurance exchange, 'Covered California'\u003c/strong>\u003c/p>\n\u003cp>As for California's nascent health insurance exchange, now called Covered California, spokesman Oscar Hidalgo said in an email, \"We are moving forward with our mandate to implement the California exchange.\"\u003c/p>\n\u003cp>The oversight board and staff of Covered California have been busy putting into place the state’s online insurance shopping portal and vetting the menu of a la carte insurance products. But there is widespread agreement that the online marketplace would falter if a Romney Administration were to cut off the federal subsidies aimed at helping working-class and middle-income individuals and families to buy coverage on the exchange.\u003c/p>\n\u003cp>Yet even in beleaguered California, there remain some who are optimistic that a Romney Administration would not signal the end of a comprehensive plan to deal with the uninsured.\u003c/p>\n\u003cp>Michael Cousineau, an associate professor of family medicine at the Keck School of Medicine at the University of Southern California and a long-time advisor to state and county officials on health care financing, said Romney's preference for state control could mean his administration might allow California to extend its Medicaid waiver and coverage expansion of low-income adults. \"The question is how much money would the federal government put into it?\" said Cousineau.\u003c/p>\n\u003cp>\u003cstrong>Gov. Brown's Prop. 30 to fund education has health insurance ramifications, if it fails \u003c/strong>\u003c/p>\n\u003cp>But a new administration in Washington turning off the spigot is not the Golden State’s only worry. On Tuesday, Californians will weigh in on a ballot measure, Proposition 30, that would increase the state’s sales tax by .25 percent and raise income taxes on high-income earners. The initiative’s biggest backer is California Gov. Jerry Brown who has said if the measure fails, he will be left with an $8.5 billion budget hole. That deficit will largely be closed by cuts to public schools, Brown and Democratic lawmakers argue, since the legislature has already slashed $23 billion in funding for health and welfare services, criminal justice and other programs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, health care leaders here say if Proposition 30 fails, and Obama holds onto his job and the Affordable Care Act, the state will nonetheless enter a grim era of budget austerity. In that scenario, where the state is likely to cut weeks off the school year for public school children, Brown might be unwilling, they say, to move ahead with California’s planned Medicaid expansion. \"It would be very hard,\" said Wright, \"to move forward with anything that even costs a dime.\"\u003c/p>\n\n",
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"excerpt": "But the high risk pools, as they are known, have an expiration date. They are slated to shut down in January 2014 when, under the federal health law, people with pre-existing conditions can buy plans from private insurers through newly created insurance exchanges.\r\n\r\nIf Romney follows through with his pledge to dismantle President Barack Obama’s signature domestic legislation and Congress is unable to quickly enact a meaningful alternative, Cunningham worries she will, once again, be uninsured. \"I called the Romney campaign and asked them what they’re going to do,\" said Cunningham. \"I hope they wouldn’t dump us.\"",
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"title": "Health Care Stakes are High in California | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Sarah Varney,\u003c/strong> \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/November/05/health-care-election-california.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/November/05/health-care-election-california.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8793\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/SupCt_Day2_taken03272012_MarkWilson_Getty.jpg\">\u003cimg class=\"size-medium wp-image-8793 \" title=\"President Obama's health care overhaul largely survived court challenges, but the presidential election poses another hurdle for its fate. (Mark Wilson: Getty)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/SupCt_Day2_taken03272012_MarkWilson_Getty-300x200.jpg\" alt=\"President Obama's health care overhaul largely survived court challenges, but the presidential election poses another hurdle for its fate. (Mark Wilson: Getty)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Obama's health care overhaul largely survived court challenges. The presidential election poses another hurdle. (Mark Wilson: Getty)\u003c/figcaption>\u003c/figure>\n\u003cp>If Caroline Cunningham wakes up in her Studio City home on Wednesday morning to a President-elect Mitt Romney, she knows the first thing she will do. \"I have to rush and get back surgery,\" she says.\u003c/p>\n\u003cp>Cunningham, a 62-year-old mental health therapist with spinal stenosis, has health insurance coverage through a temporary program established for people with pre-existing conditions under the Affordable Care Act. The pre-existing condition insurance plans, mandated in every state and subsidized by the federal government, offer coverage to those deemed uninsurable.\u003c/p>\n\u003cp>But the high risk pools, as they are known, have an expiration date. They are slated to shut down in January 2014 when, under the federal health law, people with pre-existing conditions can buy plans from private insurers through newly created insurance exchanges.\u003c/p>\n\u003cp>If Romney follows through with his pledge to dismantle President Barack Obama’s signature domestic legislation and Congress is unable to quickly enact a meaningful alternative, Cunningham worries she will, once again, be uninsured. \"I called the Romney campaign and asked them what they’re going to do,\" said Cunningham. \"I hope they wouldn’t dump us.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Medicaid Expansion\u003c/strong>\u003c/p>\n\u003cp>More than any other state, California has wagered heavily on the Affordable Care Act. It has moved quickly to erect an insurance exchange and establish the high risk pool. It has also put federal consumer protections into state law.\u003c!--more-->\u003c/p>\n\u003cp>In 2010, the state signed a $10 billion Medicaid waiver with the Obama administration that allowed counties from Democratic Los Angeles to Republican San Diego to enroll as many as 500,000 low-income adults into a 'Medicaid-lite' program -- years ahead of the Medicaid expansion required by the act. Similar to the high risk pool, 'Medicaid-lite' -- officially called the Low Income Health Plan -- is a temporary measure until January 2014. That’s when California would open up its Medicaid program to millions of poor people, an expansion paid for largely by the federal government.\u003c/p>\n\u003cp>But if a Romney Administration follows through with its vow to undo the health law, that deadline could come and go without an expanded Medicaid program or a health insurance exchange in place.\u003c/p>\n\u003cp>\"It’s the ballgame at stake,\" said Anthony Wright, executive director of Health Access California, an advocacy group. \"We go from the major reforms to a salvage operation.\"\u003c/p>\n\u003cp>The various provisions in the health law and California’s Medicaid waiver were all designed to work in concert. \"The fundamental design of health reform in California was a layering of stuff,\" said Peter Harbage, a policy analyst who has advised Republican and Democratic administrations on health issues. \"Phase one, phase two and phase three, and if one of the later phases doesn’t materialize, then people could be left without insurance.\"\u003c/p>\n\u003cp>\u003cstrong>California's health insurance exchange, 'Covered California'\u003c/strong>\u003c/p>\n\u003cp>As for California's nascent health insurance exchange, now called Covered California, spokesman Oscar Hidalgo said in an email, \"We are moving forward with our mandate to implement the California exchange.\"\u003c/p>\n\u003cp>The oversight board and staff of Covered California have been busy putting into place the state’s online insurance shopping portal and vetting the menu of a la carte insurance products. But there is widespread agreement that the online marketplace would falter if a Romney Administration were to cut off the federal subsidies aimed at helping working-class and middle-income individuals and families to buy coverage on the exchange.\u003c/p>\n\u003cp>Yet even in beleaguered California, there remain some who are optimistic that a Romney Administration would not signal the end of a comprehensive plan to deal with the uninsured.\u003c/p>\n\u003cp>Michael Cousineau, an associate professor of family medicine at the Keck School of Medicine at the University of Southern California and a long-time advisor to state and county officials on health care financing, said Romney's preference for state control could mean his administration might allow California to extend its Medicaid waiver and coverage expansion of low-income adults. \"The question is how much money would the federal government put into it?\" said Cousineau.\u003c/p>\n\u003cp>\u003cstrong>Gov. Brown's Prop. 30 to fund education has health insurance ramifications, if it fails \u003c/strong>\u003c/p>\n\u003cp>But a new administration in Washington turning off the spigot is not the Golden State’s only worry. On Tuesday, Californians will weigh in on a ballot measure, Proposition 30, that would increase the state’s sales tax by .25 percent and raise income taxes on high-income earners. The initiative’s biggest backer is California Gov. Jerry Brown who has said if the measure fails, he will be left with an $8.5 billion budget hole. That deficit will largely be closed by cuts to public schools, Brown and Democratic lawmakers argue, since the legislature has already slashed $23 billion in funding for health and welfare services, criminal justice and other programs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, health care leaders here say if Proposition 30 fails, and Obama holds onto his job and the Affordable Care Act, the state will nonetheless enter a grim era of budget austerity. In that scenario, where the state is likely to cut weeks off the school year for public school children, Brown might be unwilling, they say, to move ahead with California’s planned Medicaid expansion. \"It would be very hard,\" said Wright, \"to move forward with anything that even costs a dime.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sacramento County Joins Road to Medi-Cal Expansion, But Only the Poorest Will Benefit",
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"content": "\u003cp>By Pauline Bartolone, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/November/02/california-medicaid-expansion-sacramento.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/November/02/california-medicaid-expansion-sacramento.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership that includes \u003ca href=\"http://www.capradio.org/news\">Capital Public Radio\u003c/a>, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_8776\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Gledel-300.jpg\">\u003cimg class=\"size-full wp-image-8776\" title=\"Gledel Beacham picks up medication at the Primary Care Center, but says it’s easier to see a doctor elsewhere (Photo: Andrew Nixon).\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Gledel-300.jpg\" alt=\"Gledel Beacham picks up medication at the Primary Care Center, but says it’s easier to see a doctor elsewhere (Photo: Andrew Nixon).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gledel Beacham picks up medication at the Primary Care Center, but says it’s easier to see a doctor elsewhere (Photo: Andrew Nixon).\u003c/figcaption>\u003c/figure>\n\u003cp>Midday on a Monday outside the Primary Care Center on Broadway and Stockton Boulevard in Sacramento, patients linger outside, waiting for services.\u003c/p>\n\u003cp>Asked about their experiences at the clinic, they are eager to share – and many offer complaints.\u003c/p>\n\u003cp>Willie McGee says he waited six hours at the clinic, only to be scheduled to see a doctor for another day. Tanya Carrillo says she was sent by a hospital for follow up care, and was booked for an appointment more than three months out. Gledel Beacham picks up medication at the clinic, but says it’s easier to see a doctor elsewhere.\u003c/p>\n\u003cp>\"Here, it's like a circus,\" he says about the only county-run health clinic in Sacramento.\u003c/p>\n\u003cp>Beacham says he has used county health services for years. When another clinic near Florin Road was open, he says he could see a doctor every week if he wanted to: \"[It was] great because it was closest to me, I could walk in, it's not so packed.\" At Primary Care, he says, he's seen a doctor one time in the past two years.\u003c!--more-->\u003c/p>\n\u003cp>Sacramento County has closed all but one of its six clinics in recent years. But this month the county rolls out the Low Income Health Program, known as LIHP, with state support and an infusion of federal funds that officials hope will help provide better service. Sacramento will contract with Molina Healthcare to connect 12 existing, independent community clinics as a network. Still, Sacramento lags behind most of the rest of California in implementing LIHP, and it will be serving only the poorest of the poor in the county.\u003c/p>\n\u003cp>The LIHP program is expected to reach between 10,000 and 14,000 Sacramento County residents who don’t qualify for Medi-Cal, the state’s Medicaid program. It extends coverage to childless adults with an annual income of less than $7,500.\u003c/p>\n\u003cp>Stacey Wittorff has heard complaints about the current Sacramento county health program for years. She’s an attorney at Legal Services of Northern California. She says patients first have problems becoming eligible for services, and when they become eligible, there are often delays in care. Legal Services of Northern California recently filed suit against Sacramento County over eligibility.\u003c/p>\n\u003cp>\"People are trying to…access services and they’re being told they have to wait months for specialty care or months for just a follow-up appointment for chronic conditions,\" says Wittorff.\u003c/p>\n\u003cp>\u003cstrong>Getting Counties Ready For 2014\u003c/strong>\u003c/p>\n\u003cp>Last month, Sacramento County announced it was joining LIHP and California's \"Bridge to Reform\" initiative, a state program which gives counties access to federal funds in advance of the Medicaid expansion called for in the federal health law in 2014. Almost all of California’s 58 counties have signed up and have enrolled 552,000 people in new coverage.\u003c/p>\n\u003cp>The LIHP brings new standards to county indigent health programs. Patients are guaranteed a doctor visit within 30 days of request, and doctors will have to be within 30 miles or 60 minutes away. The emphasis is on prevention, not services of last resort.\u003c/p>\n\u003cp>The county budgeted $53 million for LIHP during fiscal year 2012-2013, but numbers will be readjusted to account for the November start of services. Half of those dollars will come from the federal government.\u003c/p>\n\u003cp>\"It is a huge, huge, undertaking,\" Sandy Damiano, a deputy director with the Department of Health and Human Services for Sacramento County says. \"We…did not have the appropriate infrastructure due to recurrent budget reductions or expertise to build a large infrastructure.\"\u003c/p>\n\u003cp>Nevertheless, Damiano says the program is an exciting opportunity to transform the way the county currently provides services for its most needy residents.\u003c/p>\n\u003cp>\"We're hoping that [LIHP] can really get them stabilized in terms of their medical conditions and also decrease the hospital emergency room use,\" says Damiano.\u003c/p>\n\u003cp>\u003cstrong>Some Counties Had A Running Start\u003c/strong>\u003c/p>\n\u003cp>In other counties, the LIHP program – and the people it serves – look quite different.\u003c/p>\n\u003cp>The San Francisco bay area county of Alameda is using federal funds to serve people up to 200 percent of federal poverty, or $22,340 for an individual. Alameda implemented the program beginning in July 2011.\u003c/p>\n\u003cp>But Alameda had a head start that helped, says County Health Director Alex Briscoe. It is one of 10 California counties that benefited from federal funds for a prior state project to improve local public health programs. That has allowed the county to be more proactive with low-income patients it serves.\u003c/p>\n\u003cp>\"Now if you're getting seen in one of our primary care clinics and you go to the emergency room three times in the same month, we call that primary care home and say, 'Hey, what's up? How come this person's been to the ED three times and you haven’t seen them?' We never did that previously,\" Briscoe says.\u003c/p>\n\u003cp>The Alameda health budget also had the cash flow needed to bring in the federal dollars, and an infrastructure of community clinics to tap into.\u003c/p>\n\u003cp>\"Instead of running big, public health clinics, we contract with…community-based organizations with a long history of providing direct clinical care,\" says Briscoe.\u003c/p>\n\u003cp>Since the LIHP was implemented in Alameda, the county has been able to increase access to and decrease wait times for specialty care, he says.\u003c/p>\n\u003cp>There are other counties that have struggled to take advantage of the program – Santa Barbara County has not even announced an implementation date yet. Neither has Stanislaus, which will only offer new benefits to people at 50 percent of the federal poverty level. Merced and Tulare will join the state effort in January 2013. Merced, Fresno and San Luis Obispo counties will not participate.\u003c/p>\n\u003cp>Briscoe attributes the uneven roll out of the low income programs to a difference in county politics, investment in health, and administrative sophistication. To him, the geographic disparities in the LIHP program are cause for deep concern.\u003c/p>\n\u003cp>\"Federal dollars will be left on the table that could have been brought to bear to mitigate the human suffering that is, frankly, everywhere,\" Briscoe said.\u003c/p>\n\u003cp>\u003cstrong>For Most Needy, New Program Could Be A \"Solution\"\u003c/strong>\u003c/p>\n\u003cp>Back in Sacramento, Gledel Beacham struggles to find a place to sleep at night. Some nights, it’s on the streets. He finds his way to the Primary Care Center to pick up medication that helps manage his depression and keep pain from a back injury at bay. But the emergency room is a frequent place of care, he says, and seeing another doctor in Woodland is easier than trying to get an appointment at the county clinic.\u003c/p>\n\u003cp>Having more health clinics available to people like him \"sounds like a solution,\" he says. In Sacramento's Low Income Health Program, he may have a medical home, at least, to call his own.\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership that includes \u003c/em>\u003ca href=\"http://www.capradio.org/news\">\u003cem>Capital Public Radio\u003c/em>\u003c/a>\u003cem>, \u003ca href=\"http://www.npr.org/\">NPR\u003c/a> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Pauline Bartolone, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/November/02/california-medicaid-expansion-sacramento.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/November/02/california-medicaid-expansion-sacramento.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership that includes \u003ca href=\"http://www.capradio.org/news\">Capital Public Radio\u003c/a>, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_8776\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Gledel-300.jpg\">\u003cimg class=\"size-full wp-image-8776\" title=\"Gledel Beacham picks up medication at the Primary Care Center, but says it’s easier to see a doctor elsewhere (Photo: Andrew Nixon).\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Gledel-300.jpg\" alt=\"Gledel Beacham picks up medication at the Primary Care Center, but says it’s easier to see a doctor elsewhere (Photo: Andrew Nixon).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gledel Beacham picks up medication at the Primary Care Center, but says it’s easier to see a doctor elsewhere (Photo: Andrew Nixon).\u003c/figcaption>\u003c/figure>\n\u003cp>Midday on a Monday outside the Primary Care Center on Broadway and Stockton Boulevard in Sacramento, patients linger outside, waiting for services.\u003c/p>\n\u003cp>Asked about their experiences at the clinic, they are eager to share – and many offer complaints.\u003c/p>\n\u003cp>Willie McGee says he waited six hours at the clinic, only to be scheduled to see a doctor for another day. Tanya Carrillo says she was sent by a hospital for follow up care, and was booked for an appointment more than three months out. Gledel Beacham picks up medication at the clinic, but says it’s easier to see a doctor elsewhere.\u003c/p>\n\u003cp>\"Here, it's like a circus,\" he says about the only county-run health clinic in Sacramento.\u003c/p>\n\u003cp>Beacham says he has used county health services for years. When another clinic near Florin Road was open, he says he could see a doctor every week if he wanted to: \"[It was] great because it was closest to me, I could walk in, it's not so packed.\" At Primary Care, he says, he's seen a doctor one time in the past two years.\u003c!--more-->\u003c/p>\n\u003cp>Sacramento County has closed all but one of its six clinics in recent years. But this month the county rolls out the Low Income Health Program, known as LIHP, with state support and an infusion of federal funds that officials hope will help provide better service. Sacramento will contract with Molina Healthcare to connect 12 existing, independent community clinics as a network. Still, Sacramento lags behind most of the rest of California in implementing LIHP, and it will be serving only the poorest of the poor in the county.\u003c/p>\n\u003cp>The LIHP program is expected to reach between 10,000 and 14,000 Sacramento County residents who don’t qualify for Medi-Cal, the state’s Medicaid program. It extends coverage to childless adults with an annual income of less than $7,500.\u003c/p>\n\u003cp>Stacey Wittorff has heard complaints about the current Sacramento county health program for years. She’s an attorney at Legal Services of Northern California. She says patients first have problems becoming eligible for services, and when they become eligible, there are often delays in care. Legal Services of Northern California recently filed suit against Sacramento County over eligibility.\u003c/p>\n\u003cp>\"People are trying to…access services and they’re being told they have to wait months for specialty care or months for just a follow-up appointment for chronic conditions,\" says Wittorff.\u003c/p>\n\u003cp>\u003cstrong>Getting Counties Ready For 2014\u003c/strong>\u003c/p>\n\u003cp>Last month, Sacramento County announced it was joining LIHP and California's \"Bridge to Reform\" initiative, a state program which gives counties access to federal funds in advance of the Medicaid expansion called for in the federal health law in 2014. Almost all of California’s 58 counties have signed up and have enrolled 552,000 people in new coverage.\u003c/p>\n\u003cp>The LIHP brings new standards to county indigent health programs. Patients are guaranteed a doctor visit within 30 days of request, and doctors will have to be within 30 miles or 60 minutes away. The emphasis is on prevention, not services of last resort.\u003c/p>\n\u003cp>The county budgeted $53 million for LIHP during fiscal year 2012-2013, but numbers will be readjusted to account for the November start of services. Half of those dollars will come from the federal government.\u003c/p>\n\u003cp>\"It is a huge, huge, undertaking,\" Sandy Damiano, a deputy director with the Department of Health and Human Services for Sacramento County says. \"We…did not have the appropriate infrastructure due to recurrent budget reductions or expertise to build a large infrastructure.\"\u003c/p>\n\u003cp>Nevertheless, Damiano says the program is an exciting opportunity to transform the way the county currently provides services for its most needy residents.\u003c/p>\n\u003cp>\"We're hoping that [LIHP] can really get them stabilized in terms of their medical conditions and also decrease the hospital emergency room use,\" says Damiano.\u003c/p>\n\u003cp>\u003cstrong>Some Counties Had A Running Start\u003c/strong>\u003c/p>\n\u003cp>In other counties, the LIHP program – and the people it serves – look quite different.\u003c/p>\n\u003cp>The San Francisco bay area county of Alameda is using federal funds to serve people up to 200 percent of federal poverty, or $22,340 for an individual. Alameda implemented the program beginning in July 2011.\u003c/p>\n\u003cp>But Alameda had a head start that helped, says County Health Director Alex Briscoe. It is one of 10 California counties that benefited from federal funds for a prior state project to improve local public health programs. That has allowed the county to be more proactive with low-income patients it serves.\u003c/p>\n\u003cp>\"Now if you're getting seen in one of our primary care clinics and you go to the emergency room three times in the same month, we call that primary care home and say, 'Hey, what's up? How come this person's been to the ED three times and you haven’t seen them?' We never did that previously,\" Briscoe says.\u003c/p>\n\u003cp>The Alameda health budget also had the cash flow needed to bring in the federal dollars, and an infrastructure of community clinics to tap into.\u003c/p>\n\u003cp>\"Instead of running big, public health clinics, we contract with…community-based organizations with a long history of providing direct clinical care,\" says Briscoe.\u003c/p>\n\u003cp>Since the LIHP was implemented in Alameda, the county has been able to increase access to and decrease wait times for specialty care, he says.\u003c/p>\n\u003cp>There are other counties that have struggled to take advantage of the program – Santa Barbara County has not even announced an implementation date yet. Neither has Stanislaus, which will only offer new benefits to people at 50 percent of the federal poverty level. Merced and Tulare will join the state effort in January 2013. Merced, Fresno and San Luis Obispo counties will not participate.\u003c/p>\n\u003cp>Briscoe attributes the uneven roll out of the low income programs to a difference in county politics, investment in health, and administrative sophistication. To him, the geographic disparities in the LIHP program are cause for deep concern.\u003c/p>\n\u003cp>\"Federal dollars will be left on the table that could have been brought to bear to mitigate the human suffering that is, frankly, everywhere,\" Briscoe said.\u003c/p>\n\u003cp>\u003cstrong>For Most Needy, New Program Could Be A \"Solution\"\u003c/strong>\u003c/p>\n\u003cp>Back in Sacramento, Gledel Beacham struggles to find a place to sleep at night. Some nights, it’s on the streets. He finds his way to the Primary Care Center to pick up medication that helps manage his depression and keep pain from a back injury at bay. But the emergency room is a frequent place of care, he says, and seeing another doctor in Woodland is easier than trying to get an appointment at the county clinic.\u003c/p>\n\u003cp>Having more health clinics available to people like him \"sounds like a solution,\" he says. In Sacramento's Low Income Health Program, he may have a medical home, at least, to call his own.\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership that includes \u003c/em>\u003ca href=\"http://www.capradio.org/news\">\u003cem>Capital Public Radio\u003c/em>\u003c/a>\u003cem>, \u003ca href=\"http://www.npr.org/\">NPR\u003c/a> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>By Mary Agnes Carey,\u003c/em> \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/31/health-law-obama-romney-election.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/31/health-law-obama-romney-election.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>On the presidential campaign trail, Republican Mitt Romney has repeatedly called for repeal of the 2010 health law and President Barack Obama has vowed to implement it. Yet both men could face obstacles: Romney may be stymied by the lack of a majority in Congress to do his will and Obama could be forced by fiscal concerns or public opinion to revamp parts of the law.\u003c/p>\n\u003cp>Here is a look at how Obama and Romney might change the health law in the years ahead based on interviews with health policy experts.\u003c/p>\n\u003cp>\u003cstrong>OBAMA'S CHALLENGES\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8758\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Obama-300.jpg\">\u003cimg class=\"size-full wp-image-8758 \" title=\"President Barack Obama waves to an audience of about 15,000 supporters during a campaign rally in Virginia (Photo by Chip Somodevilla/Getty Images).\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Obama-300.jpg\" alt=\"President Barack Obama waves to an audience of about 15,000 supporters during a campaign rally in Virginia (Photo by Chip Somodevilla/Getty Images).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Barack Obama waves to an audience of about 15,000 supporters during a campaign rally in Virginia (Chip Somodevilla: Getty Images).\u003c/figcaption>\u003c/figure>\n\u003cp>President Barack Obama has urged voters to re-elect him so that he can put the law fully into effect. But some analysts predict the mounting pressures to reduce federal spending will complicate that plan. And others note that in a second term, Obama may be more open to working with Congress to tweak provisions of the law that have raised concerns. Leading up to this tight election, Obama and Democrats have been reluctant to make modifications to the law, known as the Affordable Care Act (ACA).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Right now (Democrats) can’t criticize the ACA. It’s just not politically smart,\" said Dan Mendelson, chief executive of the consulting firm Avalere Health who oversaw health programs at the Clinton administration’s Office of Management and Budget. But should Obama win a second term and Democrats retain control of the Senate, \"I think that adjustments are on the table\" as part of a larger deal to reduce the federal deficit, he said.\u003c/p>\n\u003cp>\u003cstrong>Scale Back Subsidies:\u003c/strong> As part of that effort to reduce federal spending, there could be pressure to scale back the health law’s subsidies that help low-income residents afford coverage. People who earn up to 400 percent of poverty – currently about $92,000 for a family of four – are eligible to get financial help in purchasing coverage. Another big-ticket item is the expansion of Medicaid coverage to anyone up to 133 percent of the poverty level, or about $30,656 for a family of four.\u003c!--more-->\u003c/p>\n\u003cp>The ACA is \"so vast that by default it has to be impacted if there is a bipartisan, grand bargain debt deal,\" said Mike Tuffin, managing director of the consulting firm APCO Worldwide’s Washington, D.C., office and formerly executive vice president of America’s Health Insurance Plans, an insurance industry trade group. \"You can imagine the subsidies being impacted, the Medicaid expansion being impacted.\"\u003c/p>\n\u003cp>Changing the law’s implementation schedule is wishful thinking among Republicans, Mendelson said. Any delay in full implementation could risk political backlash from consumers, who have waited years for the major provisions of the ACA to kick in. Delays may also open the law to other changes that Obama and Democrats don’t want.\u003c/p>\n\u003cp>\"My feeling is that it would be a major political liability for the president to encourage delay,\" he said, \"and that if this is going to be his legacy, I see no indication from the policy makers that they either want or expect there to be a delay.\"\u003c/p>\n\u003cp>The president \"is willing to work with anyone with good ideas to improve the Affordable Care Act. What he is not willing to do is reopen old partisan battles over the central guarantees of Obamacare,\" said Adam Fetcher, a spokesman for the Obama campaign.\u003c/p>\n\u003cp>\u003cstrong>Change in Age Rating Bands:\u003c/strong> The ACA prohibits insurers from charging more than three times as much for a policy sold to an older person than to a younger person. (This does not affect people over 65 who are covered by Medicare.) This is a change from current law in most states where there are \u003ca href=\"http://www.kaiserhealthnews.org/stories/2009/august/31/age-rating.aspx\" target=\"_blank\">no limits on how much more insurers can charge older people\u003c/a>. America’s Health Insurance Plans is advocating that the law’s rating bands be changed to 5:1 to prevent what the group describes as “rate shock” for younger people and families.\u003c/p>\n\u003cp>The issue that arises is that the law “makes coverage more affordable for the elderly but more expensive for the young people they want to buy coverage,” said Paul Heldman, senior health policy analyst with Potomac Research Group, a Washington research firm.\u003c/p>\n\u003cp>\u003cstrong>Medical Device Tax Cut:\u003c/strong> Of the many taxes in the health law, one has come under especially withering criticism: a 2.3 percent tax on the sale of any taxable medical device. Medical device manufacturers have loudly opposed the tax and won some key congressional support.\u003c/p>\n\u003cp>\"For some, it could truly be the difference between surviving and having to close their doors,\" Michael R. Minogue, CEO and chairman of the board of Abiomed, Inc., which makes cardiac medical devices, told Congress this summer. But other analysts contend that the industry will do better under the law because more people will have coverage for treatments that use medical devices.\u003c/p>\n\u003cp>Legislation to repeal the tax \u003ca href=\"http://www.kaiserhealthnews.org/daily-reports/2012/june/08/medical-device-tax-repeal.aspx\" target=\"_blank\">passed the House in June\u003c/a> with 37 Democrats joining Republicans to support the measure, although it is unlikely to receive Senate consideration this year.\u003c/p>\n\u003cp>The problem with this – or any change – in the law’s taxes is finding another area to make up the loss of revenue. \"It’s easy to hate a tax. It’s harder to find a pay for,\" says Mendelson.\u003c/p>\n\u003cp>Nonetheless, Tuffin says that this and other taxes could raise concerns if the public sees them as making health insurance or medical care more expensive.\u003c/p>\n\u003cp>\"All of those hit simultaneously and overnight in 2014 and they are going to drive up the cost of coverage,\" he says. \"Consumers are going to feel that, small businesses are going to feel that.\"\u003c/p>\n\u003cp>\u003cstrong>IPAB:\u003c/strong> One of the most contentious provisions of the health law is the creation of a 15-member panel charged with making recommendations to reduce Medicare spending if the amount the government spends grows beyond a target rate. Congress must pass alternative cuts of the same size, or the recommendations from the panel, known as the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/May/09/ipab-faq.aspx\" target=\"_blank\">Independent Payment Advisory Board\u003c/a> (IPAB), become law. IPAB members are prohibited from making recommendations that would increase revenues or change benefits, eligibility or Medicare beneficiary cost-sharing.\u003c/p>\n\u003cp>The board is disliked by many lawmakers. Some Republicans charge it amounts to health care rationing while members from both parties hate the idea of surrendering the power of the purse.\u003c/p>\n\u003cp>\"IPAB is not a political must-have for the president,\" Mendelson said. \"It is the kind of thing that could be treated in the context of other legislative adjustments….\"\u003c/p>\n\u003cp>\u003cstrong>ROMNEY'S CHALLENGES\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8760\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Romney-300.jpg\">\u003cimg class=\"size-full wp-image-8760\" title=\"GOP pesidential candidate, former Massachusetts Gov. Mitt Romney greets supporters during a campaign rally in Ohio (Photo by Justin Sullivan/Getty Images).\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Romney-300.jpg\" alt=\"GOP pesidential candidate, former Massachusetts Gov. Mitt Romney greets supporters during a campaign rally in Ohio (Photo by Justin Sullivan/Getty Images).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">GOP pesidential candidate, former Massachusetts Gov. Mitt Romney greets supporters during a campaign rally in Ohio (Justin Sullivan: Getty Images).\u003c/figcaption>\u003c/figure>\n\u003cp>Gov. Mitt Romney has promised a full-scale repeal of the ACA. \"He will repeal it in its entirety and replace it with reforms of his own,\" Romney spokeswoman Andrea Saul said in an e-mail.\u003c/p>\n\u003cp>But short of Republicans controlling both chambers of Congress, he would have to rely on the federal regulatory process to choke off funding and give states wide latitude to implement – or ignore -- the law. If Republicans took control of the Senate but had fewer than the 60 votes needed to pass most legislation, Romney could be forced to use a difficult legislative process known as \"reconciliation\" to try to dismantle the measure.\u003c/p>\n\u003cp>Still, some of the law’s supporters believe such a Republican effort could be successful. \"I would say the bulk of it can be dismantled,\" said former Senate Majority Leader Tom Daschle, D-S.D. \"[Romney] can use reconciliation for certain amounts affecting the budget of the federal government….He could have a profound effect on the outcome of the ACA in a very short period of time.\"\u003c/p>\n\u003cp>\u003cstrong>Slowing Down Implementation:\u003c/strong> The health law gives tremendous power to the secretary of Health and Human Services to implement the health law, and a Romney administration could use that power to slow the rulemaking process to a crawl.\u003c/p>\n\u003cp>\"[Romney] can really do a lot to change the course of the legislation because – especially with the Affordable Care Act – the secretary and the president were given wide latitude,\" Daschle said.\u003c/p>\n\u003cp>If Republicans win control of the Senate, they could also use the reconciliation process—which requires only a majority instead of the 60 votes usually needed to pass a measure -- to strip out sections of the law that relate to the federal budget. That would include some of the law’s biggest provisions – such as the health insurance exchanges, subsidies to purchase coverage and the Medicaid expansion. Removing those sections would gut the law’s goal of covering 30 million more Americans.\u003c/p>\n\u003cp>But reconciliation can be a cumbersome and difficult process. In addition, it only applies to budget measures so large chunks of the law would be unaffected. And changes made under the process can’t increase the deficit.\u003c/p>\n\u003cp>\"I think as people get into the details, it doesn’t work quite the way they thought,\" Senate Budget Committee Chairman Kent Conrad said when Senate Democrats were debating using reconciliation to pass the health law. Reconciliation, he said, \u003ca href=\"http://www.kaiserhealthnews.org/checking-in-with/conrad.aspx\" target=\"_blank\">\"is anything but a slam dunk.\"\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Waivers:\u003c/strong> Romney has said he would allow states to opt-out of the health law by using a waiver process. He could also use the process to give states wide latitude to implement provisions, like health insurance exchanges, that differ from requirements in the ACA. But there are many rules that govern the waiver process; ignoring those might not be so easy, analysts say.\u003c/p>\n\u003cp>An \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1387811\" target=\"_blank\">article in the Journal of the American Medical Association\u003c/a> this week examines the power an administration would have to block the law. It points out that under the Constitution, the president is required to \"take care that the laws be faithfully executed\" and can’t \"refuse to execute laws passed by Congress with which he disagrees,\" unless Congress grants that discretion.\u003c/p>\n\u003cp>Authors John Kraemer and Lawrence Gostin note that because the ACA \"provides no such blanket waiver authority, granting states authority to disregard the ACA's key provisions would likely violate the ‘take care’ clause.\" The ACA, however, does allow states to seek waivers starting in 2017 if they can demonstrate an alternative approach that could increase coverage and reduce cost without raising the federal deficit.\u003c/p>\n\u003cp>If Romney opted not to move forward on the law, the administration could also be sued by individuals and groups. That litigation could take months – maybe years – to be resolved.\u003c/p>\n\u003cp>\u003cstrong>What Might Stay:\u003c/strong> Romney has said that he expects insurers to keep coverage that allows adult children to stay on a parent’s health insurance policy until age 26, although it’s unclear if he would support legislation or regulations to make that happen. He also has \u003ca href=\"http://www.mittromney.com/issues/health-care\" target=\"_blank\">expressed support\u003c/a> for states to set up health insurance exchanges and high-risk pools to cover the uninsured.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Avik Roy, a senior fellow at the conservative Manhattan Institute and an outside adviser to the Romney campaign, says Romney wants most people to own their own health insurance rather than rely on their employers for coverage. \"There are still other things you can do to expand [existing federal] protections to people who have credible coverage,\" he said. \"And then for people who still have those gaps, do more with high-risk pools and do other things to make sure that the people who can’t get insurance today have the ability to get it through subsidized high-risk pools at the state level.\"\u003c/p>\n\n",
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"excerpt": "On the presidential campaign trail, Republican Mitt Romney has repeatedly called for repeal of the 2010 health law and President Barack Obama has vowed to implement it. Yet both men could face obstacles: Romney may be stymied by the lack of a majority in Congress to do his will and Obama could be forced by fiscal concerns or public opinion to revamp parts of the law.\r\n\r\nHere is a look at how Obama and Romney might change the health law in the years ahead based on interviews with health policy experts.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>By Mary Agnes Carey,\u003c/em> \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/31/health-law-obama-romney-election.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/31/health-law-obama-romney-election.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>On the presidential campaign trail, Republican Mitt Romney has repeatedly called for repeal of the 2010 health law and President Barack Obama has vowed to implement it. Yet both men could face obstacles: Romney may be stymied by the lack of a majority in Congress to do his will and Obama could be forced by fiscal concerns or public opinion to revamp parts of the law.\u003c/p>\n\u003cp>Here is a look at how Obama and Romney might change the health law in the years ahead based on interviews with health policy experts.\u003c/p>\n\u003cp>\u003cstrong>OBAMA'S CHALLENGES\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8758\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Obama-300.jpg\">\u003cimg class=\"size-full wp-image-8758 \" title=\"President Barack Obama waves to an audience of about 15,000 supporters during a campaign rally in Virginia (Photo by Chip Somodevilla/Getty Images).\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Obama-300.jpg\" alt=\"President Barack Obama waves to an audience of about 15,000 supporters during a campaign rally in Virginia (Photo by Chip Somodevilla/Getty Images).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Barack Obama waves to an audience of about 15,000 supporters during a campaign rally in Virginia (Chip Somodevilla: Getty Images).\u003c/figcaption>\u003c/figure>\n\u003cp>President Barack Obama has urged voters to re-elect him so that he can put the law fully into effect. But some analysts predict the mounting pressures to reduce federal spending will complicate that plan. And others note that in a second term, Obama may be more open to working with Congress to tweak provisions of the law that have raised concerns. Leading up to this tight election, Obama and Democrats have been reluctant to make modifications to the law, known as the Affordable Care Act (ACA).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Right now (Democrats) can’t criticize the ACA. It’s just not politically smart,\" said Dan Mendelson, chief executive of the consulting firm Avalere Health who oversaw health programs at the Clinton administration’s Office of Management and Budget. But should Obama win a second term and Democrats retain control of the Senate, \"I think that adjustments are on the table\" as part of a larger deal to reduce the federal deficit, he said.\u003c/p>\n\u003cp>\u003cstrong>Scale Back Subsidies:\u003c/strong> As part of that effort to reduce federal spending, there could be pressure to scale back the health law’s subsidies that help low-income residents afford coverage. People who earn up to 400 percent of poverty – currently about $92,000 for a family of four – are eligible to get financial help in purchasing coverage. Another big-ticket item is the expansion of Medicaid coverage to anyone up to 133 percent of the poverty level, or about $30,656 for a family of four.\u003c!--more-->\u003c/p>\n\u003cp>The ACA is \"so vast that by default it has to be impacted if there is a bipartisan, grand bargain debt deal,\" said Mike Tuffin, managing director of the consulting firm APCO Worldwide’s Washington, D.C., office and formerly executive vice president of America’s Health Insurance Plans, an insurance industry trade group. \"You can imagine the subsidies being impacted, the Medicaid expansion being impacted.\"\u003c/p>\n\u003cp>Changing the law’s implementation schedule is wishful thinking among Republicans, Mendelson said. Any delay in full implementation could risk political backlash from consumers, who have waited years for the major provisions of the ACA to kick in. Delays may also open the law to other changes that Obama and Democrats don’t want.\u003c/p>\n\u003cp>\"My feeling is that it would be a major political liability for the president to encourage delay,\" he said, \"and that if this is going to be his legacy, I see no indication from the policy makers that they either want or expect there to be a delay.\"\u003c/p>\n\u003cp>The president \"is willing to work with anyone with good ideas to improve the Affordable Care Act. What he is not willing to do is reopen old partisan battles over the central guarantees of Obamacare,\" said Adam Fetcher, a spokesman for the Obama campaign.\u003c/p>\n\u003cp>\u003cstrong>Change in Age Rating Bands:\u003c/strong> The ACA prohibits insurers from charging more than three times as much for a policy sold to an older person than to a younger person. (This does not affect people over 65 who are covered by Medicare.) This is a change from current law in most states where there are \u003ca href=\"http://www.kaiserhealthnews.org/stories/2009/august/31/age-rating.aspx\" target=\"_blank\">no limits on how much more insurers can charge older people\u003c/a>. America’s Health Insurance Plans is advocating that the law’s rating bands be changed to 5:1 to prevent what the group describes as “rate shock” for younger people and families.\u003c/p>\n\u003cp>The issue that arises is that the law “makes coverage more affordable for the elderly but more expensive for the young people they want to buy coverage,” said Paul Heldman, senior health policy analyst with Potomac Research Group, a Washington research firm.\u003c/p>\n\u003cp>\u003cstrong>Medical Device Tax Cut:\u003c/strong> Of the many taxes in the health law, one has come under especially withering criticism: a 2.3 percent tax on the sale of any taxable medical device. Medical device manufacturers have loudly opposed the tax and won some key congressional support.\u003c/p>\n\u003cp>\"For some, it could truly be the difference between surviving and having to close their doors,\" Michael R. Minogue, CEO and chairman of the board of Abiomed, Inc., which makes cardiac medical devices, told Congress this summer. But other analysts contend that the industry will do better under the law because more people will have coverage for treatments that use medical devices.\u003c/p>\n\u003cp>Legislation to repeal the tax \u003ca href=\"http://www.kaiserhealthnews.org/daily-reports/2012/june/08/medical-device-tax-repeal.aspx\" target=\"_blank\">passed the House in June\u003c/a> with 37 Democrats joining Republicans to support the measure, although it is unlikely to receive Senate consideration this year.\u003c/p>\n\u003cp>The problem with this – or any change – in the law’s taxes is finding another area to make up the loss of revenue. \"It’s easy to hate a tax. It’s harder to find a pay for,\" says Mendelson.\u003c/p>\n\u003cp>Nonetheless, Tuffin says that this and other taxes could raise concerns if the public sees them as making health insurance or medical care more expensive.\u003c/p>\n\u003cp>\"All of those hit simultaneously and overnight in 2014 and they are going to drive up the cost of coverage,\" he says. \"Consumers are going to feel that, small businesses are going to feel that.\"\u003c/p>\n\u003cp>\u003cstrong>IPAB:\u003c/strong> One of the most contentious provisions of the health law is the creation of a 15-member panel charged with making recommendations to reduce Medicare spending if the amount the government spends grows beyond a target rate. Congress must pass alternative cuts of the same size, or the recommendations from the panel, known as the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/May/09/ipab-faq.aspx\" target=\"_blank\">Independent Payment Advisory Board\u003c/a> (IPAB), become law. IPAB members are prohibited from making recommendations that would increase revenues or change benefits, eligibility or Medicare beneficiary cost-sharing.\u003c/p>\n\u003cp>The board is disliked by many lawmakers. Some Republicans charge it amounts to health care rationing while members from both parties hate the idea of surrendering the power of the purse.\u003c/p>\n\u003cp>\"IPAB is not a political must-have for the president,\" Mendelson said. \"It is the kind of thing that could be treated in the context of other legislative adjustments….\"\u003c/p>\n\u003cp>\u003cstrong>ROMNEY'S CHALLENGES\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8760\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Romney-300.jpg\">\u003cimg class=\"size-full wp-image-8760\" title=\"GOP pesidential candidate, former Massachusetts Gov. Mitt Romney greets supporters during a campaign rally in Ohio (Photo by Justin Sullivan/Getty Images).\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Romney-300.jpg\" alt=\"GOP pesidential candidate, former Massachusetts Gov. Mitt Romney greets supporters during a campaign rally in Ohio (Photo by Justin Sullivan/Getty Images).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">GOP pesidential candidate, former Massachusetts Gov. Mitt Romney greets supporters during a campaign rally in Ohio (Justin Sullivan: Getty Images).\u003c/figcaption>\u003c/figure>\n\u003cp>Gov. Mitt Romney has promised a full-scale repeal of the ACA. \"He will repeal it in its entirety and replace it with reforms of his own,\" Romney spokeswoman Andrea Saul said in an e-mail.\u003c/p>\n\u003cp>But short of Republicans controlling both chambers of Congress, he would have to rely on the federal regulatory process to choke off funding and give states wide latitude to implement – or ignore -- the law. If Republicans took control of the Senate but had fewer than the 60 votes needed to pass most legislation, Romney could be forced to use a difficult legislative process known as \"reconciliation\" to try to dismantle the measure.\u003c/p>\n\u003cp>Still, some of the law’s supporters believe such a Republican effort could be successful. \"I would say the bulk of it can be dismantled,\" said former Senate Majority Leader Tom Daschle, D-S.D. \"[Romney] can use reconciliation for certain amounts affecting the budget of the federal government….He could have a profound effect on the outcome of the ACA in a very short period of time.\"\u003c/p>\n\u003cp>\u003cstrong>Slowing Down Implementation:\u003c/strong> The health law gives tremendous power to the secretary of Health and Human Services to implement the health law, and a Romney administration could use that power to slow the rulemaking process to a crawl.\u003c/p>\n\u003cp>\"[Romney] can really do a lot to change the course of the legislation because – especially with the Affordable Care Act – the secretary and the president were given wide latitude,\" Daschle said.\u003c/p>\n\u003cp>If Republicans win control of the Senate, they could also use the reconciliation process—which requires only a majority instead of the 60 votes usually needed to pass a measure -- to strip out sections of the law that relate to the federal budget. That would include some of the law’s biggest provisions – such as the health insurance exchanges, subsidies to purchase coverage and the Medicaid expansion. Removing those sections would gut the law’s goal of covering 30 million more Americans.\u003c/p>\n\u003cp>But reconciliation can be a cumbersome and difficult process. In addition, it only applies to budget measures so large chunks of the law would be unaffected. And changes made under the process can’t increase the deficit.\u003c/p>\n\u003cp>\"I think as people get into the details, it doesn’t work quite the way they thought,\" Senate Budget Committee Chairman Kent Conrad said when Senate Democrats were debating using reconciliation to pass the health law. Reconciliation, he said, \u003ca href=\"http://www.kaiserhealthnews.org/checking-in-with/conrad.aspx\" target=\"_blank\">\"is anything but a slam dunk.\"\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Waivers:\u003c/strong> Romney has said he would allow states to opt-out of the health law by using a waiver process. He could also use the process to give states wide latitude to implement provisions, like health insurance exchanges, that differ from requirements in the ACA. But there are many rules that govern the waiver process; ignoring those might not be so easy, analysts say.\u003c/p>\n\u003cp>An \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1387811\" target=\"_blank\">article in the Journal of the American Medical Association\u003c/a> this week examines the power an administration would have to block the law. It points out that under the Constitution, the president is required to \"take care that the laws be faithfully executed\" and can’t \"refuse to execute laws passed by Congress with which he disagrees,\" unless Congress grants that discretion.\u003c/p>\n\u003cp>Authors John Kraemer and Lawrence Gostin note that because the ACA \"provides no such blanket waiver authority, granting states authority to disregard the ACA's key provisions would likely violate the ‘take care’ clause.\" The ACA, however, does allow states to seek waivers starting in 2017 if they can demonstrate an alternative approach that could increase coverage and reduce cost without raising the federal deficit.\u003c/p>\n\u003cp>If Romney opted not to move forward on the law, the administration could also be sued by individuals and groups. That litigation could take months – maybe years – to be resolved.\u003c/p>\n\u003cp>\u003cstrong>What Might Stay:\u003c/strong> Romney has said that he expects insurers to keep coverage that allows adult children to stay on a parent’s health insurance policy until age 26, although it’s unclear if he would support legislation or regulations to make that happen. He also has \u003ca href=\"http://www.mittromney.com/issues/health-care\" target=\"_blank\">expressed support\u003c/a> for states to set up health insurance exchanges and high-risk pools to cover the uninsured.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Avik Roy, a senior fellow at the conservative Manhattan Institute and an outside adviser to the Romney campaign, says Romney wants most people to own their own health insurance rather than rely on their employers for coverage. \"There are still other things you can do to expand [existing federal] protections to people who have credible coverage,\" he said. \"And then for people who still have those gaps, do more with high-risk pools and do other things to make sure that the people who can’t get insurance today have the ability to get it through subsidized high-risk pools at the state level.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Voucher Program Could Raise Medicare Premiums Across Country",
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"content": "\u003cp>\u003cstrong>If the program had existed in 2010, Californians would have paid in excess of $100 more per month, study finds\u003c/strong>\u003c/p>\n\u003cp>\u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/15/premium-support-medicare-study.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/15/premium-support-medicare-study.aspx\" target=\"_blank\">By Jordan Rau, Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/SeniorWalking_KaiserHealthNews.jpg\">\u003cimg class=\"alignright size-full wp-image-8633\" title=\"OLYMPUS DIGITAL CAMERA\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/SeniorWalking_KaiserHealthNews.jpg\" alt=\"\" width=\"300\" height=\"215\">\u003c/a>The type of proposal championed by Republicans to overhaul Medicare by giving beneficiaries a fixed amount of money to purchase insurance could lead to significant increases in premium costs in some parts of the country, according to a new study.\u003c/p>\n\u003cp>If the plan had been in place in 2010, six in 10 Medicare beneficiaries—about 25 million people both in traditional Medicare and in private Medicare Advantage plans —would have faced higher premiums if they didn’t switch to a cheaper plan, according to researchers at the Kaiser Family Foundation. (The foundation is not affiliated with Kaiser Permanente).\u003c/p>\n\u003cp>The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new study estimated how the plan would have worked in 2010 by looking at the cost of traditional Medicare and private Medicare Advantage plans around the country. The study’s authors emphasized that their model was not an exact replica of any existing proposal for a variety of reasons, including that most plans, among them Ryan’s, wouldn’t phase in for a decade and even then would affect only new Medicare beneficiaries.\u003c/p>\n\u003cp>The study found that 59 percent of Medicare beneficiaries would have paid higher premiums in 2010 unless they shifted into a cheaper plan. In California, Michigan, New Jersey, Nevada and New York, average extra premiums would exceed $100 a month, and in Florida they would exceed $200 a month, the study calculated.\u003c!--more-->\u003c/p>\n\u003cp>Medicare spends vastly different amounts per beneficiary around the country, ranging from less than $500 a month per beneficiary in some places to more than $900 a month per beneficiary elsewhere. That’s often because people in some areas of the country are sicker and need more care; it’s also because providers in some places favor more interventions and more expensive ones. In those high-cost areas, beneficiaries would see significant monthly increases in premiums if they remained in traditional Medicare. The study found people in Los Angeles would have paid $260 more and people in Miami would have paid $492 more, for instance.\u003c/p>\n\u003cp>In other regions where Medicare costs were low—such as Alaska, Delaware, Hawaii, Wyoming and Washington, D.C.— people in traditional Medicare would not pay more, but people in many private Medicare Advantage plans would face higher premiums if they didn’t want to change to traditional Medicare. People in Portland, Ore., for instance, would have paid $211 more a month and people in Honolulu would have paid $254 a month to stay in their preferred private plan. About one in every four Medicare beneficiaries are now enrolled in these private plans, some of which are preferred provider organizations while others are HMOs.\u003c/p>\n\u003cp>Although the fight over premium support often has been characterized as a battle between defenders of traditional Medicare and proponents of private health plans, the study found that it could have a substantial impact on people who enrolled in Medicare Advantage plans. Nationwide, 88 percent of those beneficiaries would have paid more to stay in their plans, averaging $87 more per month, if it had been in place in 2010.\u003c/p>\n\u003cp>Of course, getting many beneficiaries to switch to less expensive plans is how the architects of premium support envision saving money. They say it will bring pressure on insurers, doctors and hospitals to offer lower prices. The study noted, however, that such shifts might mean significant changes in the type and quality of care for beneficiaries.\u003c/p>\n\u003cp>In some regions, the low cost plans might be HMOs, which have tightly controlled networks of doctors and hospitals. If beneficiaries switched from traditional Medicare to HMOs, they might not be able to keep seeing their regular doctors or go to their preferred hospital. In other areas, beneficiaries –perhaps people in private plans that coordinate care – might not like shifting into less costly traditional Medicare.\u003c/p>\n\u003cp>\"Beneficiaries' preferences and plan choices are not purely driven by premiums, and some beneficiaries may not view the low-cost plan, whether a private plan or traditional Medicare, as optimal for meeting their individual needs and circumstances,\" wrote the authors, led by analyst Gretchen Jacobson.\u003c/p>\n\u003cp>Other studies have found that only a small portion of Medicare beneficiaries switch their Part D prescription drug or Medicare Advantage plans each year, even when doing so could save them money. \"There are tradeoffs involved in making changes and we know from Part D and Medicare Advantage that people don’t really change very often,\" said Tricia Neuman, who oversees the foundation’s Medicare analyses.\u003c/p>\n\u003cp>In addition, the new study noted that some low-cost plans might not be able to handle an influx of new beneficiaries. A particularly glaring example is in Los Angeles County, where fewer than 10,000 beneficiaries are enrolled in one of the two lowest-cost plans, while more than 900,000 beneficiaries are enrolled in traditional Medicare or other plans\u003c/p>\n\u003cp>The study did not estimate how much money the plan would have saved Medicare. In a statement, the Romney campaign said: \"As the authors stress, this is not a study of the Romney-Ryan plan. Our plan would always provide future beneficiaries guaranteed coverage options with no increase in out-of-pocket costs from today's Medicare.\" The Obama campaign trumpeted the study, saying it \"demonstrates how hollow\" is Romney’s claim that the elderly would retain the option of enrolling in traditional Medicare under their plan.\u003c/p>\n\u003cp>Joe Antos, a health care expert at the American Enterprise Institute, said that the study is \"the best technical study so far of this sort,\" although he expected a premium support market would be much more competitive than the current Medicare Advantage market is, since the latter is guaranteed a certain payment by the federal government.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"The competition would be even more intense,\" he said, especially since most Medicare beneficiaries would not be able to afford anything more expensive than the benchmark plan, and thus insurers would compete to meet those prices. \"You just can't have high costs if people can’t pay it,\" he said.\u003c/p>\n\n",
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"description": "If the program had existed in 2010, Californians would have paid in excess of $100 more per month, study finds By Jordan Rau, Kaiser Health News The type of proposal championed by Republicans to overhaul Medicare by giving beneficiaries a fixed amount of money to purchase insurance could lead to significant increases in premium costs",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>If the program had existed in 2010, Californians would have paid in excess of $100 more per month, study finds\u003c/strong>\u003c/p>\n\u003cp>\u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/15/premium-support-medicare-study.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/15/premium-support-medicare-study.aspx\" target=\"_blank\">By Jordan Rau, Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/SeniorWalking_KaiserHealthNews.jpg\">\u003cimg class=\"alignright size-full wp-image-8633\" title=\"OLYMPUS DIGITAL CAMERA\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/SeniorWalking_KaiserHealthNews.jpg\" alt=\"\" width=\"300\" height=\"215\">\u003c/a>The type of proposal championed by Republicans to overhaul Medicare by giving beneficiaries a fixed amount of money to purchase insurance could lead to significant increases in premium costs in some parts of the country, according to a new study.\u003c/p>\n\u003cp>If the plan had been in place in 2010, six in 10 Medicare beneficiaries—about 25 million people both in traditional Medicare and in private Medicare Advantage plans —would have faced higher premiums if they didn’t switch to a cheaper plan, according to researchers at the Kaiser Family Foundation. (The foundation is not affiliated with Kaiser Permanente).\u003c/p>\n\u003cp>The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new study estimated how the plan would have worked in 2010 by looking at the cost of traditional Medicare and private Medicare Advantage plans around the country. The study’s authors emphasized that their model was not an exact replica of any existing proposal for a variety of reasons, including that most plans, among them Ryan’s, wouldn’t phase in for a decade and even then would affect only new Medicare beneficiaries.\u003c/p>\n\u003cp>The study found that 59 percent of Medicare beneficiaries would have paid higher premiums in 2010 unless they shifted into a cheaper plan. In California, Michigan, New Jersey, Nevada and New York, average extra premiums would exceed $100 a month, and in Florida they would exceed $200 a month, the study calculated.\u003c!--more-->\u003c/p>\n\u003cp>Medicare spends vastly different amounts per beneficiary around the country, ranging from less than $500 a month per beneficiary in some places to more than $900 a month per beneficiary elsewhere. That’s often because people in some areas of the country are sicker and need more care; it’s also because providers in some places favor more interventions and more expensive ones. In those high-cost areas, beneficiaries would see significant monthly increases in premiums if they remained in traditional Medicare. The study found people in Los Angeles would have paid $260 more and people in Miami would have paid $492 more, for instance.\u003c/p>\n\u003cp>In other regions where Medicare costs were low—such as Alaska, Delaware, Hawaii, Wyoming and Washington, D.C.— people in traditional Medicare would not pay more, but people in many private Medicare Advantage plans would face higher premiums if they didn’t want to change to traditional Medicare. People in Portland, Ore., for instance, would have paid $211 more a month and people in Honolulu would have paid $254 a month to stay in their preferred private plan. About one in every four Medicare beneficiaries are now enrolled in these private plans, some of which are preferred provider organizations while others are HMOs.\u003c/p>\n\u003cp>Although the fight over premium support often has been characterized as a battle between defenders of traditional Medicare and proponents of private health plans, the study found that it could have a substantial impact on people who enrolled in Medicare Advantage plans. Nationwide, 88 percent of those beneficiaries would have paid more to stay in their plans, averaging $87 more per month, if it had been in place in 2010.\u003c/p>\n\u003cp>Of course, getting many beneficiaries to switch to less expensive plans is how the architects of premium support envision saving money. They say it will bring pressure on insurers, doctors and hospitals to offer lower prices. The study noted, however, that such shifts might mean significant changes in the type and quality of care for beneficiaries.\u003c/p>\n\u003cp>In some regions, the low cost plans might be HMOs, which have tightly controlled networks of doctors and hospitals. If beneficiaries switched from traditional Medicare to HMOs, they might not be able to keep seeing their regular doctors or go to their preferred hospital. In other areas, beneficiaries –perhaps people in private plans that coordinate care – might not like shifting into less costly traditional Medicare.\u003c/p>\n\u003cp>\"Beneficiaries' preferences and plan choices are not purely driven by premiums, and some beneficiaries may not view the low-cost plan, whether a private plan or traditional Medicare, as optimal for meeting their individual needs and circumstances,\" wrote the authors, led by analyst Gretchen Jacobson.\u003c/p>\n\u003cp>Other studies have found that only a small portion of Medicare beneficiaries switch their Part D prescription drug or Medicare Advantage plans each year, even when doing so could save them money. \"There are tradeoffs involved in making changes and we know from Part D and Medicare Advantage that people don’t really change very often,\" said Tricia Neuman, who oversees the foundation’s Medicare analyses.\u003c/p>\n\u003cp>In addition, the new study noted that some low-cost plans might not be able to handle an influx of new beneficiaries. A particularly glaring example is in Los Angeles County, where fewer than 10,000 beneficiaries are enrolled in one of the two lowest-cost plans, while more than 900,000 beneficiaries are enrolled in traditional Medicare or other plans\u003c/p>\n\u003cp>The study did not estimate how much money the plan would have saved Medicare. In a statement, the Romney campaign said: \"As the authors stress, this is not a study of the Romney-Ryan plan. Our plan would always provide future beneficiaries guaranteed coverage options with no increase in out-of-pocket costs from today's Medicare.\" The Obama campaign trumpeted the study, saying it \"demonstrates how hollow\" is Romney’s claim that the elderly would retain the option of enrolling in traditional Medicare under their plan.\u003c/p>\n\u003cp>Joe Antos, a health care expert at the American Enterprise Institute, said that the study is \"the best technical study so far of this sort,\" although he expected a premium support market would be much more competitive than the current Medicare Advantage market is, since the latter is guaranteed a certain payment by the federal government.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The competition would be even more intense,\" he said, especially since most Medicare beneficiaries would not be able to afford anything more expensive than the benchmark plan, and thus insurers would compete to meet those prices. \"You just can't have high costs if people can’t pay it,\" he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Fact checkers wasted no time today in pointing out flaws in both candidates' statements during the presidential debate.\u003c/p>\n\u003cp>\u003ca title=\"http://www.politico.com/news/stories/1012/82003.html\" href=\"http://www.politico.com/news/stories/1012/82003.html\" target=\"_blank\">Politico\u003c/a> --Analyzing Health Care Statements\u003c/p>\n\u003cblockquote>\u003cp>President Barack Obama and Mitt Romney had at it out over health care Wednesday night — providing some of the toughest, and wonkiest, moments of the night.\u003c/p>\n\u003cp>Both candidates also showed they had done their research, citing studies to back their claims about Obama's health care law and how the other would cut Medicare spending — but they both managed to stretch the truth.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003c/blockquote>\n\u003cp>\u003ca title=\"http://www.latimes.com/news/politics/la-pn-fact-check-romney-healthcare-20121003,0,5148610.story\" href=\"http://www.latimes.com/news/politics/la-pn-fact-check-romney-healthcare-20121003,0,5148610.story\" target=\"_blank\">Los Angeles Times\u003c/a> -- Romney Repeats Erroneous Claims on Health Care\u003c/p>\n\u003cblockquote>\u003cp>\u003ca id=\"PEPLT007376\" title=\"Mitt Romney\" href=\"http://www.latimes.com/topic/politics/government/mitt-romney-PEPLT007376.topic\">Mitt Romney\u003c/a> repeated a number of erroneous claims during Wednesday’s debate about \u003ca id=\"PEPLT007408\" title=\"Barack Obama\" href=\"http://www.latimes.com/topic/politics/government/barack-obama-PEPLT007408.topic\">President Obama\u003c/a>’s healthcare law, including that it relies on a board that will decide \"what kind of treatment” patients can get.\u003c/p>\n\u003cp>This is a myth advanced repeatedly by critics of the \u003ca id=\"EVGAP00039\" title=\"Patient Protection and Affordable Care Act\" href=\"http://www.latimes.com/topic/health/healthcare-laws/patient-protection-affordable-care-act-EVGAP00039.topic\">Affordable Care Act\u003c/a> and debunked consistently by independent fact-checkers.\u003c/p>\u003c/blockquote>\n\u003cp>\u003ca title=\"http://www.washingtonpost.com/blogs/election-2012/wp/2012/10/03/fact-check-the-700b-medicare-cut/\" href=\"http://www.washingtonpost.com/blogs/election-2012/wp/2012/10/03/fact-check-the-700b-medicare-cut/\"> Washington Post\u003c/a> -- The $700 Billion Medicare Cut\u003c/p>\n\u003cblockquote>\u003cp>Romney accused Obama of taking $716 billion from Medicare. This $700 billion figure comes from the difference over 10 years (2013-2022) between anticipated Medicare spending (what is known as “the baseline”) and the changes that the law makes to reduce spending. The savings mostly are wrung from health-care providers, not Medicare beneficiaries — who, as a result of the health-care law, ended up with new benefits for preventive care and prescription drugs.\u003c/p>\u003c/blockquote>\n\u003cp> \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Fact checkers wasted no time today in pointing out flaws in both candidates' statements during the presidential debate.\u003c/p>\n\u003cp>\u003ca title=\"http://www.politico.com/news/stories/1012/82003.html\" href=\"http://www.politico.com/news/stories/1012/82003.html\" target=\"_blank\">Politico\u003c/a> --Analyzing Health Care Statements\u003c/p>\n\u003cblockquote>\u003cp>President Barack Obama and Mitt Romney had at it out over health care Wednesday night — providing some of the toughest, and wonkiest, moments of the night.\u003c/p>\n\u003cp>Both candidates also showed they had done their research, citing studies to back their claims about Obama's health care law and how the other would cut Medicare spending — but they both managed to stretch the truth.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003c/blockquote>\n\u003cp>\u003ca title=\"http://www.latimes.com/news/politics/la-pn-fact-check-romney-healthcare-20121003,0,5148610.story\" href=\"http://www.latimes.com/news/politics/la-pn-fact-check-romney-healthcare-20121003,0,5148610.story\" target=\"_blank\">Los Angeles Times\u003c/a> -- Romney Repeats Erroneous Claims on Health Care\u003c/p>\n\u003cblockquote>\u003cp>\u003ca id=\"PEPLT007376\" title=\"Mitt Romney\" href=\"http://www.latimes.com/topic/politics/government/mitt-romney-PEPLT007376.topic\">Mitt Romney\u003c/a> repeated a number of erroneous claims during Wednesday’s debate about \u003ca id=\"PEPLT007408\" title=\"Barack Obama\" href=\"http://www.latimes.com/topic/politics/government/barack-obama-PEPLT007408.topic\">President Obama\u003c/a>’s healthcare law, including that it relies on a board that will decide \"what kind of treatment” patients can get.\u003c/p>\n\u003cp>This is a myth advanced repeatedly by critics of the \u003ca id=\"EVGAP00039\" title=\"Patient Protection and Affordable Care Act\" href=\"http://www.latimes.com/topic/health/healthcare-laws/patient-protection-affordable-care-act-EVGAP00039.topic\">Affordable Care Act\u003c/a> and debunked consistently by independent fact-checkers.\u003c/p>\u003c/blockquote>\n\u003cp>\u003ca title=\"http://www.washingtonpost.com/blogs/election-2012/wp/2012/10/03/fact-check-the-700b-medicare-cut/\" href=\"http://www.washingtonpost.com/blogs/election-2012/wp/2012/10/03/fact-check-the-700b-medicare-cut/\"> Washington Post\u003c/a> -- The $700 Billion Medicare Cut\u003c/p>\n\u003cblockquote>\u003cp>Romney accused Obama of taking $716 billion from Medicare. This $700 billion figure comes from the difference over 10 years (2013-2022) between anticipated Medicare spending (what is known as “the baseline”) and the changes that the law makes to reduce spending. The savings mostly are wrung from health-care providers, not Medicare beneficiaries — who, as a result of the health-care law, ended up with new benefits for preventive care and prescription drugs.\u003c/p>\u003c/blockquote>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Analysis: Access to Health Care Starting to Resemble Access to Air Travel",
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"content": "\u003cp>By Michael L. Millenson, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/September/26/millenson-health-care-and-airlines.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/September/26/millenson-health-care-and-airlines.aspx\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8528\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/AirplaneSeats_Victor_L_Antunez_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8528 \" title=\"Each one of these seats might have a different price, much like any health procedure. (Victor L. Antunez: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/AirplaneSeats_Victor_L_Antunez_Flickr-300x225.jpg\" alt=\"Each one of these seats might have a different price, much like any health procedure. (Victor L. Antunez: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Each one of these seats might have a different price, much like a health insurance policy. (Victor L. Antunez: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The old axis of access in U.S. health care -- insured or uninsured -- is being replaced by the kind of gradations and complexity in determining who-gets-what-when-for-what-price for which the airline industry has become famous.\u003c/p>\n\u003cp>Some recent data and reactions to the provisions of the Affordable Care Act reinforce the trend. Here's an overview:\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Being able to afford any kind of seat\u003c/em>.\u003c/strong> Sure, the number of Americans left standing at the gate because they can't afford a health insurance \"ticket\" is declining. But, the scheduled takeoff in insurance coverage has run into mechanical difficulties. The Census Bureau announced this month \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/September/12/census-number-of-uninsured-drops.aspx\">that the number of uninsured\u003c/a> dropped slightly in 2011 to 48.6 million, or 15.7 percent of the population. That slide is partly because parents can keep children on their insurance plans until age 26.\u003c/p>\n\u003cp>But prospects of adding another 30 million Americans starting in 2014 are now up in the air. While the Supreme Court \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/06/28/supreme-court-health-care-decision/\" href=\"http://ww2.kqed.org/stateofhealth/2012/06/28/supreme-court-health-care-decision/\" target=\"_blank\">upheld most of the federal health law\u003c/a>, it struck down the penalty designed to compel states to expand Medicaid. That decision could void tickets to health insurance for an estimated three million people, says the \u003ca href=\"http://www.cbo.gov/publication/43472\">Congressional Budget Office and Joint Committee on Taxation\u003c/a>, and possibly a lot more, according to a \u003ca href=\"http://healthaffairs.org/blog/2012/07/31/cbos-updated-affordable-care-act-estimates-resting-on-shaky-assumptions/\">critical analysis\u003c/a> by two liberal legal experts.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>\u003cem>A ticket isn't the same as a seat\u003c/em>.\u003c/strong> As airline passengers have learned, having a ticket isn't the same as having a confirmed seat. In 2011\u003cstrong>, \u003c/strong>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22869644\">nearly one-third of physicians said\u003c/a> they wouldn't accept new Medicaid patients because of payment issues; a smaller number of doctors have said the same thing about Medicare patients. Even with some private plans, you may be on permanent standby because the doctor of your choice does not accept your health plan.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Your private jet is ready\u003c/em>.\u003c/strong> Of course, when money is no object, there are those who rate the equivalent of a private jet. That group would include individuals paying \u003ca href=\"http://www.nytimes.com/2011/04/30/your-money/30wealth.html?pagewanted=all\">a reported $6,000 to $27,000 a month\u003c/a> for \"boutique\" services like Guardian 24/7 (whose one-page public\u003cstrong> \u003c/strong>\u003ca href=\"http://www.guardian247.com/\">website\u003c/a> simply says, \"By Invitation Only\"), \u003ca href=\"http://www.worldclinic.com/\">World Clinic\u003c/a> and \u003ca href=\"http://www.pinnaclecare.com/\">PinnacleCare Private Health Advisory\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Business class\u003c/em>\u003c/strong>. Unlike Medicaid \"recipients,\" Medicare \"beneficiaries\" start off with a generous benefit at a modest price and can easily upgrade. They can choose a Medicare Advantage plan in which the average enrollee receives additional benefits and reduced cost-sharing. In addition\u003cstrong>, \u003c/strong>\u003ca href=\"http://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html\">Medigap\u003c/a> plans provide wrap-around coverage to pay costs traditional Medicare doesn't.\u003c/p>\n\u003cp>Also traveling business class are those participants in the fast-dwindling number of health plans provided by unions, \u003ca href=\"http://www.daytondailynews.com/news/news/township-employees-pay-least-for-health-care-cover/nR485/\">municipal employers\u003c/a> or private companies where the worker contribution is minimal and benefits are generous.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Coach, but some people get better seats and prices\u003c/em>.\u003c/strong> Patients with traditional Medicare coverage, \u003ca href=\"http://content.healthaffairs.org/content/31/8/1866.short\">a recent study found\u003c/a>, are more likely than those with private health insurance to get needed care, to avoid access problems due to cost, and to be satisfied with their coverage. Medicare even \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21841296\">reduces racial and ethnic disparities\u003c/a> in access and drug expenditures.\u003c/p>\n\u003cp>But being a high-wage worker with a good employer-sponsored plan also is a great way to get a good ticket. A new \u003ca href=\"http://content.healthaffairs.org/content/early/2012/09/07/hlthaff.2012.0708.full\">Kaiser Family Foundation survey\u003c/a> found that workers at businesses with more low-wage employees paid an average of nearly $1,000 more for their share of premiums than workers in a high-wage environment.\u003c/p>\n\u003cp>Workers at small firms face higher cost sharing, including higher copayments and higher deductibles, and may face a greater premium contribution, the KFF survey found. Think of it as a high-cost ticket and maybe a middle seat, to boot.\u003cem> \u003c/em>In that same vein, the health overhaul's ban on insurers using pre-existing condition information to refuse coverage or raise prices doesn't take effect until 2014, which affects today's self-employed workers who are older and have families. Those workers can find themselves paying much more than the \u003ca href=\"http://content.healthaffairs.org/content/early/2012/09/07/hlthaff.2012.0708.full\" target=\"_blank\">$15,745 average premium cost for family coverage\u003c/a> under an employer plan. State plans for high-risk individuals who are otherwise uninsurable typically are high priced and full of restrictions.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Sorry, your flight has been delayed\u003c/em>.\u003c/strong> Of course, even sitting in first class doesn't mean your flight won't have mechanical problems or a rough landing. Similarly, the most comprehensive insurance is no guarantee of high-quality, safe and appropriate care.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>A new ticketing system?\u003c/em>\u003c/strong> For all the inconveniences of the current health insurance system, it is at least familiar. However, both the public and private sectors have plans to shake up the shopping-for-insurance process as has happened in the era of deregulated airlines.\u003c/p>\n\u003cp>Unlike with airline tickets, however, consumer choices in health care can lead to consequences that truly are non-changeable and non-refundable. Whether the industry turmoil leads to more Americans getting a better \"seat\" at a better price remains to be seen.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Michael L. Millenson is a Highland Park, Illinois-based consultant, a visiting scholar at the Kellogg School of Management and the author of \u003c/em>\u003ca href=\"http://www.press.uchicago.edu/Misc/Chicago/525872.html\" target=\"_blank\">\u003cem>Demanding Medical Excellence: Doctors and Accountability in the Information Age\u003c/em>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n",
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"excerpt": "The old axis of access in U.S. health care -- insured or uninsured -- is being replaced by the kind of gradations and complexity in determining who-gets-what-when-for-what-price for which the airline industry has become famous.\r\n\r\nSome recent data and reactions to the provisions of the Affordable Care Act reinforce the trend. Here's an overview:\r\n\r\nBeing able to afford any kind of seat. Sure, the number of Americans left standing at the gate because they can't afford a health insurance \"ticket\" is declining. But, the scheduled takeoff in insurance coverage has run into mechanical difficulties. The Census Bureau announced this month that the number of uninsured dropped slightly in 2011 to 48.6 million, or 15.7 percent of the population. That slide is partly because parents can keep children on their insurance plans until age 26.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Michael L. Millenson, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/September/26/millenson-health-care-and-airlines.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/September/26/millenson-health-care-and-airlines.aspx\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8528\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/AirplaneSeats_Victor_L_Antunez_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8528 \" title=\"Each one of these seats might have a different price, much like any health procedure. (Victor L. Antunez: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/AirplaneSeats_Victor_L_Antunez_Flickr-300x225.jpg\" alt=\"Each one of these seats might have a different price, much like any health procedure. (Victor L. Antunez: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Each one of these seats might have a different price, much like a health insurance policy. (Victor L. Antunez: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The old axis of access in U.S. health care -- insured or uninsured -- is being replaced by the kind of gradations and complexity in determining who-gets-what-when-for-what-price for which the airline industry has become famous.\u003c/p>\n\u003cp>Some recent data and reactions to the provisions of the Affordable Care Act reinforce the trend. Here's an overview:\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Being able to afford any kind of seat\u003c/em>.\u003c/strong> Sure, the number of Americans left standing at the gate because they can't afford a health insurance \"ticket\" is declining. But, the scheduled takeoff in insurance coverage has run into mechanical difficulties. The Census Bureau announced this month \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/September/12/census-number-of-uninsured-drops.aspx\">that the number of uninsured\u003c/a> dropped slightly in 2011 to 48.6 million, or 15.7 percent of the population. That slide is partly because parents can keep children on their insurance plans until age 26.\u003c/p>\n\u003cp>But prospects of adding another 30 million Americans starting in 2014 are now up in the air. While the Supreme Court \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/06/28/supreme-court-health-care-decision/\" href=\"http://ww2.kqed.org/stateofhealth/2012/06/28/supreme-court-health-care-decision/\" target=\"_blank\">upheld most of the federal health law\u003c/a>, it struck down the penalty designed to compel states to expand Medicaid. That decision could void tickets to health insurance for an estimated three million people, says the \u003ca href=\"http://www.cbo.gov/publication/43472\">Congressional Budget Office and Joint Committee on Taxation\u003c/a>, and possibly a lot more, according to a \u003ca href=\"http://healthaffairs.org/blog/2012/07/31/cbos-updated-affordable-care-act-estimates-resting-on-shaky-assumptions/\">critical analysis\u003c/a> by two liberal legal experts.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\u003cem>A ticket isn't the same as a seat\u003c/em>.\u003c/strong> As airline passengers have learned, having a ticket isn't the same as having a confirmed seat. In 2011\u003cstrong>, \u003c/strong>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22869644\">nearly one-third of physicians said\u003c/a> they wouldn't accept new Medicaid patients because of payment issues; a smaller number of doctors have said the same thing about Medicare patients. Even with some private plans, you may be on permanent standby because the doctor of your choice does not accept your health plan.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Your private jet is ready\u003c/em>.\u003c/strong> Of course, when money is no object, there are those who rate the equivalent of a private jet. That group would include individuals paying \u003ca href=\"http://www.nytimes.com/2011/04/30/your-money/30wealth.html?pagewanted=all\">a reported $6,000 to $27,000 a month\u003c/a> for \"boutique\" services like Guardian 24/7 (whose one-page public\u003cstrong> \u003c/strong>\u003ca href=\"http://www.guardian247.com/\">website\u003c/a> simply says, \"By Invitation Only\"), \u003ca href=\"http://www.worldclinic.com/\">World Clinic\u003c/a> and \u003ca href=\"http://www.pinnaclecare.com/\">PinnacleCare Private Health Advisory\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Business class\u003c/em>\u003c/strong>. Unlike Medicaid \"recipients,\" Medicare \"beneficiaries\" start off with a generous benefit at a modest price and can easily upgrade. They can choose a Medicare Advantage plan in which the average enrollee receives additional benefits and reduced cost-sharing. In addition\u003cstrong>, \u003c/strong>\u003ca href=\"http://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html\">Medigap\u003c/a> plans provide wrap-around coverage to pay costs traditional Medicare doesn't.\u003c/p>\n\u003cp>Also traveling business class are those participants in the fast-dwindling number of health plans provided by unions, \u003ca href=\"http://www.daytondailynews.com/news/news/township-employees-pay-least-for-health-care-cover/nR485/\">municipal employers\u003c/a> or private companies where the worker contribution is minimal and benefits are generous.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Coach, but some people get better seats and prices\u003c/em>.\u003c/strong> Patients with traditional Medicare coverage, \u003ca href=\"http://content.healthaffairs.org/content/31/8/1866.short\">a recent study found\u003c/a>, are more likely than those with private health insurance to get needed care, to avoid access problems due to cost, and to be satisfied with their coverage. Medicare even \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21841296\">reduces racial and ethnic disparities\u003c/a> in access and drug expenditures.\u003c/p>\n\u003cp>But being a high-wage worker with a good employer-sponsored plan also is a great way to get a good ticket. A new \u003ca href=\"http://content.healthaffairs.org/content/early/2012/09/07/hlthaff.2012.0708.full\">Kaiser Family Foundation survey\u003c/a> found that workers at businesses with more low-wage employees paid an average of nearly $1,000 more for their share of premiums than workers in a high-wage environment.\u003c/p>\n\u003cp>Workers at small firms face higher cost sharing, including higher copayments and higher deductibles, and may face a greater premium contribution, the KFF survey found. Think of it as a high-cost ticket and maybe a middle seat, to boot.\u003cem> \u003c/em>In that same vein, the health overhaul's ban on insurers using pre-existing condition information to refuse coverage or raise prices doesn't take effect until 2014, which affects today's self-employed workers who are older and have families. Those workers can find themselves paying much more than the \u003ca href=\"http://content.healthaffairs.org/content/early/2012/09/07/hlthaff.2012.0708.full\" target=\"_blank\">$15,745 average premium cost for family coverage\u003c/a> under an employer plan. State plans for high-risk individuals who are otherwise uninsurable typically are high priced and full of restrictions.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Sorry, your flight has been delayed\u003c/em>.\u003c/strong> Of course, even sitting in first class doesn't mean your flight won't have mechanical problems or a rough landing. Similarly, the most comprehensive insurance is no guarantee of high-quality, safe and appropriate care.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>A new ticketing system?\u003c/em>\u003c/strong> For all the inconveniences of the current health insurance system, it is at least familiar. However, both the public and private sectors have plans to shake up the shopping-for-insurance process as has happened in the era of deregulated airlines.\u003c/p>\n\u003cp>Unlike with airline tickets, however, consumer choices in health care can lead to consequences that truly are non-changeable and non-refundable. Whether the industry turmoil leads to more Americans getting a better \"seat\" at a better price remains to be seen.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Michael L. Millenson is a Highland Park, Illinois-based consultant, a visiting scholar at the Kellogg School of Management and the author of \u003c/em>\u003ca href=\"http://www.press.uchicago.edu/Misc/Chicago/525872.html\" target=\"_blank\">\u003cem>Demanding Medical Excellence: Doctors and Accountability in the Information Age\u003c/em>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What's In A Name? 'Health Benefit Exchange' Seeks New Brand",
"title": "What's In A Name? 'Health Benefit Exchange' Seeks New Brand",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cem>Editor's Note: This story is part of a partnership that includes Capitol Public Radio, NPR and \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/September/25/california-health-insurance-exchange.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/September/25/california-health-insurance-exchange.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>By Pauline Bartolone, Capital Public Radio\u003c/p>\n\u003cfigure id=\"attachment_8509\" class=\"wp-caption alignleft\" style=\"max-width: 290px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/Screen-Shot-2012-09-26-at-6.57.34-AM.png\">\u003cimg class=\"size-full wp-image-8509 \" title=\"(Image: Kaiser Health News)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/Screen-Shot-2012-09-26-at-6.57.34-AM.png\" alt=\"(Image: Kaiser Health News)\" width=\"290\" height=\"195\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Don't worry -- \"avocado\" was rejected. (Image: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>As states work to comply with the federal health care law, many are designing their insurance exchanges, where people will be able to shop for coverage.\u003c/p>\n\u003cp>But just the word \"exchange\" sounds to many like off-putting government-speak, and some states are eager to come up with a more appealing name for these new marketplaces.\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthexchange.ca.gov/Documents/HBEXPeterLeeRelease.pdf\">Peter Lee\u003c/a>, who directs California's Health Benefit Exchange, says it’s up for a new name, and he says they want it to sound fresh, dynamic and innovative.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"What we're trying to figure out is what's a name that's going to stick, that's going to grab hold, that all Californians are going to say 'Boy, that's where I go to find healthcare,' \" Lee says.\u003c/p>\n\u003cp>The exchange will have a website where people can buy private health insurance, and many consumers will have government subsidies to help them purchase the insurance. Planners hope at least 3 million California customers will enroll for benefits starting in 2014. But that 3 million is a diverse bunch — so organizers want a name that will grab\u003cem>all\u003c/em> of them.\u003c!--more-->\u003c/p>\n\u003cp>\"Almost half of the people that are going to be eligible for subsidized coverage in the exchange are Spanish-speaking,\" Lee says. \"But that's not the only market. We have about 600,000 people that speak Asian-Pacific Islander languages. Some of them speak Mandarin; some speak Hmong.\"\u003c/p>\n\u003cp>Lee and his team solicited names in California and got hundreds of suggestions. Among them: Avocado, Ursa, Eureka — names or concepts uniquely Californian. They tested them with focus groups.\u003c/p>\n\u003cp>The name Avocado got laughs but is now out of the running. Other names were borrowed from Spanish, like Calvida and Beneficia. They considered Healthifornia and Wellquest.\u003c/p>\n\u003cp>Claudia Caplan, a marketing expert with the \u003ca href=\"http://rp3agency.com/#home\">RP3 Agency\u003c/a> in Maryland, has done everything from naming fast-food hamburgers to marketing for a freight rail carrier. She says a name for a new health marketplace should have humanity but shouldn't be too cute.\u003c/p>\n\u003cp>\"This is a whole new world for people in terms of how they're going to access insurance, and it might be wise to give them a name that makes them feel metaphorically wrapped in some nice, warm arms that are going to take care of them,\" Caplan says.\u003c/p>\n\u003cp>Still, a name isn't as important as what you build around it, she notes. \"It's going to be such a turnoff if you give it this great, nurturing name and it just turns out to be the DMV all over again,\" Caplan says.\u003c/p>\n\u003cp>California's exchange staff is sharing notes with counterparts in other states. Maryland just came up with its name and logo.\u003c/p>\n\u003cp>Dr. Joshua Sharfstein, Maryland's Secretary of \u003ca href=\"http://dhmh.maryland.gov/SitePages/Home.aspx\">Health and Mental Hygeine\u003c/a> and chairman of that state's exchange, says they tossed around action names. \"We had some that had verbs in them like 'Cover Me Now Maryland,' 'Cover Insure Maryland,' 'Get Health Care Maryland,' those sorts of things,\" Sharfstein says.\u003c/p>\n\u003cp>He says one person even suggested \"www.icantbelieveitsthiseasytobuyhealthinsurance.com.\" But the Maryland planners went with something safe and trustworthy: \u003ca href=\"http://www.marylandhealthconnection.gov/\">Maryland Health Connection\u003c/a>.\u003c/p>\n\u003cp>\"We thought it was simple,\" says Sharfstein. \"It illustrated the importance of connecting: connecting with insurance brokers, producers, connecting people to insurance products as well as connecting people to health care and health.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is expected to release its new name and logo in November. The frontrunners? Eureka, a reference to the gold rush (and the state’s motto), and Ursa, which is Latin for bear and a symbol on California's state flag. Condor is off the table. While uniquely Californian, it is a vulture that almost went extinct.\u003c/p>\n\n",
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"excerpt": "As states work to comply with the federal health care law, many are designing their insurance exchanges, where people will be able to shop for coverage.\r\n\r\nBut just the word \"exchange\" sounds to many like off-putting government-speak, and some states are eager to come up with a more appealing name for these new marketplaces.\r\n\r\nPeter Lee, who directs California's Health Benefit Exchange, says it’s up for a new name, and he says they want it to sound fresh, dynamic and innovative.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor's Note: This story is part of a partnership that includes Capitol Public Radio, NPR and \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/September/25/california-health-insurance-exchange.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/September/25/california-health-insurance-exchange.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>By Pauline Bartolone, Capital Public Radio\u003c/p>\n\u003cfigure id=\"attachment_8509\" class=\"wp-caption alignleft\" style=\"max-width: 290px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/Screen-Shot-2012-09-26-at-6.57.34-AM.png\">\u003cimg class=\"size-full wp-image-8509 \" title=\"(Image: Kaiser Health News)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/Screen-Shot-2012-09-26-at-6.57.34-AM.png\" alt=\"(Image: Kaiser Health News)\" width=\"290\" height=\"195\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Don't worry -- \"avocado\" was rejected. (Image: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>As states work to comply with the federal health care law, many are designing their insurance exchanges, where people will be able to shop for coverage.\u003c/p>\n\u003cp>But just the word \"exchange\" sounds to many like off-putting government-speak, and some states are eager to come up with a more appealing name for these new marketplaces.\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthexchange.ca.gov/Documents/HBEXPeterLeeRelease.pdf\">Peter Lee\u003c/a>, who directs California's Health Benefit Exchange, says it’s up for a new name, and he says they want it to sound fresh, dynamic and innovative.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"What we're trying to figure out is what's a name that's going to stick, that's going to grab hold, that all Californians are going to say 'Boy, that's where I go to find healthcare,' \" Lee says.\u003c/p>\n\u003cp>The exchange will have a website where people can buy private health insurance, and many consumers will have government subsidies to help them purchase the insurance. Planners hope at least 3 million California customers will enroll for benefits starting in 2014. But that 3 million is a diverse bunch — so organizers want a name that will grab\u003cem>all\u003c/em> of them.\u003c!--more-->\u003c/p>\n\u003cp>\"Almost half of the people that are going to be eligible for subsidized coverage in the exchange are Spanish-speaking,\" Lee says. \"But that's not the only market. We have about 600,000 people that speak Asian-Pacific Islander languages. Some of them speak Mandarin; some speak Hmong.\"\u003c/p>\n\u003cp>Lee and his team solicited names in California and got hundreds of suggestions. Among them: Avocado, Ursa, Eureka — names or concepts uniquely Californian. They tested them with focus groups.\u003c/p>\n\u003cp>The name Avocado got laughs but is now out of the running. Other names were borrowed from Spanish, like Calvida and Beneficia. They considered Healthifornia and Wellquest.\u003c/p>\n\u003cp>Claudia Caplan, a marketing expert with the \u003ca href=\"http://rp3agency.com/#home\">RP3 Agency\u003c/a> in Maryland, has done everything from naming fast-food hamburgers to marketing for a freight rail carrier. She says a name for a new health marketplace should have humanity but shouldn't be too cute.\u003c/p>\n\u003cp>\"This is a whole new world for people in terms of how they're going to access insurance, and it might be wise to give them a name that makes them feel metaphorically wrapped in some nice, warm arms that are going to take care of them,\" Caplan says.\u003c/p>\n\u003cp>Still, a name isn't as important as what you build around it, she notes. \"It's going to be such a turnoff if you give it this great, nurturing name and it just turns out to be the DMV all over again,\" Caplan says.\u003c/p>\n\u003cp>California's exchange staff is sharing notes with counterparts in other states. Maryland just came up with its name and logo.\u003c/p>\n\u003cp>Dr. Joshua Sharfstein, Maryland's Secretary of \u003ca href=\"http://dhmh.maryland.gov/SitePages/Home.aspx\">Health and Mental Hygeine\u003c/a> and chairman of that state's exchange, says they tossed around action names. \"We had some that had verbs in them like 'Cover Me Now Maryland,' 'Cover Insure Maryland,' 'Get Health Care Maryland,' those sorts of things,\" Sharfstein says.\u003c/p>\n\u003cp>He says one person even suggested \"www.icantbelieveitsthiseasytobuyhealthinsurance.com.\" But the Maryland planners went with something safe and trustworthy: \u003ca href=\"http://www.marylandhealthconnection.gov/\">Maryland Health Connection\u003c/a>.\u003c/p>\n\u003cp>\"We thought it was simple,\" says Sharfstein. \"It illustrated the importance of connecting: connecting with insurance brokers, producers, connecting people to insurance products as well as connecting people to health care and health.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is expected to release its new name and logo in November. The frontrunners? Eureka, a reference to the gold rush (and the state’s motto), and Ursa, which is Latin for bear and a symbol on California's state flag. Condor is off the table. While uniquely Californian, it is a vulture that almost went extinct.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Low-income Parents Brace for End of 'Healthy Families'",
"title": "Low-income Parents Brace for End of 'Healthy Families'",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>By Mina Kim\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8472\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/MinaPhoto.jpg\">\u003cimg class=\"size-medium wp-image-8472\" title=\"Maria Garibay worries her daughters won't be able to stay with their current doctors when they switch from Healthy Families to Medi-Cal next year.(Mina Kim: KQED)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/MinaPhoto-300x225.jpg\" alt=\"Maria Garibay worries her daughters won't be able to stay with their current doctors when they switch from Healthy Families to Medi-Cal next year.(Mina Kim: KQED)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria Garibay worries her daughters won't be able to stay with their current doctors when they switch from Healthy Families to Medi-Cal next year.(Mina Kim: KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Next January, the state will begin transferring hundreds of thousands of low-income kids from its popular \u003ca title=\"http://www.healthyfamilies.ca.gov/Home/default.aspx\" href=\"http://www.healthyfamilies.ca.gov/Home/default.aspx\" target=\"_blank\">Healthy Families\u003c/a> insurance plan to Medi-Cal -- which offers medical coverage to the state's poorest residents.\u003c/p>\n\u003cp>Ending Healthy Families was one of Governor Jerry Brown’s budget-balancing priorities and now families are feeling the weight of that decision.\u003c/p>\n\u003cp>At \u003ca title=\"http://www.napachi.org\" href=\"http://www.napachi.org\" target=\"_blank\">Children’s Health Initiative\u003c/a> in Napa, a nonprofit that helps get kids into affordable health plans, Maria Garibay has just gotten the news. Next year, her three girls will be moved from Healthy Families to Medi-Cal.\u003c/p>\n\u003cp>Speaking through an interpreter, Garibay says she's worried her monthly premium will go up. That's because last year Medi-Cal told her she'd need to start paying $1300 each month, per child, because of her income from a part-time restaurant job.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But then Garibay learned that she qualified for Healthy Families. The federally subsidized program is for families whose incomes are just above the federal poverty level. Under Healthy Families, Garibay pays a total premium of $14 a month. It's a godsend for Garibay whose oldest daughter has a heart condition.\u003c!--more-->\u003c/p>\n\u003cp>Garibay, through the interpreter, says \"My daughter's been seeing the same cardiologist since she was three years old. Will she be able to see her same cardiologist when she switches to Medi-Cal?\"\u003c/p>\n\u003cp>Children's Health Initiative manager Elba Gonzalez-Mares says she just doesn't know. Medi-Cal reimburses doctors at a lower rate than Healthy Families, so some doctors limit the number of Medi-Cal patients they take, or refuse to see them altogether.\u003c/p>\n\u003cp>Gonzales-Mares says she's been reassuring parents that their payments will be similar when the plan changes. But she hasn't been able to guarantee that their kids will be able to see the same doctors.\u003c/p>\n\u003cp>\"The reaction is very upsetting,\" Gonzales-Mares says of the families. \"They're concerned.\"\u003c/p>\n\u003cp>The state is ending Healthy Families as part of a budget deal between Governor Brown and Democratic lawmakers. It's designed to cut costs and save other health programs. Moving the nearly 900,000 kids in the Healthy Families program to Medi-Cal is expected to save $72 million a year by 2015.\u003c/p>\n\u003cp>Latino children make up nearly half the Healthy Families enrollees, and Gonzales-Mares worries they'll suffer the greatest disruptions in care. She says a survey of families the agency sees raises concerns about whether they'll understand that Healthy Families is ending.\u003c/p>\n\u003cp>\"The Latino family, yes, they speak Spanish. But their literacy levels are very low, a third grade level,\" she says, \"even in Spanish.\"\u003c/p>\n\u003cp>But Medi-Cal officials say the program is equipped to deal with the needs of Spanish speakers. \u003ca title=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Toby Douglas\u003c/a> leads the state's Department of Health Care Services, which oversees Medi-Cal.\u003c/p>\n\u003cp>\"Our proportion of individuals on the Medi-Cal program that are Spanish speaking or Latino descent are the same as those on Healthy Families,\" Douglas explains. \"So it’s an essential component of our Medi-Cal program today.\"\u003c/p>\n\u003cp>Douglas says his office is working hard to make sure there will be enough doctors and specialists to treat these kids. \"Close to 90 percent of the providers who participate in Healthy Families participate in the Medi-Cal program, and we believe that these providers will continue to see these children when they transition.\"\u003c/p>\n\u003cp>Douglas says under the \u003ca title=\"http://www.healthcare.gov/law/index.html\" href=\"http://www.healthcare.gov/law/index.html\" target=\"_blank\">federal health care overhaul\u003c/a>, Medi-Cal reimbursement rates will rise significantly for two years, beginning this January.\u003c/p>\n\u003cp>But some pediatricians, like Napa pediatrician Victoria Morgese, are skeptical the state will maintain the higher rates when those federal funds go away. \"The way I was raised, you can't get blood out of a turnip,\" she says. \"If the money's not there, the money's not there.\"\u003c/p>\n\u003cp>Morgese is one of thousands of California doctors now forced to decide whether to keep her Healthy Families patients once they switch over to Medi-Cal. \"My mentality is to take care of these people, to be a care provider,\" she says. \"And yet, I have to take everything into consideration because I have to run a business!\"\u003c/p>\n\u003cp>Morgese has more than 500 Healthy Families patients. She limits the number of Medi-Cal recipients to 10 percent of her patient load. Morgese says at current Medi-Cal reimbursement rates, she'd need to see three times the number of patients to keep the lights on.\u003c/p>\n\u003cp>\"That means that the model of practice that we have set up here,\" she explains, \"which is to spend a long time with our patients, to have a lower than average volume of patients per day in our office ... I wouldn't be able to do that.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Some children's health advocates are pushing for a delay to the transition. The four phase, year-long transfer is scheduled to begin in January.\u003c/p>\n\n",
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"excerpt": "Next January, the state will begin transferring hundreds of thousands of low-income kids from its popular Healthy Families insurance plan to Medi-Cal -- which offers medical coverage to the state's poorest residents.\r\n\r\nEnding Healthy Families was one of Governor Jerry Brown’s budget-balancing priorities and now families are feeling the weight of that decision.\r\n\r\nAt Children’s Health Initiative in Napa, a nonprofit that helps get kids into affordable health plans, Maria Garibay has just gotten the news. Next year, her three girls will be moved from Healthy Families to Medi-Cal.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Mina Kim\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8472\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/MinaPhoto.jpg\">\u003cimg class=\"size-medium wp-image-8472\" title=\"Maria Garibay worries her daughters won't be able to stay with their current doctors when they switch from Healthy Families to Medi-Cal next year.(Mina Kim: KQED)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/MinaPhoto-300x225.jpg\" alt=\"Maria Garibay worries her daughters won't be able to stay with their current doctors when they switch from Healthy Families to Medi-Cal next year.(Mina Kim: KQED)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria Garibay worries her daughters won't be able to stay with their current doctors when they switch from Healthy Families to Medi-Cal next year.(Mina Kim: KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Next January, the state will begin transferring hundreds of thousands of low-income kids from its popular \u003ca title=\"http://www.healthyfamilies.ca.gov/Home/default.aspx\" href=\"http://www.healthyfamilies.ca.gov/Home/default.aspx\" target=\"_blank\">Healthy Families\u003c/a> insurance plan to Medi-Cal -- which offers medical coverage to the state's poorest residents.\u003c/p>\n\u003cp>Ending Healthy Families was one of Governor Jerry Brown’s budget-balancing priorities and now families are feeling the weight of that decision.\u003c/p>\n\u003cp>At \u003ca title=\"http://www.napachi.org\" href=\"http://www.napachi.org\" target=\"_blank\">Children’s Health Initiative\u003c/a> in Napa, a nonprofit that helps get kids into affordable health plans, Maria Garibay has just gotten the news. Next year, her three girls will be moved from Healthy Families to Medi-Cal.\u003c/p>\n\u003cp>Speaking through an interpreter, Garibay says she's worried her monthly premium will go up. That's because last year Medi-Cal told her she'd need to start paying $1300 each month, per child, because of her income from a part-time restaurant job.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But then Garibay learned that she qualified for Healthy Families. The federally subsidized program is for families whose incomes are just above the federal poverty level. Under Healthy Families, Garibay pays a total premium of $14 a month. It's a godsend for Garibay whose oldest daughter has a heart condition.\u003c!--more-->\u003c/p>\n\u003cp>Garibay, through the interpreter, says \"My daughter's been seeing the same cardiologist since she was three years old. Will she be able to see her same cardiologist when she switches to Medi-Cal?\"\u003c/p>\n\u003cp>Children's Health Initiative manager Elba Gonzalez-Mares says she just doesn't know. Medi-Cal reimburses doctors at a lower rate than Healthy Families, so some doctors limit the number of Medi-Cal patients they take, or refuse to see them altogether.\u003c/p>\n\u003cp>Gonzales-Mares says she's been reassuring parents that their payments will be similar when the plan changes. But she hasn't been able to guarantee that their kids will be able to see the same doctors.\u003c/p>\n\u003cp>\"The reaction is very upsetting,\" Gonzales-Mares says of the families. \"They're concerned.\"\u003c/p>\n\u003cp>The state is ending Healthy Families as part of a budget deal between Governor Brown and Democratic lawmakers. It's designed to cut costs and save other health programs. Moving the nearly 900,000 kids in the Healthy Families program to Medi-Cal is expected to save $72 million a year by 2015.\u003c/p>\n\u003cp>Latino children make up nearly half the Healthy Families enrollees, and Gonzales-Mares worries they'll suffer the greatest disruptions in care. She says a survey of families the agency sees raises concerns about whether they'll understand that Healthy Families is ending.\u003c/p>\n\u003cp>\"The Latino family, yes, they speak Spanish. But their literacy levels are very low, a third grade level,\" she says, \"even in Spanish.\"\u003c/p>\n\u003cp>But Medi-Cal officials say the program is equipped to deal with the needs of Spanish speakers. \u003ca title=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Toby Douglas\u003c/a> leads the state's Department of Health Care Services, which oversees Medi-Cal.\u003c/p>\n\u003cp>\"Our proportion of individuals on the Medi-Cal program that are Spanish speaking or Latino descent are the same as those on Healthy Families,\" Douglas explains. \"So it’s an essential component of our Medi-Cal program today.\"\u003c/p>\n\u003cp>Douglas says his office is working hard to make sure there will be enough doctors and specialists to treat these kids. \"Close to 90 percent of the providers who participate in Healthy Families participate in the Medi-Cal program, and we believe that these providers will continue to see these children when they transition.\"\u003c/p>\n\u003cp>Douglas says under the \u003ca title=\"http://www.healthcare.gov/law/index.html\" href=\"http://www.healthcare.gov/law/index.html\" target=\"_blank\">federal health care overhaul\u003c/a>, Medi-Cal reimbursement rates will rise significantly for two years, beginning this January.\u003c/p>\n\u003cp>But some pediatricians, like Napa pediatrician Victoria Morgese, are skeptical the state will maintain the higher rates when those federal funds go away. \"The way I was raised, you can't get blood out of a turnip,\" she says. \"If the money's not there, the money's not there.\"\u003c/p>\n\u003cp>Morgese is one of thousands of California doctors now forced to decide whether to keep her Healthy Families patients once they switch over to Medi-Cal. \"My mentality is to take care of these people, to be a care provider,\" she says. \"And yet, I have to take everything into consideration because I have to run a business!\"\u003c/p>\n\u003cp>Morgese has more than 500 Healthy Families patients. She limits the number of Medi-Cal recipients to 10 percent of her patient load. Morgese says at current Medi-Cal reimbursement rates, she'd need to see three times the number of patients to keep the lights on.\u003c/p>\n\u003cp>\"That means that the model of practice that we have set up here,\" she explains, \"which is to spend a long time with our patients, to have a lower than average volume of patients per day in our office ... I wouldn't be able to do that.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Some children's health advocates are pushing for a delay to the transition. The four phase, year-long transfer is scheduled to begin in January.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>By Julie Appleby, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/September/11/employer-health-coverage-survey-premiums-rise-4-percent.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/September/11/employer-health-coverage-survey-premiums-rise-4-percent.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8418\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/insured-workers-300.jpg\">\u003cimg class=\"size-full wp-image-8418\" title=\"(Image: Kaiser Health News)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/insured-workers-300.jpg\" alt=\"(Image: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Image: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>Health insurance premiums rose 4 percent for family coverage this year, well below last year’s increase and half the 8 percent average of the previous decade -– largely because people used less health care in an uncertain economy.\u003c/p>\n\u003cp>Family plan premiums hit $15,745 on average, while premiums for single employees rose to $5,615, according to a \u003ca href=\"http://ehbs.kff.org/pdf/2012/8345.pdf\" target=\"_blank\">survey of employers\u003c/a> released Tuesday by the Kaiser Family Foundation and the Health Research & Educational Trust. (KHN is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>\"We’re seeing people make more consumer-oriented decisions, going for less expensive treatments or deferring surgery,\" said Julie Stone, senior consultant at \u003ca title=\"http://www.towerswatson.com/services/Health-and-Group-Benefits?gclid=CIXLnYfwrbICFYaDQgodWmkA1g\" href=\"http://www.towerswatson.com/services/Health-and-Group-Benefits?gclid=CIXLnYfwrbICFYaDQgodWmkA1g\" target=\"_blank\">Towers Watson\u003c/a>, an employer benefit consulting firm that does its own survey. Still, hospitals and other medical providers \"are not agreeing\" to \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-prices-hospitals.aspx\" target=\"_blank\">lower their prices\u003c/a>, she said.\u003c!--more-->\u003c/p>\n\u003cp>Although the increase is less than half \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/september/27/employer-health-coverage-survey-shows-employer-spending-spike.aspx\" target=\"_blank\">last year's 9 percent spike\u003c/a>, the Kaiser foundation’s survey results will likely be seen through the prism of election-year politics. Premium increases are a big pocketbook issue for individuals and small businesses -- something both sides have used to justify their positions on the 2010 health law. Democrats have said the federal health law is working to slow spending growth, while Republicans contend it will increase costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many analysts say both sides are overplaying the law’s effect since many of its provisions are not yet in effect. Full implementation of the \u003ca title=\"http://www.healthcare.gov/law/index.html\" href=\"http://www.healthcare.gov/law/index.html\" target=\"_blank\">Affordable Care Act\u003c/a> is January 1, 2014.\u003c/p>\n\u003cp>While the law's opponents blamed it for last year’s 9 percent increase, policy analysts said the premiums rose mainly because insurers incorrectly assumed that use of medical care would rise as the economy recovered.\u003c/p>\n\u003cp>But Americans did not rush out to use medical services last year, nor has use jumped this year, helping hold down overall medical spending.\u003c/p>\n\u003cp>\u003cstrong>Weak Economy Kept Premium Increase Down\u003c/strong>\u003c/p>\n\u003cp>The historically moderate level of premium increase was \"driven mostly by the weak economy that has caused some people to use less health care,\" said \u003ca href=\"http://www.kff.org/pullingittogether/altman_premium_increase.cfm\" target=\"_blank\">Drew Altman\u003c/a>, president and CEO of the foundation.\u003c/p>\n\u003cp>In addition, many employers continued efforts to limit premium growth by \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/June/04/high-deductible-health-insurance.aspx\" target=\"_blank\">raising deductibles\u003c/a>, among other benefit changes. For example, 34 percent of covered workers had an annual deductible of at least $1,000 for employee-only coverage, up from 10 percent in 2006.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Low-wage workers were hit hardest, paying on average $1,000 more each year toward their premiums for family coverage than workers at higher-wage firms. They were also more likely to have high deductibles, according to the survey.\u003c/p>\n\n",
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"description": "By Julie Appleby, Kaiser Health News Health insurance premiums rose 4 percent for family coverage this year, well below last year’s increase and half the 8 percent average of the previous decade -– largely because people used less health care in an uncertain economy. Family plan premiums hit $15,745 on average, while premiums for single",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Julie Appleby, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/September/11/employer-health-coverage-survey-premiums-rise-4-percent.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/September/11/employer-health-coverage-survey-premiums-rise-4-percent.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8418\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/insured-workers-300.jpg\">\u003cimg class=\"size-full wp-image-8418\" title=\"(Image: Kaiser Health News)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/09/insured-workers-300.jpg\" alt=\"(Image: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Image: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>Health insurance premiums rose 4 percent for family coverage this year, well below last year’s increase and half the 8 percent average of the previous decade -– largely because people used less health care in an uncertain economy.\u003c/p>\n\u003cp>Family plan premiums hit $15,745 on average, while premiums for single employees rose to $5,615, according to a \u003ca href=\"http://ehbs.kff.org/pdf/2012/8345.pdf\" target=\"_blank\">survey of employers\u003c/a> released Tuesday by the Kaiser Family Foundation and the Health Research & Educational Trust. (KHN is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>\"We’re seeing people make more consumer-oriented decisions, going for less expensive treatments or deferring surgery,\" said Julie Stone, senior consultant at \u003ca title=\"http://www.towerswatson.com/services/Health-and-Group-Benefits?gclid=CIXLnYfwrbICFYaDQgodWmkA1g\" href=\"http://www.towerswatson.com/services/Health-and-Group-Benefits?gclid=CIXLnYfwrbICFYaDQgodWmkA1g\" target=\"_blank\">Towers Watson\u003c/a>, an employer benefit consulting firm that does its own survey. Still, hospitals and other medical providers \"are not agreeing\" to \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-prices-hospitals.aspx\" target=\"_blank\">lower their prices\u003c/a>, she said.\u003c!--more-->\u003c/p>\n\u003cp>Although the increase is less than half \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/september/27/employer-health-coverage-survey-shows-employer-spending-spike.aspx\" target=\"_blank\">last year's 9 percent spike\u003c/a>, the Kaiser foundation’s survey results will likely be seen through the prism of election-year politics. Premium increases are a big pocketbook issue for individuals and small businesses -- something both sides have used to justify their positions on the 2010 health law. Democrats have said the federal health law is working to slow spending growth, while Republicans contend it will increase costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many analysts say both sides are overplaying the law’s effect since many of its provisions are not yet in effect. Full implementation of the \u003ca title=\"http://www.healthcare.gov/law/index.html\" href=\"http://www.healthcare.gov/law/index.html\" target=\"_blank\">Affordable Care Act\u003c/a> is January 1, 2014.\u003c/p>\n\u003cp>While the law's opponents blamed it for last year’s 9 percent increase, policy analysts said the premiums rose mainly because insurers incorrectly assumed that use of medical care would rise as the economy recovered.\u003c/p>\n\u003cp>But Americans did not rush out to use medical services last year, nor has use jumped this year, helping hold down overall medical spending.\u003c/p>\n\u003cp>\u003cstrong>Weak Economy Kept Premium Increase Down\u003c/strong>\u003c/p>\n\u003cp>The historically moderate level of premium increase was \"driven mostly by the weak economy that has caused some people to use less health care,\" said \u003ca href=\"http://www.kff.org/pullingittogether/altman_premium_increase.cfm\" target=\"_blank\">Drew Altman\u003c/a>, president and CEO of the foundation.\u003c/p>\n\u003cp>In addition, many employers continued efforts to limit premium growth by \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/June/04/high-deductible-health-insurance.aspx\" target=\"_blank\">raising deductibles\u003c/a>, among other benefit changes. For example, 34 percent of covered workers had an annual deductible of at least $1,000 for employee-only coverage, up from 10 percent in 2006.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Low-wage workers were hit hardest, paying on average $1,000 more each year toward their premiums for family coverage than workers at higher-wage firms. They were also more likely to have high deductibles, according to the survey.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_8143\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/HealthCareOverhaul_SEIUInternational_Flickr_06282012.jpg\">\u003cimg class=\"size-medium wp-image-8143\" title=\"Supporters demonstrate in favor of the Affordable Care Act on June 28, 2012 when the U.S. Supreme Court issued its ruling on the health care overhaul. (SEIU International: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/HealthCareOverhaul_SEIUInternational_Flickr_06282012-300x214.jpg\" alt=\"Supporters demonstrate in favor of the Affordable Care Act on June 28, 2012 when the U.S. Supreme Court issued its ruling on the health care overhaul. (SEIU International: Flickr)\" width=\"300\" height=\"214\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Supporters demonstrate in favor of the Affordable Care Act on June 28, 2012 when the U.S. Supreme Court issued its ruling on the health care overhaul. (SEIU International: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>While Americans as a whole remain sharply divided over the \u003ca title=\"www.healthcare.gov\" href=\"http://www.healthcare.gov\" target=\"_blank\">Affordable Care Act\u003c/a>, a majority of California voters -- 54 percent -- support the federal health care overhaul, a new Field Poll shows. Just over a third of Californians -- 37 percent -- oppose the law.\u003c/p>\n\u003cp>This strong support is not terribly surprising in a heavily Democratic state. In addition, more than one in five Californians is uninsured. Support for the health care overhaul is two-to-one among those without insurance or people who say they or a family member has gone without coverage in the last two years.\u003c/p>\n\u003cp>The Field Poll also dug into the nitty-gritty of the requirements of the Affordable Care Act, specifically the Health Benefit Exchange, an online marketplace where people will be able to shop for health insurance. California was the first state to pass legislation to commence setting up an exchange. Starting next fall, people will begin enrolling for coverage that will begin January 1, 2014.\u003c!--more-->\u003c/p>\n\u003cp>While only 17 percent of those surveyed were aware of the Exchange, nearly three-fourths of respondents (74 percent) said a website for comparison shopping would help them.\u003c/p>\n\u003cp>From the \u003ca title=\" http://www.sfgate.com/politics/joegarofoli/article/Californians-favor-health-law-s-exchanges-3800134.php#ixzz247SO6liW\" href=\"http://www.sfgate.com/politics/joegarofoli/article/Californians-favor-health-law-s-exchanges-3800134.php#ixzz247SO6liW\" target=\"_blank\">San Francisco Chronicle\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>In terms of how the exchange would work, a majority of voters (59 percent) want it to require insurance companies to offer more health plans that give primary-care doctors a bigger role in coordinating care for patients.\u003c/p>\n\u003cp>\"That is a fantastic finding,\" said \u003ca href=\"http://www.sfgate.com/?controllerName=search&action=search&channel=politics%2Fjoegarofoli&search=1&inlineLink=1&query=%22Diana+Bont%C3%A1%22\">Diana Bontá\u003c/a>, president and CEO of the California Wellness Foundation and a trained nurse. \"That is a sentiment that isn't coming from government study but from the voice of the people.\"\u003c/p>\n\u003cp>The poll also found that 52 percent of the respondents want insurance companies to structure their plans to reward doctors and hospitals more for their quality of care rather than the number of people they treat.\u003c/p>\n\u003cp>Fabeola Greer, a 64-year-old warehouse production worker in Oakland who was part of the survey, would use the insurance exchange \"so long as you could compare prices easily.\"\u003c/p>\n\u003cp>Like many Californians, Greer has insurance through her employer. But she worries about her children, both in their thirties, who don't have coverage. \"There are a lot of people like that who don't have it,\" she said.\u003c/p>\u003c/blockquote>\n\u003cp>This poll is in the sixth annual health policy survey sponsored by The California Wellness Foundation. This year's poll is based on telephone interview with 1,579 registered voters, conducted in seven languages and dialects -- English, Spanish, Cantonese, Mandarin, Korean, Vietnamese and Tagalog. The survey was conducted in July, after the U.S. Supreme Court handed down its decision largely upholding the Affordable Care Act.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "While Americans as a whole remain sharply divided over the Affordable Care Act, a majority of California voters -- 54 percent -- support the federal health care overhaul, a new Field Poll shows. Just over a third of Californians -- 37 percent -- oppose the law. This strong support is not terribly surprising in a heavily Democratic state. In addition, more than one in five Californians is uninsured. Support for the health care overhaul is two-to-one among those without insurance or people who say they or a family member has gone without coverage in the last two years.",
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"description": "While Americans as a whole remain sharply divided over the Affordable Care Act, a majority of California voters -- 54 percent -- support the federal health care overhaul, a new Field Poll shows. Just over a third of Californians -- 37 percent -- oppose the law. This strong support is not terribly surprising in a heavily Democratic state. In addition, more than one in five Californians is uninsured. Support for the health care overhaul is two-to-one among those without insurance or people who say they or a family member has gone without coverage in the last two years.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_8143\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/HealthCareOverhaul_SEIUInternational_Flickr_06282012.jpg\">\u003cimg class=\"size-medium wp-image-8143\" title=\"Supporters demonstrate in favor of the Affordable Care Act on June 28, 2012 when the U.S. Supreme Court issued its ruling on the health care overhaul. (SEIU International: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/HealthCareOverhaul_SEIUInternational_Flickr_06282012-300x214.jpg\" alt=\"Supporters demonstrate in favor of the Affordable Care Act on June 28, 2012 when the U.S. Supreme Court issued its ruling on the health care overhaul. (SEIU International: Flickr)\" width=\"300\" height=\"214\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Supporters demonstrate in favor of the Affordable Care Act on June 28, 2012 when the U.S. Supreme Court issued its ruling on the health care overhaul. (SEIU International: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>While Americans as a whole remain sharply divided over the \u003ca title=\"www.healthcare.gov\" href=\"http://www.healthcare.gov\" target=\"_blank\">Affordable Care Act\u003c/a>, a majority of California voters -- 54 percent -- support the federal health care overhaul, a new Field Poll shows. Just over a third of Californians -- 37 percent -- oppose the law.\u003c/p>\n\u003cp>This strong support is not terribly surprising in a heavily Democratic state. In addition, more than one in five Californians is uninsured. Support for the health care overhaul is two-to-one among those without insurance or people who say they or a family member has gone without coverage in the last two years.\u003c/p>\n\u003cp>The Field Poll also dug into the nitty-gritty of the requirements of the Affordable Care Act, specifically the Health Benefit Exchange, an online marketplace where people will be able to shop for health insurance. California was the first state to pass legislation to commence setting up an exchange. Starting next fall, people will begin enrolling for coverage that will begin January 1, 2014.\u003c!--more-->\u003c/p>\n\u003cp>While only 17 percent of those surveyed were aware of the Exchange, nearly three-fourths of respondents (74 percent) said a website for comparison shopping would help them.\u003c/p>\n\u003cp>From the \u003ca title=\" http://www.sfgate.com/politics/joegarofoli/article/Californians-favor-health-law-s-exchanges-3800134.php#ixzz247SO6liW\" href=\"http://www.sfgate.com/politics/joegarofoli/article/Californians-favor-health-law-s-exchanges-3800134.php#ixzz247SO6liW\" target=\"_blank\">San Francisco Chronicle\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>In terms of how the exchange would work, a majority of voters (59 percent) want it to require insurance companies to offer more health plans that give primary-care doctors a bigger role in coordinating care for patients.\u003c/p>\n\u003cp>\"That is a fantastic finding,\" said \u003ca href=\"http://www.sfgate.com/?controllerName=search&action=search&channel=politics%2Fjoegarofoli&search=1&inlineLink=1&query=%22Diana+Bont%C3%A1%22\">Diana Bontá\u003c/a>, president and CEO of the California Wellness Foundation and a trained nurse. \"That is a sentiment that isn't coming from government study but from the voice of the people.\"\u003c/p>\n\u003cp>The poll also found that 52 percent of the respondents want insurance companies to structure their plans to reward doctors and hospitals more for their quality of care rather than the number of people they treat.\u003c/p>\n\u003cp>Fabeola Greer, a 64-year-old warehouse production worker in Oakland who was part of the survey, would use the insurance exchange \"so long as you could compare prices easily.\"\u003c/p>\n\u003cp>Like many Californians, Greer has insurance through her employer. But she worries about her children, both in their thirties, who don't have coverage. \"There are a lot of people like that who don't have it,\" she said.\u003c/p>\u003c/blockquote>\n\u003cp>This poll is in the sixth annual health policy survey sponsored by The California Wellness Foundation. This year's poll is based on telephone interview with 1,579 registered voters, conducted in seven languages and dialects -- English, Spanish, Cantonese, Mandarin, Korean, Vietnamese and Tagalog. The survey was conducted in July, after the U.S. Supreme Court handed down its decision largely upholding the Affordable Care Act.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Paul Ryan's Plan for Medicare",
"title": "Paul Ryan's Plan for Medicare",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By \u003ca href=\"http://www.kaiserhealthnews.org/Reporters/SerafiniM.aspx\">Marilyn Werber Serafini\u003c/a>, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/August/11/faq-paul-ryan-house-republican-medicare-plan.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/August/11/faq-paul-ryan-house-republican-medicare-plan.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8069\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/ryan-romney-300_WinMcNamee_Getty.jpg\">\u003cimg class=\"size-full wp-image-8069 \" title=\"Republican Presidential Candidate Mitt Romney Announces Rep. Paul Ryan As His Vice Presidential Pick\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/ryan-romney-300_WinMcNamee_Getty.jpg\" alt=\"Republican Presidential Candidate Mitt Romney Announces Rep. Paul Ryan As His Vice Presidential Pick\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mitt Romney introduces Paul Ryan as his choice for running mate in Norfolk, Va., last Saturday. (Photo by Win McNamee/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Wisconsin Republican Paul Ryan, GOP presidential hopeful Mitt Romney’s choice for vice president, has provoked consternation from Democrats and anxiety among some congressional Republicans with his proposals to reshape Medicare.\u003c/p>\n\u003cp>The Republican-controlled House, along party lines, twice approved his proposals to overhaul the popular social insurance program for the elderly and disabled by giving beneficiaries a set amount of money every year to buy coverage from competing health plans. That is a fundamental shift from today’s program, where the federal government pays for as many services as beneficiaries use.\u003c/p>\n\u003cp>The proposals were never enacted because of opposition from the Democratic-controlled Senate and President Barack Obama.\u003c/p>\n\u003cp>This year, Democratic congressional candidates nationwide are making the protection of traditional Medicare a centerpiece of their campaigns, just as Republicans attacked them two years ago for curbing future Medicare spending as part of the 2010 health care law. Now, Democrats are hammering their GOP opponents for voting for Ryan’s proposals, which were included in the last two House budget resolutions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Here is a guide to some of the issues and questions raised by Ryan's plan.\u003c/p>\n\u003cp>\u003cstrong>Q. What is Ryan’s latest Medicare plan?\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>Ryan would gradually raise the eligibility age of Medicare from 65 to 67 by 2034, and cap its spending increases at half a percentage point higher than the growth rate of the economy, or the gross domestic product. Ryan’s plan would provide a set amount of money annually for future Medicare beneficiaries -- those currently under age 55 -- to be used to purchase either a private health plan, or the traditional government-administered program through a newly created Medicare exchange.\u003c/p>\n\u003cp>Under the proposal all plans, including traditional Medicare, would submit bids for how much they would charge to cover a beneficiary's health care costs. All plans would include a minimum set of benefits equal to the value of those in the traditional program. The government would pay the full premium for the private plan with the second lowest bid, or for traditional Medicare, whichever is lower. Beneficiaries would have to pay the difference if they chose a plan that set rates higher. There could be one less expensive plan option, and beneficiaries who chose it would get a rebate for the difference.\u003c/p>\n\u003cp>Private health plans would have to offer coverage that is at least actuarially equivalent to that offered in the traditional, government-administered plan. That means that while the benefits could vary, the value of the plan would have to be the same.\u003c/p>\n\u003cp>\u003cstrong>Q. So seniors could stay in the traditional, government-run Medicare program if they like?\u003c/strong>\u003c/p>\n\u003cp>Ryan says that is the case, but Democrats and some critics argue that the plan would so fundamentally alter Medicare that \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/March/09/GOP-Dilemma-What-To-Do-About-Medicare.aspx\" target=\"_blank\">it might no longer be a desirable – or affordable -- option.\u003c/a>\u003c/p>\n\u003cp>\"The real question is what it would cost,\" and whether seniors would pay more out of pocket than they do now, said Jonathan Gruber, an economist at the Massachusetts Institute of Technology. He cited the risk the government-run plan would attract the sickest people, driving up its costs, while private plans would lure the healthiest. In addition, medical providers could abandon the program if Medicare cut their reimbursement rates to curb costs.\u003c/p>\n\u003cp>\u003cstrong>Q. Would the changes apply to current seniors?\u003c/strong>\u003c/p>\n\u003cp>Ryan’s plan would apply only to those under age 55. Current Medicare beneficiaries and those nearing eligibility would continue to get Medicare as it exists today.\u003c/p>\n\u003cp>\u003cstrong>Q. Would seniors pay more under Ryan’s plan?\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office estimated that \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/april/06/cbo-seniors-pay-more-medicare-ryan-plan.aspx\" target=\"_blank\">Ryan's original proposal for 2012\u003c/a> would require a typical 65-year-old person to pay a lot more for Medicare by 2030. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/March/20/ryan-budget-medicare-medicaid-republicans.aspx\" target=\"_blank\">His latest plan\u003c/a> is missing key details, however, so the CBO has been limited in its analysis of the impact.\u003c/p>\n\u003cp>Although Ryan would give future seniors the option of remaining in the traditional, government-run Medicare program, that program would have to compete with private plans. Critics predict that traditional Medicare could become unaffordable if it attracts the sickest people who require more health care and who, therefore, drive up the program’s costs.\u003c/p>\n\u003cp>\u003cstrong>Q. Ryan’s most recent plan is similar to one he co-authored with a Democrat last year. Does that mean it has bipartisan support?\u003c/strong>\u003c/p>\n\u003cp>No. Sen. Ron Wyden, D-Ore., did not endorse Ryan’s Medicare plan in the last House budget resolution. It is similar to a \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/december/15/wyden-ryan-medicare-plan.aspx\" target=\"_blank\">plan that the two wrote\u003c/a> together last year, but there is an important difference. The limit on federal spending per beneficiary was not as strict in the plan they wrote together: The two had placed the cap at GDP growth rate plus 1 percent. Also, no other Democrat supported their 2011 proposal.\u003c/p>\n\u003cp>\u003cstrong>Q. How do Ryan’s proposals compare to Democratic plans?\u003c/strong>\u003c/p>\n\u003cp>President Barack Obama and many Democrats have said they agree the federal government needs to restrain the growth of Medicare spending, but they seek to do it without making direct cuts to benefits. Democrats want to preserve the program’s defined benefit basis, meaning that the government will pay whatever it takes to cover a specified set of services. During budget deficit reduction negotiations in Washington, Obama proposed holding Medicare spending to half a percentage point higher than the growth rate of the economy. Romney later adopted the same cap.\u003c/p>\n\u003cp>As part of last year’s budget negotiations, Obama also proposed gradually raising the Medicare eligibility age – if Republicans agreed to revenue raising proposals. But no agreement was reached.\u003c/p>\n\u003cp>The health law tackles Medicare spending growth, in part, by creating an expert panel, called the Independent Payment Advisory Board (IPAB), which would be responsible for finding ways to reduce spending if Medicare grows at a higher rate than the target. But the board is not allowed to recommend anything that would ration care or that would change benefits, eligibility or cost sharing for Part A (hospital services) or Part B (physician services). It also couldn't do anything to change the percentage of premium that seniors pay for prescription drug coverage, or the subsidies that low-income individuals get. The expectation is that reductions would come from medical providers, although hospitals are protected at first.\u003c/p>\n\u003cp>\u003cstrong>Q. If both Obama and Ryan are proposing a target rate of GDP growth plus half a percentage point for Medicare, wouldn’t federal spending be the same under both scenarios?\u003c/strong>\u003c/p>\n\u003cp>There are \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/May/04/obama-ryan-controlling-federal-medicare-spending-faq.aspx\" target=\"_blank\">important differences\u003c/a>. Ryan's plan is a hard cap on federal spending. He would automatically lower Medicare spending so that it is below the trigger level.\u003c/p>\n\u003cp>Obama is proposing a target that might not bring federal spending down to that level. His proposal follows an effort in the 2010 health law to curb Medicare cost growth by tying the spending target to the Consumer Price Index in early years, and later on to the rate of GDP growth plus 1 percentage point. Now Obama is proposing to lower the target to the rate of GDP plus half a percentage point. If federal spending per Medicare beneficiary rises faster than that – a determination made by the Medicare actuary – then the expert panel must recommend cuts to Congress, which would go into effect unless lawmakers passed an alternative cost-cutting plan. The cuts would come as a percent reduction in Medicare spending, and wouldn’t necessarily be sufficient to meet the target.\u003c/p>\n\u003cp>Moreover, the panel’s future may be in question, as Republicans – and some Democrats – have sought to kill it, arguing the board would be able to ration care and would have too much control over Medicare. Obama has yet to nominate the panel's 15 members, who must be confirmed by the Senate.\u003c/p>\n\u003cp>Some health care analysts also argue that reducing payments to medical providers could drive them out of accepting Medicare patients, creating access issues for beneficiaries. Richard Foster, Medicare's chief actuary, warned in the 2012 Medicare trustees' report that the health law will eventually lower payments to medical providers so much that \"Congress would have to intervene to prevent the withdrawal of providers from the Medicare market and the severe problems with beneficiary access to care that would result.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>Read More: \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/August/11/paul-ryan-republican-vice-president-candidate-medicare.aspx\">Paul Ryan's Plan For Medicare: Essential Reading\u003c/a>\u003c/strong>\u003c/p>\n\n",
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"excerpt": "Wisconsin Republican Paul Ryan, GOP presidential hopeful Mitt Romney’s choice for vice president, has provoked consternation from Democrats and anxiety among some congressional Republicans with his proposals to reshape Medicare.\r\n\r\nMitt Romney introduces Paul Ryan as his choice for running mate in Norfolk, Va., Saturday (Photo by Win McNamee/Getty Images).\r\n\r\nThe Republican-controlled House, along party lines, twice approved his proposals to overhaul the popular social insurance program for the elderly and disabled by giving beneficiaries a set amount of money every year to buy coverage from competing health plans. That is a fundamental shift from today’s program, where the federal government pays for as many services as beneficiaries use.\r\n\r\nThe proposals were never enacted because of opposition from the Democratic-controlled Senate and President Barack Obama.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://www.kaiserhealthnews.org/Reporters/SerafiniM.aspx\">Marilyn Werber Serafini\u003c/a>, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/August/11/faq-paul-ryan-house-republican-medicare-plan.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/August/11/faq-paul-ryan-house-republican-medicare-plan.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8069\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/ryan-romney-300_WinMcNamee_Getty.jpg\">\u003cimg class=\"size-full wp-image-8069 \" title=\"Republican Presidential Candidate Mitt Romney Announces Rep. Paul Ryan As His Vice Presidential Pick\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/ryan-romney-300_WinMcNamee_Getty.jpg\" alt=\"Republican Presidential Candidate Mitt Romney Announces Rep. Paul Ryan As His Vice Presidential Pick\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mitt Romney introduces Paul Ryan as his choice for running mate in Norfolk, Va., last Saturday. (Photo by Win McNamee/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Wisconsin Republican Paul Ryan, GOP presidential hopeful Mitt Romney’s choice for vice president, has provoked consternation from Democrats and anxiety among some congressional Republicans with his proposals to reshape Medicare.\u003c/p>\n\u003cp>The Republican-controlled House, along party lines, twice approved his proposals to overhaul the popular social insurance program for the elderly and disabled by giving beneficiaries a set amount of money every year to buy coverage from competing health plans. That is a fundamental shift from today’s program, where the federal government pays for as many services as beneficiaries use.\u003c/p>\n\u003cp>The proposals were never enacted because of opposition from the Democratic-controlled Senate and President Barack Obama.\u003c/p>\n\u003cp>This year, Democratic congressional candidates nationwide are making the protection of traditional Medicare a centerpiece of their campaigns, just as Republicans attacked them two years ago for curbing future Medicare spending as part of the 2010 health care law. Now, Democrats are hammering their GOP opponents for voting for Ryan’s proposals, which were included in the last two House budget resolutions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Here is a guide to some of the issues and questions raised by Ryan's plan.\u003c/p>\n\u003cp>\u003cstrong>Q. What is Ryan’s latest Medicare plan?\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>Ryan would gradually raise the eligibility age of Medicare from 65 to 67 by 2034, and cap its spending increases at half a percentage point higher than the growth rate of the economy, or the gross domestic product. Ryan’s plan would provide a set amount of money annually for future Medicare beneficiaries -- those currently under age 55 -- to be used to purchase either a private health plan, or the traditional government-administered program through a newly created Medicare exchange.\u003c/p>\n\u003cp>Under the proposal all plans, including traditional Medicare, would submit bids for how much they would charge to cover a beneficiary's health care costs. All plans would include a minimum set of benefits equal to the value of those in the traditional program. The government would pay the full premium for the private plan with the second lowest bid, or for traditional Medicare, whichever is lower. Beneficiaries would have to pay the difference if they chose a plan that set rates higher. There could be one less expensive plan option, and beneficiaries who chose it would get a rebate for the difference.\u003c/p>\n\u003cp>Private health plans would have to offer coverage that is at least actuarially equivalent to that offered in the traditional, government-administered plan. That means that while the benefits could vary, the value of the plan would have to be the same.\u003c/p>\n\u003cp>\u003cstrong>Q. So seniors could stay in the traditional, government-run Medicare program if they like?\u003c/strong>\u003c/p>\n\u003cp>Ryan says that is the case, but Democrats and some critics argue that the plan would so fundamentally alter Medicare that \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/March/09/GOP-Dilemma-What-To-Do-About-Medicare.aspx\" target=\"_blank\">it might no longer be a desirable – or affordable -- option.\u003c/a>\u003c/p>\n\u003cp>\"The real question is what it would cost,\" and whether seniors would pay more out of pocket than they do now, said Jonathan Gruber, an economist at the Massachusetts Institute of Technology. He cited the risk the government-run plan would attract the sickest people, driving up its costs, while private plans would lure the healthiest. In addition, medical providers could abandon the program if Medicare cut their reimbursement rates to curb costs.\u003c/p>\n\u003cp>\u003cstrong>Q. Would the changes apply to current seniors?\u003c/strong>\u003c/p>\n\u003cp>Ryan’s plan would apply only to those under age 55. Current Medicare beneficiaries and those nearing eligibility would continue to get Medicare as it exists today.\u003c/p>\n\u003cp>\u003cstrong>Q. Would seniors pay more under Ryan’s plan?\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office estimated that \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/april/06/cbo-seniors-pay-more-medicare-ryan-plan.aspx\" target=\"_blank\">Ryan's original proposal for 2012\u003c/a> would require a typical 65-year-old person to pay a lot more for Medicare by 2030. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/March/20/ryan-budget-medicare-medicaid-republicans.aspx\" target=\"_blank\">His latest plan\u003c/a> is missing key details, however, so the CBO has been limited in its analysis of the impact.\u003c/p>\n\u003cp>Although Ryan would give future seniors the option of remaining in the traditional, government-run Medicare program, that program would have to compete with private plans. Critics predict that traditional Medicare could become unaffordable if it attracts the sickest people who require more health care and who, therefore, drive up the program’s costs.\u003c/p>\n\u003cp>\u003cstrong>Q. Ryan’s most recent plan is similar to one he co-authored with a Democrat last year. Does that mean it has bipartisan support?\u003c/strong>\u003c/p>\n\u003cp>No. Sen. Ron Wyden, D-Ore., did not endorse Ryan’s Medicare plan in the last House budget resolution. It is similar to a \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/december/15/wyden-ryan-medicare-plan.aspx\" target=\"_blank\">plan that the two wrote\u003c/a> together last year, but there is an important difference. The limit on federal spending per beneficiary was not as strict in the plan they wrote together: The two had placed the cap at GDP growth rate plus 1 percent. Also, no other Democrat supported their 2011 proposal.\u003c/p>\n\u003cp>\u003cstrong>Q. How do Ryan’s proposals compare to Democratic plans?\u003c/strong>\u003c/p>\n\u003cp>President Barack Obama and many Democrats have said they agree the federal government needs to restrain the growth of Medicare spending, but they seek to do it without making direct cuts to benefits. Democrats want to preserve the program’s defined benefit basis, meaning that the government will pay whatever it takes to cover a specified set of services. During budget deficit reduction negotiations in Washington, Obama proposed holding Medicare spending to half a percentage point higher than the growth rate of the economy. Romney later adopted the same cap.\u003c/p>\n\u003cp>As part of last year’s budget negotiations, Obama also proposed gradually raising the Medicare eligibility age – if Republicans agreed to revenue raising proposals. But no agreement was reached.\u003c/p>\n\u003cp>The health law tackles Medicare spending growth, in part, by creating an expert panel, called the Independent Payment Advisory Board (IPAB), which would be responsible for finding ways to reduce spending if Medicare grows at a higher rate than the target. But the board is not allowed to recommend anything that would ration care or that would change benefits, eligibility or cost sharing for Part A (hospital services) or Part B (physician services). It also couldn't do anything to change the percentage of premium that seniors pay for prescription drug coverage, or the subsidies that low-income individuals get. The expectation is that reductions would come from medical providers, although hospitals are protected at first.\u003c/p>\n\u003cp>\u003cstrong>Q. If both Obama and Ryan are proposing a target rate of GDP growth plus half a percentage point for Medicare, wouldn’t federal spending be the same under both scenarios?\u003c/strong>\u003c/p>\n\u003cp>There are \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/May/04/obama-ryan-controlling-federal-medicare-spending-faq.aspx\" target=\"_blank\">important differences\u003c/a>. Ryan's plan is a hard cap on federal spending. He would automatically lower Medicare spending so that it is below the trigger level.\u003c/p>\n\u003cp>Obama is proposing a target that might not bring federal spending down to that level. His proposal follows an effort in the 2010 health law to curb Medicare cost growth by tying the spending target to the Consumer Price Index in early years, and later on to the rate of GDP growth plus 1 percentage point. Now Obama is proposing to lower the target to the rate of GDP plus half a percentage point. If federal spending per Medicare beneficiary rises faster than that – a determination made by the Medicare actuary – then the expert panel must recommend cuts to Congress, which would go into effect unless lawmakers passed an alternative cost-cutting plan. The cuts would come as a percent reduction in Medicare spending, and wouldn’t necessarily be sufficient to meet the target.\u003c/p>\n\u003cp>Moreover, the panel’s future may be in question, as Republicans – and some Democrats – have sought to kill it, arguing the board would be able to ration care and would have too much control over Medicare. Obama has yet to nominate the panel's 15 members, who must be confirmed by the Senate.\u003c/p>\n\u003cp>Some health care analysts also argue that reducing payments to medical providers could drive them out of accepting Medicare patients, creating access issues for beneficiaries. Richard Foster, Medicare's chief actuary, warned in the 2012 Medicare trustees' report that the health law will eventually lower payments to medical providers so much that \"Congress would have to intervene to prevent the withdrawal of providers from the Medicare market and the severe problems with beneficiary access to care that would result.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Read More: \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/August/11/paul-ryan-republican-vice-president-candidate-medicare.aspx\">Paul Ryan's Plan For Medicare: Essential Reading\u003c/a>\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
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"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
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"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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