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"content": "\u003cp>This month's election results could have big implications for those who now have insurance because of the Affordable Care Act — either through the exchanges or Medicaid expansion. President-elect Trump and Republicans in Congress have made it clear they want to scrap the law, but it's unclear what may replace it. That gap between repeal and replacement has left many unsure of what will happen with their medical care. We have these reports from around the country from people who could be affected by changes.\u003c/p>\n\u003cp>\u003cstrong>Little Lula's Preexisting Condition Is Cancer\u003c/strong>\u003c/p>\n\u003cp>If you stop by Julep, a Kansas City, Missouri, bar and restaurant, you might catch a glimpse of Lula — the blond, blue-eyed toddler daughter of the owners, Keely Edgington and Beau Williams. They let her inspect the customers a bit before the place gets too busy.\u003c/p>\n\u003cp>\"She likes to go out there and essentially just stare everybody down and smile at them,\" Edgington says.\u003c/p>\n\u003cp>She's so smiley you'd never guess how much she's been through in her short life. \"She happens to have \u003ca href=\"http://www.cancer.org/cancer/neuroblastoma/detailedguide/neuroblastoma-staging\">4S non-amplified neuroblastoma\u003c/a>,\" Edgington says. It's a cancer in her adrenal gland that doctors discovered when Lula was 9 months old. She needed emergency surgery because of the size and location of the tumor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The cost was enormous. Edgington says she stopped looking at bills after they topped $350,000, and that was before the surgery. The vast majority of the cost was paid for through the insurance the family gets through HealthCare.gov, the federal health insurance marketplace created under the Affordable Care Act. They say, as small business owners, the exchange and subsidies they received because of the law were their only way they could get covered.\u003c/p>\n\u003cp>Even with coverage, the family was still on the hook for $10,000.\u003c/p>\n\u003cp>Lula has responded well to the treatment. She's been in remission for a few months, but the family still faces high medical costs. At a minimum, Lula will need intensive, expensive screenings and scans for a few years, then she'll have to be monitored for health conditions that might come up as a result of chemotherapy.\u003c/p>\n\u003cp>Since the election, the family says they've been on eggshells waiting to see what will happen with their insurance. They fear possibly losing subsidies. And, before the Affordable Care Act insurance companies could deny coverage to people with preexisting medical conditions like Lula's, and the companies could set lifetime limits on the amount they'd pay for someone's care. Insurers could also take into account an individual's health history, so that someone with a chronic disease might pay many times more than a healthier person.\u003c/p>\n\u003cp>The family has been thinking about how they might cope with huge medical or insurance costs that might come if Obamacare is repealed. They've pondered a second mortgage, selling their business or even more desperate measures.\u003c/p>\n\u003cp>\"Do we have to move to Canada and hope we get coverage there? That's really extreme, but what wouldn't you do for your child's life?\" says Edgington.\u003c/p>\n\u003cp>Trump has said he'd make sure insurance companies couldn't deny coverage to a person with a preexisting condition, but he has provided no formal plan, and much of what happens next is in Congress's hands. Insurance and legal analysts are also unclear about what will happen, although most think the biggest changes probably wouldn't go into effect until at least 2018. — \u003cem>Alex Smith, KCUR, Kansas City, Missouri\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Obamacare Choices Are Dwindling For Some \u003cbr>\u003c/strong>\u003c/p>\n\u003cp>Michael Cluck and his wife Nancy live in Edwardsville, Illinois, just outside St. Louis. Cluck, 62, and his wife, Nancy, 58, bought insurance through HealthCare.gov in 2015, and it, \"actually saved us $300 a month, and we were really happy with it,\" he says.\u003c/p>\n\u003cp>But two providers, including his own insurer, Coventry, dropped out of the health insurance exchange in his county and two adjacent ones for 2017. There's now just one choice there: Blue Cross Blue Shield of Illinois.\u003c/p>\n\u003cp>\"Premiums were not that bad. Deductibles were not that bad,\" Cluck says of Blue Cross. \"But the problem was, they would not cover any doctors or hospital stays on the Missouri side of the river.\"\u003c/p>\n\u003cp>Cluck had prostate cancer. He is now free of cancer, but he still needs regular checkups and he fears the cancer may return. It takes him about 30 minutes to drive to oncology appointments now, but the \u003ca href=\"http://www.npr.org/sections/health-shots/2014/07/16/331419293/patients-with-low-cost-insurance-struggle-to-find-specialists\">in-network providers\u003c/a> Blue Cross Blue Shield of Illinois shows in its directory are farther away.\u003c/p>\n\u003cp>\"That's where the problem came in. Because all of my cancer doctors, and Siteman Cancer Center, are in St. Louis, Missouri,\" Cluck says.\u003c/p>\n\u003cp>To Cluck, it's a frustrating display of flaws in the Affordable Care Act.\u003c/p>\n\u003cp>\"This was not supposed to happen,\" he says. \"When they put the Affordable Care Act in place, we were promised we could keep our doctors. We were promised it would cost $2,500 less than what we were currently paying. And nothing's come true.\"\u003c/p>\n\u003cp>On Nov. 8, when faced with a choice between Democratic presidential nominee Hillary Clinton and Donald Trump, he voted for the Republican.\u003c/p>\n\u003cp>\"For a lot of reasons, not just Obamacare,\" he says. But while he hopes that there's a good replacement plan ready for any changes to Obamacare, he's is frustrated by the insurance companies' narrow networks.\u003c/p>\n\u003cp>\"I don't understand why, when the health care companies are recording record profits that they're not staying in the Affordable Care Act. That's the one thing that just boggles my mind.\"\u003c/p>\n\u003cp>So, he hopes Trump follows through on his promise to repeal and replace.\u003c/p>\n\u003cp>\"There's a lot of things they need to fix, because there's a lot of people who are reliant upon medical care and health care. I think this should really be fixing, dismantling--however you want to call it--the Affordable Care Act, I think that needs to really be a priority for the new administration.\" — \u003cem>Durrie Bouscaren, St. Louis Public Radio.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Fears About Losing Insurance Limited Job Options\u003cbr>\u003c/strong>\u003c/p>\n\u003cp>Leigh Kvetko, 46, of Dallas, has to take 10 medications twice a day because she's had two organ transplants to replace her pancreas and kidney in 2003. Several of the pills she takes cost nearly $1,000 each per month. For years, Kvetko stuck with a job she hated in large part because it offered health insurance. When the Affordable Care Act passed, insurers could no longer discriminate against people like Kvetko, who have diagnosed health problems, and she and her husband finally felt free.\u003c/p>\n\u003cp>\"It gave me hope and [my husband and I] decided to sell our house, to downsize, and to start our own businesses and start a new chapter of our lives.\"\u003c/p>\n\u003cp>In this new chapter, Kvetko is retail manager at a busy Dallas coffee shop. She struts through the store in cowboy boots, her long red hair framing green-speckled eyes. She looks happy — and healthy. But her pancreas is failing, and she's terrified about President-elect Trump's promise to dismantle the Affordable Care Act. She fears it will put health care out of reach for her, and another \u003ca href=\"http://keranews.org/post/about-12-million-texans-signed-through-health-exchange\">1.2 million Texans\u003c/a> who rely on subsidized plans. — \u003cem>Lauren Silverman, KERA, Dallas.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>These reports come to us as part of a partnership with NPR, local member stations and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">Kaiser Health News\u003c/a>. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Worries+About+Health+Insurance+Cross+Political+Boundaries&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The cost was enormous. Edgington says she stopped looking at bills after they topped $350,000, and that was before the surgery. The vast majority of the cost was paid for through the insurance the family gets through HealthCare.gov, the federal health insurance marketplace created under the Affordable Care Act. They say, as small business owners, the exchange and subsidies they received because of the law were their only way they could get covered.\u003c/p>\n\u003cp>Even with coverage, the family was still on the hook for $10,000.\u003c/p>\n\u003cp>Lula has responded well to the treatment. She's been in remission for a few months, but the family still faces high medical costs. At a minimum, Lula will need intensive, expensive screenings and scans for a few years, then she'll have to be monitored for health conditions that might come up as a result of chemotherapy.\u003c/p>\n\u003cp>Since the election, the family says they've been on eggshells waiting to see what will happen with their insurance. They fear possibly losing subsidies. And, before the Affordable Care Act insurance companies could deny coverage to people with preexisting medical conditions like Lula's, and the companies could set lifetime limits on the amount they'd pay for someone's care. Insurers could also take into account an individual's health history, so that someone with a chronic disease might pay many times more than a healthier person.\u003c/p>\n\u003cp>The family has been thinking about how they might cope with huge medical or insurance costs that might come if Obamacare is repealed. They've pondered a second mortgage, selling their business or even more desperate measures.\u003c/p>\n\u003cp>\"Do we have to move to Canada and hope we get coverage there? That's really extreme, but what wouldn't you do for your child's life?\" says Edgington.\u003c/p>\n\u003cp>Trump has said he'd make sure insurance companies couldn't deny coverage to a person with a preexisting condition, but he has provided no formal plan, and much of what happens next is in Congress's hands. Insurance and legal analysts are also unclear about what will happen, although most think the biggest changes probably wouldn't go into effect until at least 2018. — \u003cem>Alex Smith, KCUR, Kansas City, Missouri\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Obamacare Choices Are Dwindling For Some \u003cbr>\u003c/strong>\u003c/p>\n\u003cp>Michael Cluck and his wife Nancy live in Edwardsville, Illinois, just outside St. Louis. Cluck, 62, and his wife, Nancy, 58, bought insurance through HealthCare.gov in 2015, and it, \"actually saved us $300 a month, and we were really happy with it,\" he says.\u003c/p>\n\u003cp>But two providers, including his own insurer, Coventry, dropped out of the health insurance exchange in his county and two adjacent ones for 2017. There's now just one choice there: Blue Cross Blue Shield of Illinois.\u003c/p>\n\u003cp>\"Premiums were not that bad. Deductibles were not that bad,\" Cluck says of Blue Cross. \"But the problem was, they would not cover any doctors or hospital stays on the Missouri side of the river.\"\u003c/p>\n\u003cp>Cluck had prostate cancer. He is now free of cancer, but he still needs regular checkups and he fears the cancer may return. It takes him about 30 minutes to drive to oncology appointments now, but the \u003ca href=\"http://www.npr.org/sections/health-shots/2014/07/16/331419293/patients-with-low-cost-insurance-struggle-to-find-specialists\">in-network providers\u003c/a> Blue Cross Blue Shield of Illinois shows in its directory are farther away.\u003c/p>\n\u003cp>\"That's where the problem came in. Because all of my cancer doctors, and Siteman Cancer Center, are in St. Louis, Missouri,\" Cluck says.\u003c/p>\n\u003cp>To Cluck, it's a frustrating display of flaws in the Affordable Care Act.\u003c/p>\n\u003cp>\"This was not supposed to happen,\" he says. \"When they put the Affordable Care Act in place, we were promised we could keep our doctors. We were promised it would cost $2,500 less than what we were currently paying. And nothing's come true.\"\u003c/p>\n\u003cp>On Nov. 8, when faced with a choice between Democratic presidential nominee Hillary Clinton and Donald Trump, he voted for the Republican.\u003c/p>\n\u003cp>\"For a lot of reasons, not just Obamacare,\" he says. But while he hopes that there's a good replacement plan ready for any changes to Obamacare, he's is frustrated by the insurance companies' narrow networks.\u003c/p>\n\u003cp>\"I don't understand why, when the health care companies are recording record profits that they're not staying in the Affordable Care Act. That's the one thing that just boggles my mind.\"\u003c/p>\n\u003cp>So, he hopes Trump follows through on his promise to repeal and replace.\u003c/p>\n\u003cp>\"There's a lot of things they need to fix, because there's a lot of people who are reliant upon medical care and health care. I think this should really be fixing, dismantling--however you want to call it--the Affordable Care Act, I think that needs to really be a priority for the new administration.\" — \u003cem>Durrie Bouscaren, St. Louis Public Radio.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Fears About Losing Insurance Limited Job Options\u003cbr>\u003c/strong>\u003c/p>\n\u003cp>Leigh Kvetko, 46, of Dallas, has to take 10 medications twice a day because she's had two organ transplants to replace her pancreas and kidney in 2003. Several of the pills she takes cost nearly $1,000 each per month. For years, Kvetko stuck with a job she hated in large part because it offered health insurance. When the Affordable Care Act passed, insurers could no longer discriminate against people like Kvetko, who have diagnosed health problems, and she and her husband finally felt free.\u003c/p>\n\u003cp>\"It gave me hope and [my husband and I] decided to sell our house, to downsize, and to start our own businesses and start a new chapter of our lives.\"\u003c/p>\n\u003cp>In this new chapter, Kvetko is retail manager at a busy Dallas coffee shop. She struts through the store in cowboy boots, her long red hair framing green-speckled eyes. She looks happy — and healthy. But her pancreas is failing, and she's terrified about President-elect Trump's promise to dismantle the Affordable Care Act. She fears it will put health care out of reach for her, and another \u003ca href=\"http://keranews.org/post/about-12-million-texans-signed-through-health-exchange\">1.2 million Texans\u003c/a> who rely on subsidized plans. — \u003cem>Lauren Silverman, KERA, Dallas.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>These reports come to us as part of a partnership with NPR, local member stations and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">Kaiser Health News\u003c/a>. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Worries+About+Health+Insurance+Cross+Political+Boundaries&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "No Immediate Changes to Your Obamacare Coverage",
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"content": "\u003cp>To the millions of Californians who obtained health insurance as a result of the Affordable Care Act, know this: Despite the election of Donald Trump, who has promised to repeal the health law, nothing is going to happen to your coverage immediately.\u003c/p>\n\u003cp>In fact, open enrollment for Covered California plans continues through January 31 despite the election outcome.\u003c/p>\n\u003cp>“Don’t panic. The open enrollment period is set,” says Myles Pappadato, an insurance agent based in Valencia whose firm, \u003ca href=\"http://www.quotebroker.com/\" target=\"_blank\">QuoteBroker\u003c/a>, has about 600 clients with Covered California policies. He fielded about a dozen calls the morning after the election from worried consumers.\u003c/p>\n\u003cp>“Don’t make any decisions based on speculation,” he adds.\u003c/p>\n\u003cp>Beyond that, uncertainty reigns.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In California, two major Obamacare initiatives brought health insurance to millions of people: About 1.3 million of you have plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a>, the state health insurance exchange. And about 3.7 million others joined \u003ca href=\"http://centerforhealthreporting.org/article/medi-cal-and-obamacare-more-confusing-twists\" target=\"_blank\">Medi-Cal\u003c/a>, the state’s Medicaid program for low-income residents, after it expanded its eligibility criteria.\u003c/p>\n\u003cp>It’s not yet clear how Trump and the Republican-dominated Congress will seek to pick apart Obamacare next year — or how long that could take. An outright repeal \u003ca href=\"http://californiahealthline.org/news/repealing-the-affordable-care-act-could-be-more-complicated-than-it-looks/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=37396635&_hsenc=p2ANqtz-9aanSH42gAveSfgTPrn_VrHvjt7rmUC5RKZWxi67PHhBa605aa40A241EiJaXyMHY9KR_ZuAZq2d7AL4vHPFgK1V_4JA&_hsmi=37396635\" target=\"_blank\">might be difficult \u003c/a>because it would require 60 votes in the U.S. Senate to overcome a Democratic filibuster, which means the Republicans would need the support of at least eight Democrats.\u003c/p>\n\u003cp>Republicans could use budget procedures instead to kill critical portions of the law, including the funding for Medicaid expansion in states like California and the federal tax credits that lower premiums for most Covered California enrollees.\u003c/p>\n\u003cp>“If the subsidies go away, the vast majority of folks are not going to be able to afford their coverage. They’re struggling as it is,” Pappadato says.\u003c/p>\n\u003cp>Officials from Covered California, Medi-Cal and the state Health and Human Services Agency are scrambling to figure out what’s next, but the outlook isn’t good.\u003c/p>\n\u003cp>“I cannot provide false comfort,” says Anthony Wright, executive director of the advocacy group \u003ca href=\"http://www.health-access.org/\" target=\"_blank\">Health Access California\u003c/a>. “This is a real risk for coverage that millions of Californians depend on.”\u003c/p>\n\u003cp>Lyn Jutronich, of San Diego, came close to tears when describing the anxiety she felt before Obamacare. Jutronich, 44, has three children under the age of 12 who are now covered by Medi-Cal. She and her husband, a contractor, have a Covered California plan and receive tax credits.\u003c/p>\n\u003cp>“When my child got sick or injured, I used to ask myself, ‘How am I going to pay for this?’ That burden was completely relieved” by Obamacare, she says.\u003c/p>\n\u003cp>“The thought of having to go back to that is just shattering.”\u003c/p>\n\u003cp>Before the law, Jutronich went without insurance for more than a year because she had preexisting medical conditions. At that time, insurers were not required to cover people who had previous medical problems, or they could charge them significantly more.\u003c/p>\n\u003cp>The premiums for the family’s insurance — with her included — would have been about $3,000 to $4,000 a month before Obamacare, so they opted to buy a plan for the kids and her husband, because of his dangerous job.\u003c/p>\n\u003cp>“I’m terrified that in the near future I will have to go without insurance again, and that I will again have that horrible ‘Do I really need to take my child to the emergency room today or can it wait?’ question looming in my head,” Jutronich says.\u003c/p>\n\u003cp>Covered California’s executive director, Peter Lee, wants to reassure consumers, saying it’s business as usual for now.\u003c/p>\n\u003cp>“People have some reasonable questions and those questions will take time to answer,” Lee says. “We will be working very hard to get the word out that the subsidies are available and the rules remain in place under the law.”\u003c/p>\n\u003cp>The Department of Health Care Services, which administers Medi-Cal, says “there are no immediate changes” to that program. It did not offer advice to Medi-Cal enrollees.\u003c/p>\n\u003cp>But Jen Flory, a senior attorney at the \u003ca href=\"https://wclp.org/\" target=\"_blank\">Western Center on Law & Poverty\u003c/a>, says Medi-Cal expansion enrollees should “feel free to use their Medi-Cal. If they qualify and haven’t applied, they should still apply. No new law has been passed.”\u003c/p>\n\u003cp>And if you’ve been waiting to get a medical procedure or delaying an exam, “don’t put anything off,” Flory suggests.\u003c/p>\n\u003cp>State Sen. Ed Hernandez, D-West Covina, chair of the \u003ca href=\"http://shea.senate.ca.gov/\" target=\"_blank\">Senate Health Committee\u003c/a>, also wants Californians to keep enrolling in the coverage they’re eligible for and using the coverage they have.\u003c/p>\n\u003cp>“Continue doing what you’ve been doing. You have health insurance. Use it as you need it,” he says.\u003c/p>\n\u003cp>Hernandez expects California lawmakers to do “everything we can to protect patients to make sure they have access to health care.”\u003c/p>\n\u003cp>Could that include finding state money to replace any federal funding that may be cut?\u003c/p>\n\u003cp>“We have to ask ourselves the billion-dollar question: Does the state take on that responsibility?” Hernandez says. “That’s a discussion the state Legislature will have to have, but we’re not there yet.”\u003c/p>\n\u003cp>Wright, of Health Access, urges Californians to advocate for themselves in the meantime.\u003c/p>\n\u003cp>“Until something happens, people should sign up for the benefits and then join the political fight to keep them,” he says.\u003c/p>\n\u003cp>Jeffrey Kolsin, a certified public accountant in Fountain Valley, agrees that consumers need to speak up.\u003c/p>\n\u003cp>Kolsin, 61, and his wife receive tax credits for their Covered California policy, and the cost of their monthly premiums would double if federal funding were cut.\u003c/p>\n\u003cp>“What happens to people like myself who have depended on those tax credits, and all of a sudden they’re gone and now you have this huge bill?” he asks. “How do you pay for it?”\u003c/p>\n\u003cp>He plans to share his opinion with lawmakers, asking them not to repeal or gut Obamacare without coming up with a replacement plan first. He wants others to do the same.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Write to the existing and new Congress members and Trump,” Kolsin says. “Fill their mailboxes, basically saying ‘Whatever you do with the Affordable Care Act, do not kill it until the day the new law goes into effect.’”\u003c/p>\n\n",
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"excerpt": "Healthcare columnist says people concerned about Trump's attacks on Obamacare should watch and wait, and continue to take advantage of coverage through the Affordable Care Act. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>To the millions of Californians who obtained health insurance as a result of the Affordable Care Act, know this: Despite the election of Donald Trump, who has promised to repeal the health law, nothing is going to happen to your coverage immediately.\u003c/p>\n\u003cp>In fact, open enrollment for Covered California plans continues through January 31 despite the election outcome.\u003c/p>\n\u003cp>“Don’t panic. The open enrollment period is set,” says Myles Pappadato, an insurance agent based in Valencia whose firm, \u003ca href=\"http://www.quotebroker.com/\" target=\"_blank\">QuoteBroker\u003c/a>, has about 600 clients with Covered California policies. He fielded about a dozen calls the morning after the election from worried consumers.\u003c/p>\n\u003cp>“Don’t make any decisions based on speculation,” he adds.\u003c/p>\n\u003cp>Beyond that, uncertainty reigns.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In California, two major Obamacare initiatives brought health insurance to millions of people: About 1.3 million of you have plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a>, the state health insurance exchange. And about 3.7 million others joined \u003ca href=\"http://centerforhealthreporting.org/article/medi-cal-and-obamacare-more-confusing-twists\" target=\"_blank\">Medi-Cal\u003c/a>, the state’s Medicaid program for low-income residents, after it expanded its eligibility criteria.\u003c/p>\n\u003cp>It’s not yet clear how Trump and the Republican-dominated Congress will seek to pick apart Obamacare next year — or how long that could take. An outright repeal \u003ca href=\"http://californiahealthline.org/news/repealing-the-affordable-care-act-could-be-more-complicated-than-it-looks/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=37396635&_hsenc=p2ANqtz-9aanSH42gAveSfgTPrn_VrHvjt7rmUC5RKZWxi67PHhBa605aa40A241EiJaXyMHY9KR_ZuAZq2d7AL4vHPFgK1V_4JA&_hsmi=37396635\" target=\"_blank\">might be difficult \u003c/a>because it would require 60 votes in the U.S. Senate to overcome a Democratic filibuster, which means the Republicans would need the support of at least eight Democrats.\u003c/p>\n\u003cp>Republicans could use budget procedures instead to kill critical portions of the law, including the funding for Medicaid expansion in states like California and the federal tax credits that lower premiums for most Covered California enrollees.\u003c/p>\n\u003cp>“If the subsidies go away, the vast majority of folks are not going to be able to afford their coverage. They’re struggling as it is,” Pappadato says.\u003c/p>\n\u003cp>Officials from Covered California, Medi-Cal and the state Health and Human Services Agency are scrambling to figure out what’s next, but the outlook isn’t good.\u003c/p>\n\u003cp>“I cannot provide false comfort,” says Anthony Wright, executive director of the advocacy group \u003ca href=\"http://www.health-access.org/\" target=\"_blank\">Health Access California\u003c/a>. “This is a real risk for coverage that millions of Californians depend on.”\u003c/p>\n\u003cp>Lyn Jutronich, of San Diego, came close to tears when describing the anxiety she felt before Obamacare. Jutronich, 44, has three children under the age of 12 who are now covered by Medi-Cal. She and her husband, a contractor, have a Covered California plan and receive tax credits.\u003c/p>\n\u003cp>“When my child got sick or injured, I used to ask myself, ‘How am I going to pay for this?’ That burden was completely relieved” by Obamacare, she says.\u003c/p>\n\u003cp>“The thought of having to go back to that is just shattering.”\u003c/p>\n\u003cp>Before the law, Jutronich went without insurance for more than a year because she had preexisting medical conditions. At that time, insurers were not required to cover people who had previous medical problems, or they could charge them significantly more.\u003c/p>\n\u003cp>The premiums for the family’s insurance — with her included — would have been about $3,000 to $4,000 a month before Obamacare, so they opted to buy a plan for the kids and her husband, because of his dangerous job.\u003c/p>\n\u003cp>“I’m terrified that in the near future I will have to go without insurance again, and that I will again have that horrible ‘Do I really need to take my child to the emergency room today or can it wait?’ question looming in my head,” Jutronich says.\u003c/p>\n\u003cp>Covered California’s executive director, Peter Lee, wants to reassure consumers, saying it’s business as usual for now.\u003c/p>\n\u003cp>“People have some reasonable questions and those questions will take time to answer,” Lee says. “We will be working very hard to get the word out that the subsidies are available and the rules remain in place under the law.”\u003c/p>\n\u003cp>The Department of Health Care Services, which administers Medi-Cal, says “there are no immediate changes” to that program. It did not offer advice to Medi-Cal enrollees.\u003c/p>\n\u003cp>But Jen Flory, a senior attorney at the \u003ca href=\"https://wclp.org/\" target=\"_blank\">Western Center on Law & Poverty\u003c/a>, says Medi-Cal expansion enrollees should “feel free to use their Medi-Cal. If they qualify and haven’t applied, they should still apply. No new law has been passed.”\u003c/p>\n\u003cp>And if you’ve been waiting to get a medical procedure or delaying an exam, “don’t put anything off,” Flory suggests.\u003c/p>\n\u003cp>State Sen. Ed Hernandez, D-West Covina, chair of the \u003ca href=\"http://shea.senate.ca.gov/\" target=\"_blank\">Senate Health Committee\u003c/a>, also wants Californians to keep enrolling in the coverage they’re eligible for and using the coverage they have.\u003c/p>\n\u003cp>“Continue doing what you’ve been doing. You have health insurance. Use it as you need it,” he says.\u003c/p>\n\u003cp>Hernandez expects California lawmakers to do “everything we can to protect patients to make sure they have access to health care.”\u003c/p>\n\u003cp>Could that include finding state money to replace any federal funding that may be cut?\u003c/p>\n\u003cp>“We have to ask ourselves the billion-dollar question: Does the state take on that responsibility?” Hernandez says. “That’s a discussion the state Legislature will have to have, but we’re not there yet.”\u003c/p>\n\u003cp>Wright, of Health Access, urges Californians to advocate for themselves in the meantime.\u003c/p>\n\u003cp>“Until something happens, people should sign up for the benefits and then join the political fight to keep them,” he says.\u003c/p>\n\u003cp>Jeffrey Kolsin, a certified public accountant in Fountain Valley, agrees that consumers need to speak up.\u003c/p>\n\u003cp>Kolsin, 61, and his wife receive tax credits for their Covered California policy, and the cost of their monthly premiums would double if federal funding were cut.\u003c/p>\n\u003cp>“What happens to people like myself who have depended on those tax credits, and all of a sudden they’re gone and now you have this huge bill?” he asks. “How do you pay for it?”\u003c/p>\n\u003cp>He plans to share his opinion with lawmakers, asking them not to repeal or gut Obamacare without coming up with a replacement plan first. He wants others to do the same.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Write to the existing and new Congress members and Trump,” Kolsin says. “Fill their mailboxes, basically saying ‘Whatever you do with the Affordable Care Act, do not kill it until the day the new law goes into effect.’”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Trump Can Kill Obamacare With Or Without Help From Congress",
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"content": "\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/501203831/501477057\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>President-elect Donald Trump has promised over and over in recent months that he will repeal and replace the Affordable Care Act, also called Obamacare, when he reaches the White House.\u003c/p>\n\u003cp>\"Obamacare is a disaster. You know it. We all know it,\" Trump \u003ca href=\"http://www.npr.org/2016/10/09/497056227/fact-check-clinton-and-trump-debate-for-the-second-time\" target=\"_blank\">said at a debate\u003c/a> last month. \"We have to repeal it and replace it with something absolutely much less expensive.\"\u003c/p>\n\u003cp>Now that Trump will move into the Oval Office in January, the question is whether he'll be able to completely repeal the six-year-old law that has had an impact on every aspect of the U.S. health care system.\u003c/p>\n\u003cp>\"It's a challenge for a Trump presidency,\" says\u003ca href=\"http://explore.georgetown.edu/people/jfh7/\" target=\"_blank\"> Jack Hoadley\u003c/a>, a research professor at Georgetown University's \u003ca href=\"https://hpi.georgetown.edu/\" target=\"_blank\">Health Policy Institute\u003c/a>. \"To get a true repeal and replace through, he needs 60 votes in the Senate.\" That's the minimum number of votes needed to overcome a filibuster in the Senate.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Repeal of the law is absolutely going to come up, and the only potential defense against that would be a Democratic filibuster — if Republicans even allow a filibuster,\" says \u003ca href=\"http://theincidentaleconomist.com/wordpress/about/about-austin/\" target=\"_blank\">Austin Frakt\u003c/a>, a health economist who runs the blog \u003ca href=\"http://theincidentaleconomist.com/\" target=\"_blank\">The Incidental Economist\u003c/a>.\u003c/p>\n\u003cp>But even if Trump can't repeal the Affordable Care Act in its entirety, there's a lot he can do through rule-making and smaller legislative changes to weaken the law and mold it more to his liking.\u003c/p>\n\u003cp>\"They are probably, practically speaking, talking about leaving the ACA, as is, in place,\" Hoadley says. \"Then he can change the ACA to have it showcase the kinds of plans he wants to see in place.\"\u003c/p>\n\u003cp>During his campaign, Trump proposed a \u003ca href=\"http://www.npr.org/2016/11/02/500371785/platform-check-trump-and-clinton-on-health-care\" target=\"_blank\">series of measures\u003c/a> that he said will allow people to buy affordable health insurance policies outside of the Obamacare exchanges.\u003c/p>\n\u003cp>Those measures include promoting tax-free health savings accounts that might help individuals save money to pay for health care costs and allowing people to deduct the cost of their premiums on their personal income tax returns. Trump has said he also wants to allow insurers to \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=122965862\" target=\"_blank\">sell policies across state lines\u003c/a> to boost competition.\u003c/p>\n\u003cp>Trump could alter the Obamacare exchanges to promote high-deductible health plans and health savings accounts to get a result similar to what he's looking for.\u003c/p>\n\u003cp>\"He could change the details of how the marketplaces work,\" Hoadley says. \"It's all worked out through regulation. You could just suspend the regulations.\"\u003c/p>\n\u003cp>Alternatively, Trump could embrace the \u003ca href=\"http://abetterway.speaker.gov/?page=health-care\" target=\"_blank\">health care plan\u003c/a> promoted by House Speaker Paul Ryan, which starts with repealing the Affordable Care Act. It includes many of the same principles as Trump's plan, but has more details.\u003c/p>\n\u003cp>One of the biggest challenges Trump faces is that about \u003ca href=\"http://www.hhs.gov/about/news/2016/03/03/20-million-people-have-gained-health-insurance-coverage-because-affordable-care-act-new-estimates\" target=\"_blank\">about 20 million\u003c/a> people today have health coverage because of the Affordable Care Act, according to the Department of Health and Human Services. The uninsured rate hit an \u003ca href=\"http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201611.pdf\" target=\"_blank\">all-time low \u003c/a>of 8.9 percent this year, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>An analysis of Trump's plan by \u003ca href=\"http://www.commonwealthfund.org/publications/blog/2016/trump-clinton-presidential-health-care-proposals\" target=\"_blank\">The Commonwealth Fund\u003c/a> estimates it would increase the number of people who lack health insurance by as many as 25 million, and increase the federal budget by as much as $41 billion. That's because much of Trump's plan involves giving tax breaks to encourage people to buy insurance while taking away the requirement to buy insurance — a mandate embedded in Obamacare.\u003c/p>\n\u003cp>Even if Trump fails to repeal the law, Frakt says, he could easily destroy it from within by refusing to fund it through the budget process.\u003c/p>\n\u003cp>\"The only thing stopping that is, it's a big deal to throw millions of people off insurance without offering something in return,\" Frakt says.\u003c/p>\n\u003cp>If Trump is right that his health savings accounts are a good enough replacement, then he'll be able to get rid of Obamacare through a vote or through neglect.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Do+Parents+Invade+Children%27s+Privacy+When+They+Post+Photos+Online%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/501203831/501477057\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>President-elect Donald Trump has promised over and over in recent months that he will repeal and replace the Affordable Care Act, also called Obamacare, when he reaches the White House.\u003c/p>\n\u003cp>\"Obamacare is a disaster. You know it. We all know it,\" Trump \u003ca href=\"http://www.npr.org/2016/10/09/497056227/fact-check-clinton-and-trump-debate-for-the-second-time\" target=\"_blank\">said at a debate\u003c/a> last month. \"We have to repeal it and replace it with something absolutely much less expensive.\"\u003c/p>\n\u003cp>Now that Trump will move into the Oval Office in January, the question is whether he'll be able to completely repeal the six-year-old law that has had an impact on every aspect of the U.S. health care system.\u003c/p>\n\u003cp>\"It's a challenge for a Trump presidency,\" says\u003ca href=\"http://explore.georgetown.edu/people/jfh7/\" target=\"_blank\"> Jack Hoadley\u003c/a>, a research professor at Georgetown University's \u003ca href=\"https://hpi.georgetown.edu/\" target=\"_blank\">Health Policy Institute\u003c/a>. \"To get a true repeal and replace through, he needs 60 votes in the Senate.\" That's the minimum number of votes needed to overcome a filibuster in the Senate.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Repeal of the law is absolutely going to come up, and the only potential defense against that would be a Democratic filibuster — if Republicans even allow a filibuster,\" says \u003ca href=\"http://theincidentaleconomist.com/wordpress/about/about-austin/\" target=\"_blank\">Austin Frakt\u003c/a>, a health economist who runs the blog \u003ca href=\"http://theincidentaleconomist.com/\" target=\"_blank\">The Incidental Economist\u003c/a>.\u003c/p>\n\u003cp>But even if Trump can't repeal the Affordable Care Act in its entirety, there's a lot he can do through rule-making and smaller legislative changes to weaken the law and mold it more to his liking.\u003c/p>\n\u003cp>\"They are probably, practically speaking, talking about leaving the ACA, as is, in place,\" Hoadley says. \"Then he can change the ACA to have it showcase the kinds of plans he wants to see in place.\"\u003c/p>\n\u003cp>During his campaign, Trump proposed a \u003ca href=\"http://www.npr.org/2016/11/02/500371785/platform-check-trump-and-clinton-on-health-care\" target=\"_blank\">series of measures\u003c/a> that he said will allow people to buy affordable health insurance policies outside of the Obamacare exchanges.\u003c/p>\n\u003cp>Those measures include promoting tax-free health savings accounts that might help individuals save money to pay for health care costs and allowing people to deduct the cost of their premiums on their personal income tax returns. Trump has said he also wants to allow insurers to \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=122965862\" target=\"_blank\">sell policies across state lines\u003c/a> to boost competition.\u003c/p>\n\u003cp>Trump could alter the Obamacare exchanges to promote high-deductible health plans and health savings accounts to get a result similar to what he's looking for.\u003c/p>\n\u003cp>\"He could change the details of how the marketplaces work,\" Hoadley says. \"It's all worked out through regulation. You could just suspend the regulations.\"\u003c/p>\n\u003cp>Alternatively, Trump could embrace the \u003ca href=\"http://abetterway.speaker.gov/?page=health-care\" target=\"_blank\">health care plan\u003c/a> promoted by House Speaker Paul Ryan, which starts with repealing the Affordable Care Act. It includes many of the same principles as Trump's plan, but has more details.\u003c/p>\n\u003cp>One of the biggest challenges Trump faces is that about \u003ca href=\"http://www.hhs.gov/about/news/2016/03/03/20-million-people-have-gained-health-insurance-coverage-because-affordable-care-act-new-estimates\" target=\"_blank\">about 20 million\u003c/a> people today have health coverage because of the Affordable Care Act, according to the Department of Health and Human Services. The uninsured rate hit an \u003ca href=\"http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201611.pdf\" target=\"_blank\">all-time low \u003c/a>of 8.9 percent this year, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>An analysis of Trump's plan by \u003ca href=\"http://www.commonwealthfund.org/publications/blog/2016/trump-clinton-presidential-health-care-proposals\" target=\"_blank\">The Commonwealth Fund\u003c/a> estimates it would increase the number of people who lack health insurance by as many as 25 million, and increase the federal budget by as much as $41 billion. That's because much of Trump's plan involves giving tax breaks to encourage people to buy insurance while taking away the requirement to buy insurance — a mandate embedded in Obamacare.\u003c/p>\n\u003cp>Even if Trump fails to repeal the law, Frakt says, he could easily destroy it from within by refusing to fund it through the budget process.\u003c/p>\n\u003cp>\"The only thing stopping that is, it's a big deal to throw millions of people off insurance without offering something in return,\" Frakt says.\u003c/p>\n\u003cp>If Trump is right that his health savings accounts are a good enough replacement, then he'll be able to get rid of Obamacare through a vote or through neglect.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Do+Parents+Invade+Children%27s+Privacy+When+They+Post+Photos+Online%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Today marks the opening of \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a>, the state’s health insurance marketplace. People wanting to enroll, change, or renew their plans have from November 1, 2016 to January 31, 2017 to do so.\u003c/p>\n\u003cp>While the price of Affordable Care Act premiums is increasing nationally by roughly 22 percent, it’s not increasing as substantially in California. On average, the benchmark plan is going up by 13.2 percent statewide, and the majority of those enrolled in California are eligible for health care subsidies and won’t have to pay their full premium amount.\u003c/p>\n\u003cp>Experts say California’s health care marketplace has more stability than other states’ exchanges for several reasons, including California’s large size and large enrollment numbers (\u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\">approximately 1.4 million\u003c/a>), and a greater number of insurers, which leads to more competition. California also appropriately estimated prices from the start of Obamacare three years ago, meaning premium increases haven’t been as significant as some other states that initially priced their plans too low.\u003c/p>\n\u003cp>There are 11 health insurance companies offering a variety of plans for the 2017 year. James Scullary, a spokesman for Covered California, says 92 percent of consumers have the choice of three or more health plans, and all consumers have at least two to choose from.\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Today marks the opening of \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a>, the state’s health insurance marketplace. People wanting to enroll, change, or renew their plans have from November 1, 2016 to January 31, 2017 to do so.\u003c/p>\n\u003cp>While the price of Affordable Care Act premiums is increasing nationally by roughly 22 percent, it’s not increasing as substantially in California. On average, the benchmark plan is going up by 13.2 percent statewide, and the majority of those enrolled in California are eligible for health care subsidies and won’t have to pay their full premium amount.\u003c/p>\n\u003cp>Experts say California’s health care marketplace has more stability than other states’ exchanges for several reasons, including California’s large size and large enrollment numbers (\u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\">approximately 1.4 million\u003c/a>), and a greater number of insurers, which leads to more competition. California also appropriately estimated prices from the start of Obamacare three years ago, meaning premium increases haven’t been as significant as some other states that initially priced their plans too low.\u003c/p>\n\u003cp>There are 11 health insurance companies offering a variety of plans for the 2017 year. James Scullary, a spokesman for Covered California, says 92 percent of consumers have the choice of three or more health plans, and all consumers have at least two to choose from.\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Insurance Commissioner: California Should 'Strongly' Consider a Public Option Health Plan",
"title": "Insurance Commissioner: California Should 'Strongly' Consider a Public Option Health Plan",
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"content": "\u003cp>With major insurers retreating from the federal health law’s marketplaces, California’s insurance commissioner said he supports a public option at the state level that could bolster competition and potentially serve as a test for the controversial idea nationwide.\u003c/p>\n\u003cp>“I think we should strongly consider a public option in California,” Insurance Commissioner Dave Jones said in a recent interview with California Healthline. “It will require a lot of careful thought and work, but I think it’s something that ought to be on the table because we continue to see this consolidation in an already consolidated health insurance market.”\u003c/p>\n\u003cp>Nationally, President Barack Obama and other prominent Democrats have revived the idea of the public option in response to insurers such as \u003ca href=\"http://www.washingtontimes.com/news/2016/aug/29/aetna-unitedhealth-pulling-out-of-obamacare-leavin/\" target=\"_blank\">Aetna Inc. and UnitedHealth Group Inc. pulling back\u003c/a> from the individual insurance market and many consumers facing double-digit rate hikes.\u003c/p>\n\u003cp>The notion of a publicly run health plan competing against private insurers in government exchanges was \u003ca href=\"http://content.healthaffairs.org/content/29/6/1117.full\" target=\"_blank\">hotly debated but ultimately dropped\u003c/a> from the Affordable Care Act when it passed in 2010.\u003c/p>\n\u003cp>Health insurers have long opposed the idea, and other critics fear it would lead to a full government-run system.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Most of the discussion surrounding a public option, however, has focused on a nationwide plan, not one emanating from a state. In July, Democratic presidential nominee Hillary Clinton said she would “pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan.”\u003c/p>\n\u003cp>Jones offered few specifics on what a public option might look like in the Golden State.\u003c/p>\n\u003cp>“I don’t want to begin to prejudge it,” said Jones, an elected Democrat serving his second term as head of the state Department of Insurance, one of two insurance regulators in California. “I don’t know whether you would start in certain areas of the state and expand from there. I think there would be significant reservations about the state running it. There would be a wide variety of governance models you could come up with.”\u003c/p>\n\u003cp>Politically, the proposal may gain more traction in Sacramento than Washington with Democrats firmly in control of the state Legislature and many lawmakers eager to go beyond the boundaries of the federal health law. Depending on what form it took, a public option would require state legislation, some type of federal approval and some source of funding.\u003c/p>\n\u003cp>The idea of a California-style public option drew mixed reaction. Some consumer groups say they welcome another run at the public option after a disappointing outcome in 2010.\u003c/p>\n\u003cp>“We’re certainly very interested,” said Anthony Wright, executive director of Health Access California. “This is something we advocated for in its most ambitious form during the debate over health reform and there are elements of the proposal that could be adapted for California.”\u003c/p>\n\u003cp>Some health-policy experts questioned whether the proposal would backfire, ultimately reducing competition.\u003c/p>\n\u003cp>“I don’t know what would compel other insurers to stay in the market, so the public option could quickly become the only option,” said Katherine Hempstead, who directs the Robert Wood Johnson Foundation’s work on health insurance coverage. “I think that is only a clear win when the alternative is nothing.”\u003c/p>\n\u003cp>State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee, said a public option could make sense in some underserved areas. But he said it may not address the problem of large health systems dictating high prices, and it could interfere with the progress made by the Covered California insurance exchange.\u003c/p>\n\u003cp>Covered California said 7.4 percent of its 1.4 million enrollees will only have two health plans to choose from for 2017. The state’s biggest markets of Los Angeles, San Francisco and Orange County all feature six to seven insurers.\u003c/p>\n\u003cp>“I don’t know if a public option will create a lower price [for] the consumer,” Hernandez said. “Covered California has done a good job of keeping rates fairly stable and it has enough plans.”\u003c/p>\n\u003cp>Health insurers agreed. “Covered California has arguably one of the strongest and most stable exchanges in the country. There is robust consumer choice so we don’t think we need to mess with something that isn’t broken,” said Nicole Evans, a spokeswoman for the California Association of Health Plans, a trade group.\u003c/p>\n\u003cp>For years, Jones has criticized the lack of competition in Covered California, and more recently he has opposed the mergers proposed by industry giants Anthem Inc. and Aetna Inc., saying they’re anticompetitive.\u003c/p>\n\u003cp>Anthem wants to acquire Cigna, while Aetna is trying to merge with Humana, but the U.S. Justice Department has sued to block both deals.\u003c/p>\n\u003cp>Covered California has fared better than many states in terms of insurer competition. Eleven health plans are participating in the state-run exchange for 2017, but UnitedHealth is dropping out after just one year in California’s individual market.\u003c/p>\n\u003cp>Consumer advocates had hoped UnitedHealth would become a strong rival to the state’s four largest insurers. Anthem, Blue Shield of California, Kaiser Permanente and Health Net (now a unit of Centene) account for 90 percent of the state’s exchange enrollment.\u003c/p>\n\u003cp>After modest 4 percent rate increases in 2015 and 2016, Covered California premiums are set to climb by 13.2 percent on average next year.\u003c/p>\n\u003cp>Jones said he anticipates that critics will cite the \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/26/456220743/many-health-co-ops-fold-others-survive-startup-struggles\" target=\"_blank\">failure of numerous co-ops across the country\u003c/a>as evidence a public option won’t work. But he said that criticism is unjustified because the Republican-led Congress eliminated crucial funding that many of the co-ops were depending on.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The co-ops are nonprofit insurers backed with federal loans and designed as an alternative to commercial health plans.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With major insurers retreating from the federal health law’s marketplaces, California’s insurance commissioner said he supports a public option at the state level that could bolster competition and potentially serve as a test for the controversial idea nationwide.\u003c/p>\n\u003cp>“I think we should strongly consider a public option in California,” Insurance Commissioner Dave Jones said in a recent interview with California Healthline. “It will require a lot of careful thought and work, but I think it’s something that ought to be on the table because we continue to see this consolidation in an already consolidated health insurance market.”\u003c/p>\n\u003cp>Nationally, President Barack Obama and other prominent Democrats have revived the idea of the public option in response to insurers such as \u003ca href=\"http://www.washingtontimes.com/news/2016/aug/29/aetna-unitedhealth-pulling-out-of-obamacare-leavin/\" target=\"_blank\">Aetna Inc. and UnitedHealth Group Inc. pulling back\u003c/a> from the individual insurance market and many consumers facing double-digit rate hikes.\u003c/p>\n\u003cp>The notion of a publicly run health plan competing against private insurers in government exchanges was \u003ca href=\"http://content.healthaffairs.org/content/29/6/1117.full\" target=\"_blank\">hotly debated but ultimately dropped\u003c/a> from the Affordable Care Act when it passed in 2010.\u003c/p>\n\u003cp>Health insurers have long opposed the idea, and other critics fear it would lead to a full government-run system.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Most of the discussion surrounding a public option, however, has focused on a nationwide plan, not one emanating from a state. In July, Democratic presidential nominee Hillary Clinton said she would “pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan.”\u003c/p>\n\u003cp>Jones offered few specifics on what a public option might look like in the Golden State.\u003c/p>\n\u003cp>“I don’t want to begin to prejudge it,” said Jones, an elected Democrat serving his second term as head of the state Department of Insurance, one of two insurance regulators in California. “I don’t know whether you would start in certain areas of the state and expand from there. I think there would be significant reservations about the state running it. There would be a wide variety of governance models you could come up with.”\u003c/p>\n\u003cp>Politically, the proposal may gain more traction in Sacramento than Washington with Democrats firmly in control of the state Legislature and many lawmakers eager to go beyond the boundaries of the federal health law. Depending on what form it took, a public option would require state legislation, some type of federal approval and some source of funding.\u003c/p>\n\u003cp>The idea of a California-style public option drew mixed reaction. Some consumer groups say they welcome another run at the public option after a disappointing outcome in 2010.\u003c/p>\n\u003cp>“We’re certainly very interested,” said Anthony Wright, executive director of Health Access California. “This is something we advocated for in its most ambitious form during the debate over health reform and there are elements of the proposal that could be adapted for California.”\u003c/p>\n\u003cp>Some health-policy experts questioned whether the proposal would backfire, ultimately reducing competition.\u003c/p>\n\u003cp>“I don’t know what would compel other insurers to stay in the market, so the public option could quickly become the only option,” said Katherine Hempstead, who directs the Robert Wood Johnson Foundation’s work on health insurance coverage. “I think that is only a clear win when the alternative is nothing.”\u003c/p>\n\u003cp>State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee, said a public option could make sense in some underserved areas. But he said it may not address the problem of large health systems dictating high prices, and it could interfere with the progress made by the Covered California insurance exchange.\u003c/p>\n\u003cp>Covered California said 7.4 percent of its 1.4 million enrollees will only have two health plans to choose from for 2017. The state’s biggest markets of Los Angeles, San Francisco and Orange County all feature six to seven insurers.\u003c/p>\n\u003cp>“I don’t know if a public option will create a lower price [for] the consumer,” Hernandez said. “Covered California has done a good job of keeping rates fairly stable and it has enough plans.”\u003c/p>\n\u003cp>Health insurers agreed. “Covered California has arguably one of the strongest and most stable exchanges in the country. There is robust consumer choice so we don’t think we need to mess with something that isn’t broken,” said Nicole Evans, a spokeswoman for the California Association of Health Plans, a trade group.\u003c/p>\n\u003cp>For years, Jones has criticized the lack of competition in Covered California, and more recently he has opposed the mergers proposed by industry giants Anthem Inc. and Aetna Inc., saying they’re anticompetitive.\u003c/p>\n\u003cp>Anthem wants to acquire Cigna, while Aetna is trying to merge with Humana, but the U.S. Justice Department has sued to block both deals.\u003c/p>\n\u003cp>Covered California has fared better than many states in terms of insurer competition. Eleven health plans are participating in the state-run exchange for 2017, but UnitedHealth is dropping out after just one year in California’s individual market.\u003c/p>\n\u003cp>Consumer advocates had hoped UnitedHealth would become a strong rival to the state’s four largest insurers. Anthem, Blue Shield of California, Kaiser Permanente and Health Net (now a unit of Centene) account for 90 percent of the state’s exchange enrollment.\u003c/p>\n\u003cp>After modest 4 percent rate increases in 2015 and 2016, Covered California premiums are set to climb by 13.2 percent on average next year.\u003c/p>\n\u003cp>Jones said he anticipates that critics will cite the \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/26/456220743/many-health-co-ops-fold-others-survive-startup-struggles\" target=\"_blank\">failure of numerous co-ops across the country\u003c/a>as evidence a public option won’t work. But he said that criticism is unjustified because the Republican-led Congress eliminated crucial funding that many of the co-ops were depending on.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The co-ops are nonprofit insurers backed with federal loans and designed as an alternative to commercial health plans.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Insurers May Be Exploiting Outrage Over Drug Prices to Inflate Health Plan Premiums, Consumer Advocates Say",
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"content": "\u003cp>Rising drug costs are often blamed for driving up health insurance premiums, but a major consumer group says the numbers don’t add up — at least in California.\u003c/p>\n\u003cp>The advocacy group Consumers Union says two of California's largest insurers may be exploiting the outrage over high drug prices to artificially inflate their premiums for individual coverage under the Affordable Care Act.\u003c/p>\n\u003cp>State regulators are independently examining the issue and pressing both Anthem Inc. and Blue Shield of California to justify their rate hikes of nearly 20 percent before open enrollment this fall. Together, the insurers cover more than half of enrollees in the state’s insurance exchange, Covered California.\u003c/p>\n\u003cp>Despite the uproar over expensive hepatitis C pills and, more recently, the $600 price tag for EpiPens, the growth in spending on prescription drugs has been slowing. After a 12 percent jump in 2014, drug costs are expected to climb by roughly 7 percent next year, according to federal officials.\u003c/p>\n\u003cp>“The cost of prescription drugs is an issue,” said Dena Mendelsohn, a staff attorney at Consumers Union in San Francisco. “But pharmaceutical expenses may be the factor most open to exploitation by health plans searching for a Trojan horse with which to usher in excessively priced insurance rates.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In detailed comments recently filed with the California Department of Managed Health Care, Consumers Union asked why the cost projections submitted by Anthem and Blue Shield are so much higher than some of their competitors and other industry-wide figures. (The Consumers Union comments are included in rate filing documents \u003ca href=\"http://wpso.dmhc.ca.gov/RateReview/Detail.aspx?lrh=XbZWkzRmrkA%24\" target=\"_blank\">here\u003c/a> and \u003ca href=\"http://wpso.dmhc.ca.gov/RateReview/Detail.aspx?lrh=0QtDat9Z%2fL8%24\" target=\"_blank\">here\u003c/a>.)\u003c/p>\n\u003cp>Separately, the managed care agency has requested more information from both companies ahead of an Oct. 3 deadline to finish its review into whether their premium increases are reasonable. Blue Shield has proposed an average 19.4 percent increase for about 550,000 individual policyholders, both in the Covered California exchange and outside the marketplace. Anthem, the nation’s second-largest health insurer, wants a 17.2 percent increase for nearly 580,000 customers in and outside the exchange.\u003c/p>\n\u003cp>The state agency can pressure the insurers to reduce the increases by calling them into question, but it doesn’t have the authority to block them.\u003c/p>\n\u003cp>“We are seeking additional information and clarity from Anthem and Blue Shield on their filings,” said spokeswoman Rachel Arrezola. “We cannot discuss findings until we’ve completed our review.”\u003c/p>\n\u003cp>To make the case for substantial rate hikes, both Anthem and Blue Shield cited higher drug spending as a major factor. Anthem forecast a 17.7 percent jump in prescription drug costs for 2017; Blue Shield was close behind at 15.2 percent.\u003c/p>\n\u003cp>Blue Shield said soaring drug costs are one reason it lost money on individual policies in the first half of this year. The company said pharmacy costs on a per-member basis rose more than 30 percent last year in the individual market.\u003c/p>\n\u003cp>“We are not using any sleight of hand to justify rate increases,” said Steve Shivinsky, a spokesman for Blue Shield, a nonprofit health plan based in San Francisco. “Our numbers reflect what we’re experiencing in the market, not some national average or trend. We’re seeing a dramatic inflation in cost for run-of-the-mill drugs like EpiPen.”\u003c/p>\n\u003cp>Anthem declined to answer specific questions about its rates while the state review is pending. In a statement, the company said “factors such as increased use of medical services and added costs of drugs and medical therapies put upward pressure on rates and underscore the additional work that needs to be done to moderate the growth in health care costs.”\u003c/p>\n\u003cp>Two other big insurers in the California exchange saw things differently, according to their regulatory filings. HMO giant Kaiser Permanente predicts a 6 percent increase in drug costs next year and Health Net Inc. estimated 11 percent. Consumers Union asked regulators to seek a detailed justification for Health Net’s average rate increase of 9.4 percent as well, \u003ca href=\"http://wpso.dmhc.ca.gov/RateReview/Detail.aspx?lrh=bSEB7eCDslo%24\" target=\"_blank\">documents\u003c/a> show.\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>Other state exchanges are facing even steeper rate hikes, approaching 60 percent from some major insurers reporting heavy losses under the health law. Consumers Union said the questionable data it found in California may apply to insurers elsewhere and it urges all regulators to conduct a thorough review.\u003c/p>\n\u003cp>“We think it’s likely happening across the country with insurers using this as an opportunity to raise rates more than they should,” Mendelsohn said.\u003c/p>\n\u003cp>Many health insurers insist their losses in the individual market are substantial and higher rates are necessary to make the Obamacare marketplaces sustainable for the long term. In crafting 2017 rates, insurers said they had the benefit of detailed data on exchange customers for the first time, and it showed they had underpriced the coverage compared to the services used by members.\u003c/p>\n\u003cp>Drug costs are just one factor pushing up premiums. Another is the discontinuation of a federal reinsurance program later this year that helps insurers with large claims. Also, many companies have complained about higher than expected costs for people who sign up outside the regular open enrollment period, citing special circumstances such as a job loss.\u003c/p>\n\u003cp>Federal data and several industry reports suggest that drug costs are leveling off nationwide after a spike from several high-priced hepatitis C medications bursting on the market. Prescription drug spending grew 3.9 percent for the past 12 months through July, according to the Altarum Institute. That’s down from 8.5 percent for the previous year.\u003c/p>\n\u003cp>“We are seeing a moderation of the cost trend,” said Barbara Gniewek, a partner and health benefits expert at consulting firm PricewaterhouseCoopers. “The hepatitis C drugs were a tsunami and really caught people off guard. But I don’t see those types of blockbusters in the pipeline right now.”\u003c/p>\n\u003cp>Gniewek said the drug cost projections from Anthem and Blue Shield are outliers. “I haven’t seen numbers that high,” she said.\u003c/p>\n\u003cp>Other health policy experts, however, said there’s ample evidence that drug costs are forcing premiums higher, particularly in the more volatile individual market, and insurers might have good reason to fear the worst from drug makers.\u003c/p>\n\u003cp>“Even though there has been some moderation in drug costs, I don’t think insurers have any confidence it will last,” said Paul Ginsburg, a health economist and professor at the University of Southern California. “They are waiting for the next major drug launch. They were burned by hepatitis C and might be more conservative now.”\u003c/p>\n\u003cp>California’s health exchange negotiated the rate increases with Blue Shield and Anthem, and the agency vetted them before they were announced in July. The two big insurers drove the statewide rate increase on the exchange to 13.2 percent for next year, a sharp uptick from 4 percent average increases the previous two years.\u003c/p>\n\u003cp>Mendelsohn questioned why large insurers such as Anthem and Blue Shield can’t use their market power to better control pharmacy costs and whether the companies are fully accounting for the rebates they receive from drug manufacturers.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Shivinsky acknowledged that there’s more Blue Shield could do to address drug prices. “We’re looking at changes in our formulary and how we purchase drugs in the future,” he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Rising drug costs are often blamed for driving up health insurance premiums, but a major consumer group says the numbers don’t add up — at least in California.\u003c/p>\n\u003cp>The advocacy group Consumers Union says two of California's largest insurers may be exploiting the outrage over high drug prices to artificially inflate their premiums for individual coverage under the Affordable Care Act.\u003c/p>\n\u003cp>State regulators are independently examining the issue and pressing both Anthem Inc. and Blue Shield of California to justify their rate hikes of nearly 20 percent before open enrollment this fall. Together, the insurers cover more than half of enrollees in the state’s insurance exchange, Covered California.\u003c/p>\n\u003cp>Despite the uproar over expensive hepatitis C pills and, more recently, the $600 price tag for EpiPens, the growth in spending on prescription drugs has been slowing. After a 12 percent jump in 2014, drug costs are expected to climb by roughly 7 percent next year, according to federal officials.\u003c/p>\n\u003cp>“The cost of prescription drugs is an issue,” said Dena Mendelsohn, a staff attorney at Consumers Union in San Francisco. “But pharmaceutical expenses may be the factor most open to exploitation by health plans searching for a Trojan horse with which to usher in excessively priced insurance rates.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In detailed comments recently filed with the California Department of Managed Health Care, Consumers Union asked why the cost projections submitted by Anthem and Blue Shield are so much higher than some of their competitors and other industry-wide figures. (The Consumers Union comments are included in rate filing documents \u003ca href=\"http://wpso.dmhc.ca.gov/RateReview/Detail.aspx?lrh=XbZWkzRmrkA%24\" target=\"_blank\">here\u003c/a> and \u003ca href=\"http://wpso.dmhc.ca.gov/RateReview/Detail.aspx?lrh=0QtDat9Z%2fL8%24\" target=\"_blank\">here\u003c/a>.)\u003c/p>\n\u003cp>Separately, the managed care agency has requested more information from both companies ahead of an Oct. 3 deadline to finish its review into whether their premium increases are reasonable. Blue Shield has proposed an average 19.4 percent increase for about 550,000 individual policyholders, both in the Covered California exchange and outside the marketplace. Anthem, the nation’s second-largest health insurer, wants a 17.2 percent increase for nearly 580,000 customers in and outside the exchange.\u003c/p>\n\u003cp>The state agency can pressure the insurers to reduce the increases by calling them into question, but it doesn’t have the authority to block them.\u003c/p>\n\u003cp>“We are seeking additional information and clarity from Anthem and Blue Shield on their filings,” said spokeswoman Rachel Arrezola. “We cannot discuss findings until we’ve completed our review.”\u003c/p>\n\u003cp>To make the case for substantial rate hikes, both Anthem and Blue Shield cited higher drug spending as a major factor. Anthem forecast a 17.7 percent jump in prescription drug costs for 2017; Blue Shield was close behind at 15.2 percent.\u003c/p>\n\u003cp>Blue Shield said soaring drug costs are one reason it lost money on individual policies in the first half of this year. The company said pharmacy costs on a per-member basis rose more than 30 percent last year in the individual market.\u003c/p>\n\u003cp>“We are not using any sleight of hand to justify rate increases,” said Steve Shivinsky, a spokesman for Blue Shield, a nonprofit health plan based in San Francisco. “Our numbers reflect what we’re experiencing in the market, not some national average or trend. We’re seeing a dramatic inflation in cost for run-of-the-mill drugs like EpiPen.”\u003c/p>\n\u003cp>Anthem declined to answer specific questions about its rates while the state review is pending. In a statement, the company said “factors such as increased use of medical services and added costs of drugs and medical therapies put upward pressure on rates and underscore the additional work that needs to be done to moderate the growth in health care costs.”\u003c/p>\n\u003cp>Two other big insurers in the California exchange saw things differently, according to their regulatory filings. HMO giant Kaiser Permanente predicts a 6 percent increase in drug costs next year and Health Net Inc. estimated 11 percent. Consumers Union asked regulators to seek a detailed justification for Health Net’s average rate increase of 9.4 percent as well, \u003ca href=\"http://wpso.dmhc.ca.gov/RateReview/Detail.aspx?lrh=bSEB7eCDslo%24\" target=\"_blank\">documents\u003c/a> show.\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>Other state exchanges are facing even steeper rate hikes, approaching 60 percent from some major insurers reporting heavy losses under the health law. Consumers Union said the questionable data it found in California may apply to insurers elsewhere and it urges all regulators to conduct a thorough review.\u003c/p>\n\u003cp>“We think it’s likely happening across the country with insurers using this as an opportunity to raise rates more than they should,” Mendelsohn said.\u003c/p>\n\u003cp>Many health insurers insist their losses in the individual market are substantial and higher rates are necessary to make the Obamacare marketplaces sustainable for the long term. In crafting 2017 rates, insurers said they had the benefit of detailed data on exchange customers for the first time, and it showed they had underpriced the coverage compared to the services used by members.\u003c/p>\n\u003cp>Drug costs are just one factor pushing up premiums. Another is the discontinuation of a federal reinsurance program later this year that helps insurers with large claims. Also, many companies have complained about higher than expected costs for people who sign up outside the regular open enrollment period, citing special circumstances such as a job loss.\u003c/p>\n\u003cp>Federal data and several industry reports suggest that drug costs are leveling off nationwide after a spike from several high-priced hepatitis C medications bursting on the market. Prescription drug spending grew 3.9 percent for the past 12 months through July, according to the Altarum Institute. That’s down from 8.5 percent for the previous year.\u003c/p>\n\u003cp>“We are seeing a moderation of the cost trend,” said Barbara Gniewek, a partner and health benefits expert at consulting firm PricewaterhouseCoopers. “The hepatitis C drugs were a tsunami and really caught people off guard. But I don’t see those types of blockbusters in the pipeline right now.”\u003c/p>\n\u003cp>Gniewek said the drug cost projections from Anthem and Blue Shield are outliers. “I haven’t seen numbers that high,” she said.\u003c/p>\n\u003cp>Other health policy experts, however, said there’s ample evidence that drug costs are forcing premiums higher, particularly in the more volatile individual market, and insurers might have good reason to fear the worst from drug makers.\u003c/p>\n\u003cp>“Even though there has been some moderation in drug costs, I don’t think insurers have any confidence it will last,” said Paul Ginsburg, a health economist and professor at the University of Southern California. “They are waiting for the next major drug launch. They were burned by hepatitis C and might be more conservative now.”\u003c/p>\n\u003cp>California’s health exchange negotiated the rate increases with Blue Shield and Anthem, and the agency vetted them before they were announced in July. The two big insurers drove the statewide rate increase on the exchange to 13.2 percent for next year, a sharp uptick from 4 percent average increases the previous two years.\u003c/p>\n\u003cp>Mendelsohn questioned why large insurers such as Anthem and Blue Shield can’t use their market power to better control pharmacy costs and whether the companies are fully accounting for the rebates they receive from drug manufacturers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Shivinsky acknowledged that there’s more Blue Shield could do to address drug prices. “We’re looking at changes in our formulary and how we purchase drugs in the future,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "No Primary Care Doc? Covered California Will Get You One",
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"content": "\u003cp>Health insurers are gearing up to comply with a new Covered California rule that will require them next year to ensure that all enrollees have a primary care provider.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You need a captain of the ship.'\u003ccite> Lance Lang, chief medical officer of Covered California \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>The policy change for 2017 is part of a broader push by the exchange to improve the quality of care, even as it faces double-digit premium increases.\u003c/p>\n\u003cp>Health insurers selling through Covered California will designate a family doctor — or in some cases a nurse practitioner or physician’s assistant — for every plan holder who doesn’t already have one within 60 days of the coverage start date. The role of the assigned provider will be to help enrollees “navigate the system,” the exchange said last week.\u003c/p>\n\u003cp>The new policy applies to all enrollees, including those in Preferred Provider Organizations (PPOs), in which patients choose the physicians they want, and in HMOs, where the doctor networks are narrower and patients need a referral from their primary care doctor to see other providers.\u003c/p>\n\u003cp>“You need a captain of the ship,” Lance Lang, chief medical officer of Covered California, said of the role primary care providers play in coordinating patient health. These clinicians “[know] the patient, not just their statistics and lab values.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lang said the new policy is meant to improve both the quality and cost efficiency of care.\u003c/p>\n\u003cp>As the agency \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">unveiled its 2017 health plans and premium rates\u003c/a> last week, Executive Director Peter Lee said officials wanted to make sure that “having coverage means [policyholders] also have access to care.”\u003c/p>\n\u003cp>PPO enrollees will still have the freedom to choose their own providers and will not require referrals from their primary care doctors to see other providers.\u003c/p>\n\u003cp>For them, “this isn’t a ‘mother may I’ doctor,” said Lee.\u003c/p>\n\u003cp>Consumers Union, a nonprofit advocacy group with a seat on a Covered California advisory committee, supported the change but wants the exchange to make sure it’s easy for consumers to change doctors if they need to and to find providers in their network who are accepting new patients.\u003c/p>\n\u003cp>The move to more coordinated care did not surprise health policy experts.\u003c/p>\n\u003cp>“California has definitely, relative to the nation as a whole, been far more aggressive in moving into managed care,” said Dr. Geoffrey Joyce, director of health policy at the University of Southern California’s Schaeffer Center.\u003c/p>\n\u003cp>However, Joyce said the Covered California policy change is not a full shift to managed care because the primary care assignments would not be as binding or restrictive as in traditional HMOs, in which patients have to pay more if they see doctors to whom they are not referred.\u003c/p>\n\u003cp>But the new policy could have clinical and financial benefits, he said.\u003c/p>\n\u003cp>“Everyone’s moving towards better integrated care, better coordinated care. And so having one primary care provider be your sort of gatekeeper and your focal point makes sense,” Joyce said.\u003c/p>\n\u003cp>Lang said that Covered California is moving away from a “fragmented, disorganized, wild west” kind of care but is not trying to steer consumers away from PPOs and into HMOs.\u003c/p>\n\u003cp>Primary care relationships can simply help avoid unnecessary medical costs, Lang said, because a family doctor can prevent duplication of tests and other services and make it less likely a patient will be readmitted to a hospital.\u003c/p>\n\u003cp>The new primary care requirement is part of a series of new measures meant to improve the quality of care in Covered California health plans. The exchange’s board of directors recently approved rules that include penalizing hospitals financially for underperforming and even removing them — or doctors — from health insurance networks if they perform too poorly or charge too much.\u003c/p>\n\u003cp>Health plans will also be required to share data about chronic diseases among their patients and work to reduce health disparities.\u003c/p>\n\u003cp>Covered California’s health plan premiums will increase by an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">average of 13.2 percent statewide\u003c/a> next year, but Lang said rising costs are not the impetus for the policy change on primary care. A body of research shows the benefits of coordinated care, he said.\u003c/p>\n\u003cp>How many of the 1.4 million Covered California enrollees who currently have primary care doctors is unknown, but about half of the patients in the marketplace are in HMOs, where primary care physicians are the first point of contact.\u003c/p>\n\u003cp>The California Academy of Family Physicians applauded the Covered California decision, saying primary care can help reduce costs in the current health care system, where “patients sometimes think the emergency room is their only option for urgent care.”\u003c/p>\n\u003cp>The success of Covered California’s effort depends on how it’s carried out, and the implementation should be monitored to make sure there is an adequate number of providers for patients, the family doctors group said.\u003c/p>\n\u003cp>California laws and insurance exchange rules require health plans to ensure that patients can see providers within a certain timeframe. But in some areas where there is a shortage of primary care providers, patients already have to wait to see a clinician, Joyce said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It’s possible patients will still have to wait to see a provider under the new Covered California policy, but being assigned to a primary care provider might help expedite a patient’s search for an in-network doctor, Joyce said.\u003c/p>\n\n",
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"excerpt": "Next year, Covered California will require health plans to assign a primary care doctor to all enrollees who don’t have one. (The assignment is not binding.)",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health insurers are gearing up to comply with a new Covered California rule that will require them next year to ensure that all enrollees have a primary care provider.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You need a captain of the ship.'\u003ccite> Lance Lang, chief medical officer of Covered California \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>The policy change for 2017 is part of a broader push by the exchange to improve the quality of care, even as it faces double-digit premium increases.\u003c/p>\n\u003cp>Health insurers selling through Covered California will designate a family doctor — or in some cases a nurse practitioner or physician’s assistant — for every plan holder who doesn’t already have one within 60 days of the coverage start date. The role of the assigned provider will be to help enrollees “navigate the system,” the exchange said last week.\u003c/p>\n\u003cp>The new policy applies to all enrollees, including those in Preferred Provider Organizations (PPOs), in which patients choose the physicians they want, and in HMOs, where the doctor networks are narrower and patients need a referral from their primary care doctor to see other providers.\u003c/p>\n\u003cp>“You need a captain of the ship,” Lance Lang, chief medical officer of Covered California, said of the role primary care providers play in coordinating patient health. These clinicians “[know] the patient, not just their statistics and lab values.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lang said the new policy is meant to improve both the quality and cost efficiency of care.\u003c/p>\n\u003cp>As the agency \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">unveiled its 2017 health plans and premium rates\u003c/a> last week, Executive Director Peter Lee said officials wanted to make sure that “having coverage means [policyholders] also have access to care.”\u003c/p>\n\u003cp>PPO enrollees will still have the freedom to choose their own providers and will not require referrals from their primary care doctors to see other providers.\u003c/p>\n\u003cp>For them, “this isn’t a ‘mother may I’ doctor,” said Lee.\u003c/p>\n\u003cp>Consumers Union, a nonprofit advocacy group with a seat on a Covered California advisory committee, supported the change but wants the exchange to make sure it’s easy for consumers to change doctors if they need to and to find providers in their network who are accepting new patients.\u003c/p>\n\u003cp>The move to more coordinated care did not surprise health policy experts.\u003c/p>\n\u003cp>“California has definitely, relative to the nation as a whole, been far more aggressive in moving into managed care,” said Dr. Geoffrey Joyce, director of health policy at the University of Southern California’s Schaeffer Center.\u003c/p>\n\u003cp>However, Joyce said the Covered California policy change is not a full shift to managed care because the primary care assignments would not be as binding or restrictive as in traditional HMOs, in which patients have to pay more if they see doctors to whom they are not referred.\u003c/p>\n\u003cp>But the new policy could have clinical and financial benefits, he said.\u003c/p>\n\u003cp>“Everyone’s moving towards better integrated care, better coordinated care. And so having one primary care provider be your sort of gatekeeper and your focal point makes sense,” Joyce said.\u003c/p>\n\u003cp>Lang said that Covered California is moving away from a “fragmented, disorganized, wild west” kind of care but is not trying to steer consumers away from PPOs and into HMOs.\u003c/p>\n\u003cp>Primary care relationships can simply help avoid unnecessary medical costs, Lang said, because a family doctor can prevent duplication of tests and other services and make it less likely a patient will be readmitted to a hospital.\u003c/p>\n\u003cp>The new primary care requirement is part of a series of new measures meant to improve the quality of care in Covered California health plans. The exchange’s board of directors recently approved rules that include penalizing hospitals financially for underperforming and even removing them — or doctors — from health insurance networks if they perform too poorly or charge too much.\u003c/p>\n\u003cp>Health plans will also be required to share data about chronic diseases among their patients and work to reduce health disparities.\u003c/p>\n\u003cp>Covered California’s health plan premiums will increase by an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">average of 13.2 percent statewide\u003c/a> next year, but Lang said rising costs are not the impetus for the policy change on primary care. A body of research shows the benefits of coordinated care, he said.\u003c/p>\n\u003cp>How many of the 1.4 million Covered California enrollees who currently have primary care doctors is unknown, but about half of the patients in the marketplace are in HMOs, where primary care physicians are the first point of contact.\u003c/p>\n\u003cp>The California Academy of Family Physicians applauded the Covered California decision, saying primary care can help reduce costs in the current health care system, where “patients sometimes think the emergency room is their only option for urgent care.”\u003c/p>\n\u003cp>The success of Covered California’s effort depends on how it’s carried out, and the implementation should be monitored to make sure there is an adequate number of providers for patients, the family doctors group said.\u003c/p>\n\u003cp>California laws and insurance exchange rules require health plans to ensure that patients can see providers within a certain timeframe. But in some areas where there is a shortage of primary care providers, patients already have to wait to see a clinician, Joyce said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It’s possible patients will still have to wait to see a provider under the new Covered California policy, but being assigned to a primary care provider might help expedite a patient’s search for an in-network doctor, Joyce said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Premiums Going up 13.2% Next Year. Here's Why.",
"title": "Covered California Premiums Going up 13.2% Next Year. Here's Why.",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>Update: 2:30 p.m.\u003c/strong>\u003c/p>\n\u003cp>Covered California, the state's Obamacare marketplace, released proposed 2017 premiums Tuesday morning, and the average statewide increase will be 13.2 percent, more than triple the increase seen each of the last two years.\u003c/p>\n\u003cp>Peter Lee, the agency's executive director, cited several factors as drivers in this year's spike.\u003c/p>\n\u003cp>Most notable is an expiring federal \"reinsurance\" program, created as part of the Affordable Care Act, to spread the risk of so many newly insured people entering the risk pool. Actuarial experts estimate that alone adds 4 to 7 percent to premiums, but it's viewed as a one-time effect.\u003c/p>\n\u003cp>Rising health care costs, including specialty prescription drugs, are also a factor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lee stressed that most people could reduce their own individual increase by shopping around.\u003c/p>\n\u003cp>\"Almost 80 percent of our customers could either pay less than they are paying today or pay no more than [a] 5 percent increase,\" Lee said, if they comparison shop.\u003c/p>\n\u003cp>Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation, agreed there may be \"deals to be had.\"\u003c/p>\n\u003cp>“The market is still working much better in California than in most other states,\" he said. \"It’s quite competitive in giving consumers a large number of choices.\"\u003c/p>\n\u003cp>About 1.4 million Californians purchase their health insurance through the Covered California exchange.\u003c/p>\n\u003cp>Blue Shield and Anthem Blue Cross customers will face the steepest increases. They have about \"a quarter of the market each,\" Lee said. Anthem customers will see a statewide average increase of 16 percent, and Blue Shield is \"above 19 percent,\" Lee said.\u003c/p>\n\u003cp>In the Bay Area, those increases will be even steeper for Anthem and Blue Shield customers. Meanwhile, the average monthly premium hike for Kaiser members will be in the 5-6 percent range across much of the region.\u003c/p>\n\u003cp>\"We are committed to offering stable rates over the long term,\" said Bill Wehrle, a vice president at Kaiser Permanente, \"and are uniquely positioned to deliver more affordable health care coverage.\" He cited investments in technology and Kaiser's \"emphasis on wellness\" as factors keeping premium increases lower.\u003c/p>\n\u003cp>Here are some of the proposed rate increases for major plans in several Bay Area counties:\u003c/p>\n\u003cp>\u003cstrong>San Francisco\u003c/strong>\u003cbr>\nAverage increase: 14.8 percent\u003c/p>\n\u003cp>Kaiser: 5.3 percent\u003cbr>\nAnthem Blue Cross: 16.7 percent\u003cbr>\nBlue Shield: 24.2 percent\u003c/p>\n\u003cp>\u003cstrong>Contra Costa County\u003c/strong>\u003cbr>\nAverage increase: 13.6 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross: 22.6 percent\u003cbr>\nBlue Shield: 24.4 percent\u003c/p>\n\u003cp>\u003cstrong>Alameda County\u003c/strong>\u003cbr>\nAverage increase: 12.3 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross: 23.7 percent\u003cbr>\nBlue Shield: 18.9 percent\u003c/p>\n\u003cp>\u003cstrong>Santa Clara\u003c/strong>\u003cbr>\nAverage increase: 9.2 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross (EPO): 8.4 percent\u003cbr>\nBlue Shield: 22.3 percent\u003c/p>\n\u003cp>You can look up the proposed rate for your plan in your specific area by checking Covered California's \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA-2017-rate-booklet.pdf\" target=\"_blank\">rate booklet.\u003c/a>\u003c/p>\n\u003cp>The rates are not yet final. State regulators will review them in the coming weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>California's Obamacare customers can expect a hefty increase in their monthly health insurance premiums next year. Covered California will announce new 2017 rates Tuesday morning for people who buy their plan through the state marketplace, and experts are predicting that increases will be double or even triple what they were last year.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/274403157\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>“2017 is going to be a transition year,” said Peter Lee, executive director of Covered California, testifying before Congress last week. “We expect our rates to be higher than we saw in our first two years.”\u003c/p>\n\u003cp>In \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/07/31/californias-2015-obamacare-premiums-will-increase-modestly/\" target=\"_blank\">2015\u003c/a> and \u003ca href=\"https://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\" target=\"_blank\">2016\u003c/a>, marketplace premiums increased an average of 4 percent -- a rate celebrated by consumer advocates as “modest,” even “\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\">terrific\u003c/a>.”\u003c/p>\n\u003cp>Covered California’s proposed budget for 2017, released in May, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/05/11/californias-obamacare-premiums-may-rise-8-percent-next-year/\" target=\"_blank\">projected average rate increases of 8 percent\u003c/a>. Industry insiders are suggesting the average jump could be even higher.\u003c/p>\n\u003cp>There are three key reasons why.\u003c/p>\n\u003cp>\u003cstrong>One: Medical Costs are Up\u003c/strong>\u003c/p>\n\u003cp>Insurance companies say premium prices are going up because medical costs are going up. Doctors, hospitals, labs and pharmaceutical companies are all raising their prices.\u003c/p>\n\u003cp>“Unquestionably, runaway drug prices remain a serious problem,” said Charles Bacchi, president and CEO of the California Association of Health Plans, a trade group for insurers. “We’re seeing new drugs coming out with blockbuster prices, and we’ve seen drugs that have been around for 30 years double and triple in price for no reason.”\u003c/p>\n\u003cp>Northern Californians have felt the burden of higher medical costs more so than people in Southern California because the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">hospital market is more consolidated\u003c/a>, giving hospitals more bargaining power with insurers.\u003c/p>\n\u003cp>Early rate filings from other states indicate rising medical costs could contribute to premium increases anywhere from 3 to 9 percent.\u003c/p>\n\u003cp>California regulators will have a chance to review the proposed rate increases, and consumer advocacy groups say they look forward to participating in the process by challenging some of the assumptions health plans have made about costs.\u003c/p>\n\u003cp>\"To the extent insurers are booking a certain amount of medical inflation to prescription drugs, are they overestimating those costs?\" said Anthony Wright, executive director of Health Access. \"Is that a scapegoat or a true driver?*\u003c/p>\n\u003cp>\u003cstrong>Two: Federal Protections are Expiring\u003c/strong>\u003c/p>\n\u003cp>The Affordable Care Act established a “reinsurance” program that was designed to help insurance companies cover losses if they had a high proportion of really sick, expensive patients. Insurers didn’t know who was going to sign up for their plans, and basically had to guess how sick they would be and how much care they would need, then factor that into their premium rates.\u003c/p>\n\u003cp>Through the reinsurance program, all health plans paid into a shared pool, then those funds were distributed to companies that ended up with more high-cost patients. This meant plans didn’t have to make up losses by increasing premiums the following year. But that protection expires this year, adding a 4 to 7 percent increase to consumers’ monthly premiums in 2017, according to\u003ca href=\"http://www.actuary.org/content/drivers-2017-health-insurance-premium-changes-0\" target=\"_blank\"> an analysis\u003c/a> of the American Academy of Actuaries.\u003c/p>\n\u003cp>Another program, \"risk corridors,\" which is designed to protect consumers against excessive premium increases, also expires this year.\u003c/p>\n\u003cp>\u003cstrong>Three: People May Be Gaming the System\u003c/strong>\u003c/p>\n\u003cp>Most people buy their insurance during the set enrollment period starting in the fall. But people who lose their coverage during the year because they lose a job, get divorced or move (among other eligibility criteria) are able to buy a plan through Covered California outside normal enrollment periods.\u003c/p>\n\u003cp>But insurers are noticing that these customers have medical costs that are 25 to 40 percent higher than the rest of the health care population, said Bacchi.\u003c/p>\n\u003cp>Are people taking advantage of the system, signing up for coverage not because they had a qualifying change in life circumstances, but because they got sick? Or is it that sicker people are more motivated to look for ways to stay insured after they lose coverage through work or a divorce?\u003c/p>\n\u003cp>\u003cstrong>Californians May Be Better Off\u003c/strong>\u003c/p>\n\u003cp>Despite all these factors, state officials and the insurance industry say Californians are still better off than consumers in most other states. Peter Lee emphasized that Covered California is an “active purchaser,” meaning it negotiates with plans when they set their prices.\u003c/p>\n\u003cp>“Covered California does not negotiate by table-pounding, but rather by providing good data on the risk mix of who is enrolled and working the health plans to garner maximum enrollment,” Lee said in his remarks before Congress. “In 2015, we provided data that proved Covered California enrollees were healthier and presented less risk to insurance companies than anticipated, which helped drive down the cost of health premiums.”\u003c/p>\n\u003cp>Bacchi said consumers here also have more choice.\u003c/p>\n\u003cp>“We have a highly competitive health care market, with 11 health plans in Covered California duking it out over price and quality and in most of the regions of the state,” said Bacchi.\u003c/p>\n\u003cp>Health advocates say consumers should take advantage of that by shopping around for a better deal. So even if the average premium increases 8 to 12 percent, that doesn't mean every single plan jumped that much.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If you’re in a Blue Shield plan in your region, it may be that there’s another health plan that’s the best deal for you for 2017,” said Wright of Health Access. \"The good thing about the Affordable Care Act is customers are not locked out because of a pre-existing condition. But they’re not locked in either. They can shop around for price.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update: 2:30 p.m.\u003c/strong>\u003c/p>\n\u003cp>Covered California, the state's Obamacare marketplace, released proposed 2017 premiums Tuesday morning, and the average statewide increase will be 13.2 percent, more than triple the increase seen each of the last two years.\u003c/p>\n\u003cp>Peter Lee, the agency's executive director, cited several factors as drivers in this year's spike.\u003c/p>\n\u003cp>Most notable is an expiring federal \"reinsurance\" program, created as part of the Affordable Care Act, to spread the risk of so many newly insured people entering the risk pool. Actuarial experts estimate that alone adds 4 to 7 percent to premiums, but it's viewed as a one-time effect.\u003c/p>\n\u003cp>Rising health care costs, including specialty prescription drugs, are also a factor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lee stressed that most people could reduce their own individual increase by shopping around.\u003c/p>\n\u003cp>\"Almost 80 percent of our customers could either pay less than they are paying today or pay no more than [a] 5 percent increase,\" Lee said, if they comparison shop.\u003c/p>\n\u003cp>Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation, agreed there may be \"deals to be had.\"\u003c/p>\n\u003cp>“The market is still working much better in California than in most other states,\" he said. \"It’s quite competitive in giving consumers a large number of choices.\"\u003c/p>\n\u003cp>About 1.4 million Californians purchase their health insurance through the Covered California exchange.\u003c/p>\n\u003cp>Blue Shield and Anthem Blue Cross customers will face the steepest increases. They have about \"a quarter of the market each,\" Lee said. Anthem customers will see a statewide average increase of 16 percent, and Blue Shield is \"above 19 percent,\" Lee said.\u003c/p>\n\u003cp>In the Bay Area, those increases will be even steeper for Anthem and Blue Shield customers. Meanwhile, the average monthly premium hike for Kaiser members will be in the 5-6 percent range across much of the region.\u003c/p>\n\u003cp>\"We are committed to offering stable rates over the long term,\" said Bill Wehrle, a vice president at Kaiser Permanente, \"and are uniquely positioned to deliver more affordable health care coverage.\" He cited investments in technology and Kaiser's \"emphasis on wellness\" as factors keeping premium increases lower.\u003c/p>\n\u003cp>Here are some of the proposed rate increases for major plans in several Bay Area counties:\u003c/p>\n\u003cp>\u003cstrong>San Francisco\u003c/strong>\u003cbr>\nAverage increase: 14.8 percent\u003c/p>\n\u003cp>Kaiser: 5.3 percent\u003cbr>\nAnthem Blue Cross: 16.7 percent\u003cbr>\nBlue Shield: 24.2 percent\u003c/p>\n\u003cp>\u003cstrong>Contra Costa County\u003c/strong>\u003cbr>\nAverage increase: 13.6 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross: 22.6 percent\u003cbr>\nBlue Shield: 24.4 percent\u003c/p>\n\u003cp>\u003cstrong>Alameda County\u003c/strong>\u003cbr>\nAverage increase: 12.3 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross: 23.7 percent\u003cbr>\nBlue Shield: 18.9 percent\u003c/p>\n\u003cp>\u003cstrong>Santa Clara\u003c/strong>\u003cbr>\nAverage increase: 9.2 percent\u003c/p>\n\u003cp>Kaiser: 5.6 percent\u003cbr>\nAnthem Blue Cross (EPO): 8.4 percent\u003cbr>\nBlue Shield: 22.3 percent\u003c/p>\n\u003cp>You can look up the proposed rate for your plan in your specific area by checking Covered California's \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA-2017-rate-booklet.pdf\" target=\"_blank\">rate booklet.\u003c/a>\u003c/p>\n\u003cp>The rates are not yet final. State regulators will review them in the coming weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>California's Obamacare customers can expect a hefty increase in their monthly health insurance premiums next year. Covered California will announce new 2017 rates Tuesday morning for people who buy their plan through the state marketplace, and experts are predicting that increases will be double or even triple what they were last year.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/274403157&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/274403157'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“2017 is going to be a transition year,” said Peter Lee, executive director of Covered California, testifying before Congress last week. “We expect our rates to be higher than we saw in our first two years.”\u003c/p>\n\u003cp>In \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/07/31/californias-2015-obamacare-premiums-will-increase-modestly/\" target=\"_blank\">2015\u003c/a> and \u003ca href=\"https://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\" target=\"_blank\">2016\u003c/a>, marketplace premiums increased an average of 4 percent -- a rate celebrated by consumer advocates as “modest,” even “\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\">terrific\u003c/a>.”\u003c/p>\n\u003cp>Covered California’s proposed budget for 2017, released in May, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/05/11/californias-obamacare-premiums-may-rise-8-percent-next-year/\" target=\"_blank\">projected average rate increases of 8 percent\u003c/a>. Industry insiders are suggesting the average jump could be even higher.\u003c/p>\n\u003cp>There are three key reasons why.\u003c/p>\n\u003cp>\u003cstrong>One: Medical Costs are Up\u003c/strong>\u003c/p>\n\u003cp>Insurance companies say premium prices are going up because medical costs are going up. Doctors, hospitals, labs and pharmaceutical companies are all raising their prices.\u003c/p>\n\u003cp>“Unquestionably, runaway drug prices remain a serious problem,” said Charles Bacchi, president and CEO of the California Association of Health Plans, a trade group for insurers. “We’re seeing new drugs coming out with blockbuster prices, and we’ve seen drugs that have been around for 30 years double and triple in price for no reason.”\u003c/p>\n\u003cp>Northern Californians have felt the burden of higher medical costs more so than people in Southern California because the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">hospital market is more consolidated\u003c/a>, giving hospitals more bargaining power with insurers.\u003c/p>\n\u003cp>Early rate filings from other states indicate rising medical costs could contribute to premium increases anywhere from 3 to 9 percent.\u003c/p>\n\u003cp>California regulators will have a chance to review the proposed rate increases, and consumer advocacy groups say they look forward to participating in the process by challenging some of the assumptions health plans have made about costs.\u003c/p>\n\u003cp>\"To the extent insurers are booking a certain amount of medical inflation to prescription drugs, are they overestimating those costs?\" said Anthony Wright, executive director of Health Access. \"Is that a scapegoat or a true driver?*\u003c/p>\n\u003cp>\u003cstrong>Two: Federal Protections are Expiring\u003c/strong>\u003c/p>\n\u003cp>The Affordable Care Act established a “reinsurance” program that was designed to help insurance companies cover losses if they had a high proportion of really sick, expensive patients. Insurers didn’t know who was going to sign up for their plans, and basically had to guess how sick they would be and how much care they would need, then factor that into their premium rates.\u003c/p>\n\u003cp>Through the reinsurance program, all health plans paid into a shared pool, then those funds were distributed to companies that ended up with more high-cost patients. This meant plans didn’t have to make up losses by increasing premiums the following year. But that protection expires this year, adding a 4 to 7 percent increase to consumers’ monthly premiums in 2017, according to\u003ca href=\"http://www.actuary.org/content/drivers-2017-health-insurance-premium-changes-0\" target=\"_blank\"> an analysis\u003c/a> of the American Academy of Actuaries.\u003c/p>\n\u003cp>Another program, \"risk corridors,\" which is designed to protect consumers against excessive premium increases, also expires this year.\u003c/p>\n\u003cp>\u003cstrong>Three: People May Be Gaming the System\u003c/strong>\u003c/p>\n\u003cp>Most people buy their insurance during the set enrollment period starting in the fall. But people who lose their coverage during the year because they lose a job, get divorced or move (among other eligibility criteria) are able to buy a plan through Covered California outside normal enrollment periods.\u003c/p>\n\u003cp>But insurers are noticing that these customers have medical costs that are 25 to 40 percent higher than the rest of the health care population, said Bacchi.\u003c/p>\n\u003cp>Are people taking advantage of the system, signing up for coverage not because they had a qualifying change in life circumstances, but because they got sick? Or is it that sicker people are more motivated to look for ways to stay insured after they lose coverage through work or a divorce?\u003c/p>\n\u003cp>\u003cstrong>Californians May Be Better Off\u003c/strong>\u003c/p>\n\u003cp>Despite all these factors, state officials and the insurance industry say Californians are still better off than consumers in most other states. Peter Lee emphasized that Covered California is an “active purchaser,” meaning it negotiates with plans when they set their prices.\u003c/p>\n\u003cp>“Covered California does not negotiate by table-pounding, but rather by providing good data on the risk mix of who is enrolled and working the health plans to garner maximum enrollment,” Lee said in his remarks before Congress. “In 2015, we provided data that proved Covered California enrollees were healthier and presented less risk to insurance companies than anticipated, which helped drive down the cost of health premiums.”\u003c/p>\n\u003cp>Bacchi said consumers here also have more choice.\u003c/p>\n\u003cp>“We have a highly competitive health care market, with 11 health plans in Covered California duking it out over price and quality and in most of the regions of the state,” said Bacchi.\u003c/p>\n\u003cp>Health advocates say consumers should take advantage of that by shopping around for a better deal. So even if the average premium increases 8 to 12 percent, that doesn't mean every single plan jumped that much.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Several California congressional Republicans want the Obama administration to block the state's request to sell health insurance to undocumented immigrants on the state's exchange.\u003c/p>\n\u003cp>The move comes after Gov. Jerry Brown signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">a bill\u003c/a> earlier this month authorizing California to formally request a waiver from the Affordable Care Act provision that bars undocumented immigrants from any of the law's benefits. Under a waiver, undocumented immigrants would be able to purchase Covered California health insurance -- but they would not be eligible for subsidies. They would only be able to purchase insurance with their own money.\u003c/p>\n\u003cp>Nine of California's 14 Republican representatives have signed a letter to cabinet officials appealing to them to deny this waiver. The representatives called California's request \"a brazen attempt to circumvent the will of Congress.\"\u003c/p>\n\u003cp>The letter went on:\u003c/p>\n\u003cblockquote>\u003cp>The issue of extending coverage to illegal immigrants on the healthcare exchanges was the subject of vigorous debate during the drafting and passage of the ACA. Both the American people and lawmakers were repeatedly promised illegal immigrants would not be able to receive coverage under the law.\u003c/p>\u003c/blockquote>\n\u003cp>In a statement, State Sen. Ricardo Lara, D-Bell Gardens, author of the measure, called the law \"a zero-cost proposal\" and that the move by the representatives \"reveals the signers for what they really are: fringe, anti-immigrant obstructionists who ... are clearly out of touch with the reality in California where several immigrant integration measures -- including this waiver -- were approved in both legislative houses with bipartisan support.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Affordable Care Act allows federal agencies to grant waivers beginning next year.\u003c/p>\n\u003cp>The nine signatories to the letter are:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan class=\"s1\">Rep. Darrell Issa\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Tom McClintock\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Ken Calvert\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Dana Rohrabacher\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Duncan Hunter\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Doug LaMalfa\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Paul Cook\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Ed Royce\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Mimi Walters\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Several California congressional Republicans want the Obama administration to block the state's request to sell health insurance to undocumented immigrants on the state's exchange.\u003c/p>\n\u003cp>The move comes after Gov. Jerry Brown signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">a bill\u003c/a> earlier this month authorizing California to formally request a waiver from the Affordable Care Act provision that bars undocumented immigrants from any of the law's benefits. Under a waiver, undocumented immigrants would be able to purchase Covered California health insurance -- but they would not be eligible for subsidies. They would only be able to purchase insurance with their own money.\u003c/p>\n\u003cp>Nine of California's 14 Republican representatives have signed a letter to cabinet officials appealing to them to deny this waiver. The representatives called California's request \"a brazen attempt to circumvent the will of Congress.\"\u003c/p>\n\u003cp>The letter went on:\u003c/p>\n\u003cblockquote>\u003cp>The issue of extending coverage to illegal immigrants on the healthcare exchanges was the subject of vigorous debate during the drafting and passage of the ACA. Both the American people and lawmakers were repeatedly promised illegal immigrants would not be able to receive coverage under the law.\u003c/p>\u003c/blockquote>\n\u003cp>In a statement, State Sen. Ricardo Lara, D-Bell Gardens, author of the measure, called the law \"a zero-cost proposal\" and that the move by the representatives \"reveals the signers for what they really are: fringe, anti-immigrant obstructionists who ... are clearly out of touch with the reality in California where several immigrant integration measures -- including this waiver -- were approved in both legislative houses with bipartisan support.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Affordable Care Act allows federal agencies to grant waivers beginning next year.\u003c/p>\n\u003cp>The nine signatories to the letter are:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan class=\"s1\">Rep. Darrell Issa\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Tom McClintock\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Ken Calvert\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Dana Rohrabacher\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Duncan Hunter\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Doug LaMalfa\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Paul Cook\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Ed Royce\u003cbr>\n\u003c/span>\u003cspan class=\"s1\">Rep. Mimi Walters\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "California Assembly OKs Asking Feds to Allow Undocumented Immigrants Access to Covered California",
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"content": "\u003cp>The California Assembly approved a bill on Tuesday that would permit undocumented immigrants access to Covered California, the state's health insurance marketplace.\u003c/p>\n\u003cp>Under federal law undocumented immigrants are barred from any of the benefits of the Affordable Care Act.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">Senate Bill 10\u003c/a> would direct California to ask the federal government for a waiver that would permit undocumented immigrants the option to buy insurance on Covered California -- with their own money. It passed by a vote of 54-19.\u003c/p>\n\u003cp>California would be the first state to make such a request.\u003c/p>\n\u003cp>“This waiver will allow an estimated 390,000 immigrants who earn an income too high to qualify for Medi-Cal to purchase healthcare through the exchange under the Affordable Care Act,\" said Sen. Ricardo Lara, D-Bell Gardens, author of the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Undocumented immigrants would not be eligible for subsidies. If such a waiver were ultimately approved, families with mixed status -- where some family members are undocumented and some are lawfully present -- could all be on the same health insurance plan, potentially simplifying access to finding care.\u003c/p>\n\u003cp>Robin Hvidston, executive director of the Claremont-based group We the People Rising, a group which advocates for strict enforcement of immigration laws, criticized the measure last month in \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-undocumented-immigrant-health-insurance-20160414-story.html\" target=\"_blank\">an interview with the Los Angeles Times\u003c/a>.\u003c/p>\n\u003cp>“We oppose that [bill] because that encourages illegal immigration,” Hvidston said. “It sends a message to the world that if you come to our country you will be rewarded.”\u003c/p>\n\u003cp>A law permitting Medi-Cal coverage for undocumented children \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/13/undocumented-kids-soon-eligible-for-medi-cal/\" target=\"_blank\">went into effect earlier this month\u003c/a>. An estimated 170,000 children are expected to benefit at a cost to the state of $40 million this year and $132 million annually after that.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill goes back to the Senate this week for final approval before it can head to the governor's desk.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The California Assembly approved a bill on Tuesday that would permit undocumented immigrants access to Covered California, the state's health insurance marketplace.\u003c/p>\n\u003cp>Under federal law undocumented immigrants are barred from any of the benefits of the Affordable Care Act.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">Senate Bill 10\u003c/a> would direct California to ask the federal government for a waiver that would permit undocumented immigrants the option to buy insurance on Covered California -- with their own money. It passed by a vote of 54-19.\u003c/p>\n\u003cp>California would be the first state to make such a request.\u003c/p>\n\u003cp>“This waiver will allow an estimated 390,000 immigrants who earn an income too high to qualify for Medi-Cal to purchase healthcare through the exchange under the Affordable Care Act,\" said Sen. Ricardo Lara, D-Bell Gardens, author of the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Undocumented immigrants would not be eligible for subsidies. If such a waiver were ultimately approved, families with mixed status -- where some family members are undocumented and some are lawfully present -- could all be on the same health insurance plan, potentially simplifying access to finding care.\u003c/p>\n\u003cp>Robin Hvidston, executive director of the Claremont-based group We the People Rising, a group which advocates for strict enforcement of immigration laws, criticized the measure last month in \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-undocumented-immigrant-health-insurance-20160414-story.html\" target=\"_blank\">an interview with the Los Angeles Times\u003c/a>.\u003c/p>\n\u003cp>“We oppose that [bill] because that encourages illegal immigration,” Hvidston said. “It sends a message to the world that if you come to our country you will be rewarded.”\u003c/p>\n\u003cp>A law permitting Medi-Cal coverage for undocumented children \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/13/undocumented-kids-soon-eligible-for-medi-cal/\" target=\"_blank\">went into effect earlier this month\u003c/a>. An estimated 170,000 children are expected to benefit at a cost to the state of $40 million this year and $132 million annually after that.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill goes back to the Senate this week for final approval before it can head to the governor's desk.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Supreme Court Sends Back Birth Control Case and Both Sides Claim Victory",
"title": "Supreme Court Sends Back Birth Control Case and Both Sides Claim Victory",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>When it comes to the issue of religious rights versus no-cost contraception, the only thing the Supreme Court could agree on was not to decide the case.\u003c/p>\n\u003cp>In an \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/14-1418_8758.pdf\" target=\"_blank\">unsigned opinion\u003c/a> issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out. “The Court expresses no view on the merits of the cases,” the opinion said.\u003c/p>\n\u003cp>At issue is the extent to which religiously affiliated employers (such as universities or hospitals) need to participate in the requirement under the Affordable Care Act for most employer health plans to\u003ca href=\"http://khn.org/news/supreme-court-takes-up-birth-control-access-again/\" target=\"_blank\"> provide no-cost contraception for women.\u003c/a>\u003c/p>\n\u003cp>The government made \u003ca href=\"http://www.hhs.gov/about/news/2014/08/22/administration-takes-steps-to-ensure-womens-continued-access-to-contraception-coverage.html\" target=\"_blank\">several changes to the rules\u003c/a> over the past four years in an attempt to accommodate the religious employers’ objections while still ensuring that female employees would get contraceptive coverage. But \u003ca href=\"http://www.becketfund.org/hhsinformationcentral/\" target=\"_blank\">dozens of religious nonprofit employers sued anyway\u003c/a>, claiming that even the act of notifying the government of their objections (which would, in turn, trigger a requirement for the government to arrange coverage) made them “complicit” in providing a service they see as sinful.\u003c/p>\n\u003cp>The court’s opinion, and an \u003ca href=\"http://www.supremecourt.gov/orders/courtorders/051616zor1_g31h.pdf\" target=\"_blank\">accompanying order\u003c/a> on several similar cases that were awaiting a decision on whether the high court would take them up, erased all the lower appeals court rulings, all but one of which had sided with the government. That appeared at first glance to put at risk coverage for contraceptives for tens of thousands of employees of the organizations that filed suit.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>However, the court made clear in its opinion that because the employers who have sued have already in effect notified the government of their objections, the government can rely “on this notice, to the extent it considers it necessary, to facilitate the provision of full contraceptive coverage going forward.”\u003c/p>\n\u003cp>At the same time, however, the opinion said the government “may not impose taxes or penalties on petitioners for failure to provide the relevant notice.”\u003c/p>\n\u003cp>The goal, the justices wrote, is that both sides “should be afforded an opportunity to arrive at an approach going forward that accommodates petitions’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans ‘receive full and equal health coverage, including contraceptive coverage.’ ”\u003c/p>\n\u003cp>Both sides in the dispute claimed at least a partial victory.\u003c/p>\n\u003cp>“From our point of view this is a win for religious liberty,” said Mark Rienzi, a senior counsel for the Becket Fund for Religious Liberty, which is representing the Little Sisters of the Poor, one of the groups that sued the government. “The government can find ways to give out contraception without hassling nuns.”\u003c/p>\n\u003cp>But at the same time, said Louise Melling, deputy legal director of the Americans Civil Liberties Union, “the opinion states clearly the need for women to receive full and equal coverage.”\u003c/p>\n\u003cp>Contraceptive advocates also pointed to a concurring opinion from Justices Sonia Sotomayor and Ruth Bader Ginsburg that stressed that the decision should not be read as approving coverage strategies that make it harder for women to get the benefits.\u003c/p>\n\u003cp>For example, they wrote, “Requiring standalone contraceptive-only coverage would leave in limbo all of the women now guaranteed seamless preventive-care coverage under the Affordable Care Act. And requiring that women affirmatively opt into such coverage would ‘impose precisely the kind of barrier to the delivery of preventive services that Congress sought to eliminate.’ ”\u003c/p>\n\u003cp>It remains unclear exactly what the lower courts might do. In an effort to break what was clearly a 4-4 deadlock, the court in March asked each side for \u003ca href=\"http://khn.org/news/supreme-court-asks-for-more-information-in-birth-control-case/\" target=\"_blank\">supplemental material\u003c/a> outlining any potential compromises. The decision Monday referred to those new briefs as suggesting that providing contraceptive coverage without requiring notice from religious employers “is feasible.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But Sotomayor and Ginsburg, in their concurring opinion, noted that “the Courts of Appeals remain free to reach the same conclusion or a different one on each of the questions presented by these cases.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When it comes to the issue of religious rights versus no-cost contraception, the only thing the Supreme Court could agree on was not to decide the case.\u003c/p>\n\u003cp>In an \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/14-1418_8758.pdf\" target=\"_blank\">unsigned opinion\u003c/a> issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out. “The Court expresses no view on the merits of the cases,” the opinion said.\u003c/p>\n\u003cp>At issue is the extent to which religiously affiliated employers (such as universities or hospitals) need to participate in the requirement under the Affordable Care Act for most employer health plans to\u003ca href=\"http://khn.org/news/supreme-court-takes-up-birth-control-access-again/\" target=\"_blank\"> provide no-cost contraception for women.\u003c/a>\u003c/p>\n\u003cp>The government made \u003ca href=\"http://www.hhs.gov/about/news/2014/08/22/administration-takes-steps-to-ensure-womens-continued-access-to-contraception-coverage.html\" target=\"_blank\">several changes to the rules\u003c/a> over the past four years in an attempt to accommodate the religious employers’ objections while still ensuring that female employees would get contraceptive coverage. But \u003ca href=\"http://www.becketfund.org/hhsinformationcentral/\" target=\"_blank\">dozens of religious nonprofit employers sued anyway\u003c/a>, claiming that even the act of notifying the government of their objections (which would, in turn, trigger a requirement for the government to arrange coverage) made them “complicit” in providing a service they see as sinful.\u003c/p>\n\u003cp>The court’s opinion, and an \u003ca href=\"http://www.supremecourt.gov/orders/courtorders/051616zor1_g31h.pdf\" target=\"_blank\">accompanying order\u003c/a> on several similar cases that were awaiting a decision on whether the high court would take them up, erased all the lower appeals court rulings, all but one of which had sided with the government. That appeared at first glance to put at risk coverage for contraceptives for tens of thousands of employees of the organizations that filed suit.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>However, the court made clear in its opinion that because the employers who have sued have already in effect notified the government of their objections, the government can rely “on this notice, to the extent it considers it necessary, to facilitate the provision of full contraceptive coverage going forward.”\u003c/p>\n\u003cp>At the same time, however, the opinion said the government “may not impose taxes or penalties on petitioners for failure to provide the relevant notice.”\u003c/p>\n\u003cp>The goal, the justices wrote, is that both sides “should be afforded an opportunity to arrive at an approach going forward that accommodates petitions’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans ‘receive full and equal health coverage, including contraceptive coverage.’ ”\u003c/p>\n\u003cp>Both sides in the dispute claimed at least a partial victory.\u003c/p>\n\u003cp>“From our point of view this is a win for religious liberty,” said Mark Rienzi, a senior counsel for the Becket Fund for Religious Liberty, which is representing the Little Sisters of the Poor, one of the groups that sued the government. “The government can find ways to give out contraception without hassling nuns.”\u003c/p>\n\u003cp>But at the same time, said Louise Melling, deputy legal director of the Americans Civil Liberties Union, “the opinion states clearly the need for women to receive full and equal coverage.”\u003c/p>\n\u003cp>Contraceptive advocates also pointed to a concurring opinion from Justices Sonia Sotomayor and Ruth Bader Ginsburg that stressed that the decision should not be read as approving coverage strategies that make it harder for women to get the benefits.\u003c/p>\n\u003cp>For example, they wrote, “Requiring standalone contraceptive-only coverage would leave in limbo all of the women now guaranteed seamless preventive-care coverage under the Affordable Care Act. And requiring that women affirmatively opt into such coverage would ‘impose precisely the kind of barrier to the delivery of preventive services that Congress sought to eliminate.’ ”\u003c/p>\n\u003cp>It remains unclear exactly what the lower courts might do. In an effort to break what was clearly a 4-4 deadlock, the court in March asked each side for \u003ca href=\"http://khn.org/news/supreme-court-asks-for-more-information-in-birth-control-case/\" target=\"_blank\">supplemental material\u003c/a> outlining any potential compromises. The decision Monday referred to those new briefs as suggesting that providing contraceptive coverage without requiring notice from religious employers “is feasible.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But Sotomayor and Ginsburg, in their concurring opinion, noted that “the Courts of Appeals remain free to reach the same conclusion or a different one on each of the questions presented by these cases.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California's Obamacare Premiums May Rise 8 Percent Next Year",
"title": "California's Obamacare Premiums May Rise 8 Percent Next Year",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>California’s health insurance exchange estimates that its Obamacare premiums may rise 8 percent on average next year, which would end two consecutive years of more modest 4 percent increases.\u003c/p>\n\u003caside class=\"pullquote alignright\">Final rates won’t be known until July after Covered California conducts private negotiations with health plans\u003c/aside>\n\u003cp>The projected rate increase in California, included in the \u003ca href=\"http://board.coveredca.com/meetings/2016/5-12/2016-17-CoveredCA-Proposed-Budget.pdf\" target=\"_blank\">exchange’s proposed annual budget\u003c/a>, comes amid growing nationwide concern about insurers seeking double-digit premium hikes in the health law’s insurance marketplaces.\u003c/p>\n\u003cp>Any increases in California, a closely watched state in the health law rollout, are sure to draw intense scrutiny during a presidential election. Republicans are quick to seize on rate hikes as further proof that President Barack Obama’s signature law isn’t doing enough to hold down health care costs for the average consumer.\u003c/p>\n\u003cp>Insurers in California have submitted initial rates for 2017, but the final figures won’t be known until July after state officials conduct private negotiations.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, underscored that the estimate was preliminary but said some one-time factors under the Affordable Care Act mean “2017 will be an adjustment year” for rates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We shouldn’t put too much focus on this 8 percent number when we will know the reality in two months,” Lee told California Healthline on Tuesday. “There are a number of reasons 2017 will have higher rate increases than the last few years. But we believe in California we won’t see the significant headwinds many other states are experiencing.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"Xh5FmUmlPmuJ7DvqU73CGLqck09caN8t\"]Lee said the expiration this year of two federal programs that have helped health insurers offset expensive medical claims and cover sick patients in general will affect premium rates across the country. In addition, he cited ever-increasing medical costs, particularly for expensive specialty drugs.\u003c/p>\n\u003cp>The nation’s largest health insurer, UnitedHealth Group, already has said it will exit all but a handful of state exchanges after suffering substantial losses on individual policies.\u003c/p>\n\u003cp>Lee declined to comment on whether UnitedHealth has submitted a bid to continue selling in Covered California next year.\u003c/p>\n\u003cp>Health-policy experts said the California rate projection mirrors an upward trend around the country as health insurers reassess their pricing and strategy under Obamacare.\u003c/p>\n\u003cp>“None of us should be surprised to see average rate increases that are slightly higher than last year,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “It’s still really difficult to discern where we will end up.”\u003c/p>\n\u003cp>Robert Laszewski, a health care consultant in Alexandria, Virginia, and a frequent critic of Covered California, said Californians will be fortunate if the 8 percent projection holds up.\u003c/p>\n\u003cp>“That is not a troubling rate increase,” he said. “California is coming back toward the average. A bunch of states would die for just an 8 percent increase in 2017.”\u003c/p>\n\u003cp>A bigger concern, Laszewski said, is the tepid growth in Covered California’s enrollment and what that may mean for future premiums.\u003c/p>\n\u003cp>As part of its proposed budget for the next fiscal year, starting July 1, the state exchange expects its annual enrollment to grow by only 2 percent over the next year to 1.34 million. Covered California counts about 1.4 million as currently enrolled but that figure is expected to drop to 1.32 million as of June 30 through normal attrition as people get insurance elsewhere or drop coverage.\u003c/p>\n\u003cp>Sign-ups are crucial for keeping a diverse mix of enrollees and spreading the insurance costs across a pool of healthy and sick policyholders.\u003c/p>\n\u003cp>About 3 million Californians remain uninsured, but fewer than 1.4 million of them are eligible for premium subsidies under the Affordable Care Act, according to the exchange’s proposed budget.\u003c/p>\n\u003cp>[contextly_sidebar id=\"nFru5suNyUJbvUf5pa4fLByUhvOyuk0V\"]Lee said California already boasts one of the healthiest risk pools in the country, which insurers have cited as a main reason for the lower-than-average rate increases the past two years. He said the exchange signs up hundreds of thousands of new enrollees each year, but that’s offset by high turnover as many people leave the marketplace for job-based coverage, Medicare or Medicaid.\u003c/p>\n\u003cp>The average tenure of a Covered California enrollee is about 25 months, according to exchange data.\u003c/p>\n\u003cp>Over time, Covered California expects the gradual increases in the state’s minimum wage to $15 an hour could shift more low-income people from Medi-Cal, the state’s Medicaid program, to subsidized exchange policies as their pay increases. By 2020, the exchange expects to reach enrollment of 1.52 million.\u003c/p>\n\u003cp>“California grew very rapidly in the first few years and now we have reached a cruising altitude after three years. We are projecting modest net growth,” Lee said. “I think any questions about the sustainability [of exchanges] are just pure hot air.”\u003c/p>\n\u003cp>Covered California’s five-member board will discuss the proposed $308 million budget at a meeting Thursday and vote on it next month.\u003c/p>\n\u003cp>The proposed budget for 2017 is 8 percent lower than the current year budget, reflecting the slower enrollment growth and the fact that Covered California must operate next year without federal startup funds for the first time.\u003c/p>\n\u003cp>The exchange is planning to draw on $58 million in reserves for operations, and it wants to raise its surcharge on customer policies to 4 percent of premiums, up from 3.4 percent now, or $13.95 per member per month.\u003c/p>\n\u003cp>Covered California doesn’t receive money from the state’s general fund and relies on policyholder assessments to pay for marketing, service center operations and other expenses.\u003c/p>\n\u003cp>Health insurers have urged the exchange not to pass on any unnecessary costs to consumers.\u003c/p>\n\u003cp>[contextly_sidebar id=\"lRHYKQKJ0CMGRRDG5ZwtNzoEhBbgJplp\"]“Price is the number one factor impacting consumers when they enroll, so we must always keep an eye toward affordability,” said Charles Bacchi, chief executive of the California Association of Health Plans. “We urge Covered California to move cautiously before increasing this fee and look for cost savings.”\u003c/p>\n\u003cp>The exchange is proposing to spend $2 million to establish an ombudsman program to help resolve customer service problems.\u003c/p>\n\u003cp>Consumer groups have criticized Covered California for failing to fix long-standing enrollment and tax-related errors that have blocked people from getting coverage and left some with unforeseen bills.\u003c/p>\n\u003cp>Last month, \u003ca href=\"http://californiahealthline.org/news/lawmakers-demand-quick-action-on-covered-california-pregnancy-snafu/\" target=\"_blank\">federal lawmakers called on Covered California\u003c/a> to resolve a problem that has caused some pregnant women to be dropped from their health plans and enrolled in Medi-Cal without notice or consent.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Absolutely, some consumers have had problems with customer service,” Lee said. “We are making significant investments to do better.”\u003c/p>\n\n",
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"excerpt": "Final rates won’t be known until July after Covered California conducts private negotiations with health plans.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California’s health insurance exchange estimates that its Obamacare premiums may rise 8 percent on average next year, which would end two consecutive years of more modest 4 percent increases.\u003c/p>\n\u003caside class=\"pullquote alignright\">Final rates won’t be known until July after Covered California conducts private negotiations with health plans\u003c/aside>\n\u003cp>The projected rate increase in California, included in the \u003ca href=\"http://board.coveredca.com/meetings/2016/5-12/2016-17-CoveredCA-Proposed-Budget.pdf\" target=\"_blank\">exchange’s proposed annual budget\u003c/a>, comes amid growing nationwide concern about insurers seeking double-digit premium hikes in the health law’s insurance marketplaces.\u003c/p>\n\u003cp>Any increases in California, a closely watched state in the health law rollout, are sure to draw intense scrutiny during a presidential election. Republicans are quick to seize on rate hikes as further proof that President Barack Obama’s signature law isn’t doing enough to hold down health care costs for the average consumer.\u003c/p>\n\u003cp>Insurers in California have submitted initial rates for 2017, but the final figures won’t be known until July after state officials conduct private negotiations.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, underscored that the estimate was preliminary but said some one-time factors under the Affordable Care Act mean “2017 will be an adjustment year” for rates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We shouldn’t put too much focus on this 8 percent number when we will know the reality in two months,” Lee told California Healthline on Tuesday. “There are a number of reasons 2017 will have higher rate increases than the last few years. But we believe in California we won’t see the significant headwinds many other states are experiencing.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Lee said the expiration this year of two federal programs that have helped health insurers offset expensive medical claims and cover sick patients in general will affect premium rates across the country. In addition, he cited ever-increasing medical costs, particularly for expensive specialty drugs.\u003c/p>\n\u003cp>The nation’s largest health insurer, UnitedHealth Group, already has said it will exit all but a handful of state exchanges after suffering substantial losses on individual policies.\u003c/p>\n\u003cp>Lee declined to comment on whether UnitedHealth has submitted a bid to continue selling in Covered California next year.\u003c/p>\n\u003cp>Health-policy experts said the California rate projection mirrors an upward trend around the country as health insurers reassess their pricing and strategy under Obamacare.\u003c/p>\n\u003cp>“None of us should be surprised to see average rate increases that are slightly higher than last year,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “It’s still really difficult to discern where we will end up.”\u003c/p>\n\u003cp>Robert Laszewski, a health care consultant in Alexandria, Virginia, and a frequent critic of Covered California, said Californians will be fortunate if the 8 percent projection holds up.\u003c/p>\n\u003cp>“That is not a troubling rate increase,” he said. “California is coming back toward the average. A bunch of states would die for just an 8 percent increase in 2017.”\u003c/p>\n\u003cp>A bigger concern, Laszewski said, is the tepid growth in Covered California’s enrollment and what that may mean for future premiums.\u003c/p>\n\u003cp>As part of its proposed budget for the next fiscal year, starting July 1, the state exchange expects its annual enrollment to grow by only 2 percent over the next year to 1.34 million. Covered California counts about 1.4 million as currently enrolled but that figure is expected to drop to 1.32 million as of June 30 through normal attrition as people get insurance elsewhere or drop coverage.\u003c/p>\n\u003cp>Sign-ups are crucial for keeping a diverse mix of enrollees and spreading the insurance costs across a pool of healthy and sick policyholders.\u003c/p>\n\u003cp>About 3 million Californians remain uninsured, but fewer than 1.4 million of them are eligible for premium subsidies under the Affordable Care Act, according to the exchange’s proposed budget.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Lee said California already boasts one of the healthiest risk pools in the country, which insurers have cited as a main reason for the lower-than-average rate increases the past two years. He said the exchange signs up hundreds of thousands of new enrollees each year, but that’s offset by high turnover as many people leave the marketplace for job-based coverage, Medicare or Medicaid.\u003c/p>\n\u003cp>The average tenure of a Covered California enrollee is about 25 months, according to exchange data.\u003c/p>\n\u003cp>Over time, Covered California expects the gradual increases in the state’s minimum wage to $15 an hour could shift more low-income people from Medi-Cal, the state’s Medicaid program, to subsidized exchange policies as their pay increases. By 2020, the exchange expects to reach enrollment of 1.52 million.\u003c/p>\n\u003cp>“California grew very rapidly in the first few years and now we have reached a cruising altitude after three years. We are projecting modest net growth,” Lee said. “I think any questions about the sustainability [of exchanges] are just pure hot air.”\u003c/p>\n\u003cp>Covered California’s five-member board will discuss the proposed $308 million budget at a meeting Thursday and vote on it next month.\u003c/p>\n\u003cp>The proposed budget for 2017 is 8 percent lower than the current year budget, reflecting the slower enrollment growth and the fact that Covered California must operate next year without federal startup funds for the first time.\u003c/p>\n\u003cp>The exchange is planning to draw on $58 million in reserves for operations, and it wants to raise its surcharge on customer policies to 4 percent of premiums, up from 3.4 percent now, or $13.95 per member per month.\u003c/p>\n\u003cp>Covered California doesn’t receive money from the state’s general fund and relies on policyholder assessments to pay for marketing, service center operations and other expenses.\u003c/p>\n\u003cp>Health insurers have urged the exchange not to pass on any unnecessary costs to consumers.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“Price is the number one factor impacting consumers when they enroll, so we must always keep an eye toward affordability,” said Charles Bacchi, chief executive of the California Association of Health Plans. “We urge Covered California to move cautiously before increasing this fee and look for cost savings.”\u003c/p>\n\u003cp>The exchange is proposing to spend $2 million to establish an ombudsman program to help resolve customer service problems.\u003c/p>\n\u003cp>Consumer groups have criticized Covered California for failing to fix long-standing enrollment and tax-related errors that have blocked people from getting coverage and left some with unforeseen bills.\u003c/p>\n\u003cp>Last month, \u003ca href=\"http://californiahealthline.org/news/lawmakers-demand-quick-action-on-covered-california-pregnancy-snafu/\" target=\"_blank\">federal lawmakers called on Covered California\u003c/a> to resolve a problem that has caused some pregnant women to be dropped from their health plans and enrolled in Medi-Cal without notice or consent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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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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"mindshift": {
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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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"order": 12
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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.",
"airtime": "THU 6:30pm-7pm",
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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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},
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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": {
"id": "radiolab",
"title": "Radiolab",
"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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