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"content": "\u003cp>Covered California's Obamacare exchange has helped consumers get a better deal on health insurance in part because of its negotiating power -- power that other Affordable Care Act marketplaces don't have -- according to a \u003ca href=\"http://content.healthaffairs.org/content/35/5/880.abstract?rss=1&related-urls=yes&legid=healthaff;35/5/880\" target=\"_blank\">new analysis\u003c/a> published Monday.\u003c/p>\n\u003cp>California is one of the few states that created an \"active purchaser\" exchange, where the marketplace negotiates premiums and benefits with insurers. Most other states, as well as the federal healthcare.gov, accept any plan that seeks to participate.\u003c/p>\n\u003cp>Researchers compared California and New York and looked at the growth in premiums in 2014 and 2015 in the face of hospital competition and health plan competition.\u003c/p>\n\u003cp>While less hospital competition was associated with higher premium increases in both states, the effect of reduced insurance plan competition played out differently.\u003c/p>\n\u003cp>In New York, less competition in insurance resulted in higher premium growth. But in California, similar \"low competition\" areas had a slower rise in premiums.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Richard Scheffler, a health economist at UC Berkeley and lead author of the study, said one reason for the slower growth is California's negotiating power.\u003c/p>\n\u003cp>\"What happens here is an exchange that's competitive, but is helped by regulation,\" Scheffler said, \"that clears up the market in the sense that consumers can make apples-to-apples choices.\"\u003c/p>\n\u003cp>Scheffler called it \"a problem\" that in New York, there were so many plans available \"that it became very difficult, if not impossible, for a lot of consumers to be able to make good choices.\"\u003c/p>\n\u003cp>The two states' experiences highlight a division in the two visions in running an exchange, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>\"The approach of not negotiating, of just letting any insurer sell its wares, some would call it 'the free market,' \" Wright said. \"We call it the 'flea market' approach.\"\u003c/p>\n\u003cp>He likened Covered California to a human resources department for the \"rest of us that don't work at Google.\"\u003c/p>\n\u003cp>Covered California plans \u003ca href=\"https://www.coveredca.com/PDFs/2016-Health-Benefits-table.pdf\" target=\"_blank\">all have identical benefits\u003c/a>. The only difference between plans are price and the hospital and physician networks, making comparison straightforward.\u003c/p>\n\u003cp>\"We create a marketplace where consumers are in the driving seat,\" said Covered California executive director Peter Lee. \"[In] New York City, the consumers would be picking between 50 different products. What's the difference between them? Tweaks on co-insurance and insurance babble that most consumers don't understand.\"\u003c/p>\n\u003cp>\"The folklore in economics is that more choice is better,\" economist Scheffler said. If offered too many choices in health insurance, \"it becomes too much for consumers to look at and analyze and really absorb. So you're better off having a smaller number of choices to plan on and pick from.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Scheffler and his co-authors say that the Affordable Care Act marketplaces provide a \"natural laboratory\" to continue studying the effects of competition among hospitals and insurers.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Covered California's Obamacare exchange has helped consumers get a better deal on health insurance in part because of its negotiating power -- power that other Affordable Care Act marketplaces don't have -- according to a \u003ca href=\"http://content.healthaffairs.org/content/35/5/880.abstract?rss=1&related-urls=yes&legid=healthaff;35/5/880\" target=\"_blank\">new analysis\u003c/a> published Monday.\u003c/p>\n\u003cp>California is one of the few states that created an \"active purchaser\" exchange, where the marketplace negotiates premiums and benefits with insurers. Most other states, as well as the federal healthcare.gov, accept any plan that seeks to participate.\u003c/p>\n\u003cp>Researchers compared California and New York and looked at the growth in premiums in 2014 and 2015 in the face of hospital competition and health plan competition.\u003c/p>\n\u003cp>While less hospital competition was associated with higher premium increases in both states, the effect of reduced insurance plan competition played out differently.\u003c/p>\n\u003cp>In New York, less competition in insurance resulted in higher premium growth. But in California, similar \"low competition\" areas had a slower rise in premiums.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Richard Scheffler, a health economist at UC Berkeley and lead author of the study, said one reason for the slower growth is California's negotiating power.\u003c/p>\n\u003cp>\"What happens here is an exchange that's competitive, but is helped by regulation,\" Scheffler said, \"that clears up the market in the sense that consumers can make apples-to-apples choices.\"\u003c/p>\n\u003cp>Scheffler called it \"a problem\" that in New York, there were so many plans available \"that it became very difficult, if not impossible, for a lot of consumers to be able to make good choices.\"\u003c/p>\n\u003cp>The two states' experiences highlight a division in the two visions in running an exchange, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>\"The approach of not negotiating, of just letting any insurer sell its wares, some would call it 'the free market,' \" Wright said. \"We call it the 'flea market' approach.\"\u003c/p>\n\u003cp>He likened Covered California to a human resources department for the \"rest of us that don't work at Google.\"\u003c/p>\n\u003cp>Covered California plans \u003ca href=\"https://www.coveredca.com/PDFs/2016-Health-Benefits-table.pdf\" target=\"_blank\">all have identical benefits\u003c/a>. The only difference between plans are price and the hospital and physician networks, making comparison straightforward.\u003c/p>\n\u003cp>\"We create a marketplace where consumers are in the driving seat,\" said Covered California executive director Peter Lee. \"[In] New York City, the consumers would be picking between 50 different products. What's the difference between them? Tweaks on co-insurance and insurance babble that most consumers don't understand.\"\u003c/p>\n\u003cp>\"The folklore in economics is that more choice is better,\" economist Scheffler said. If offered too many choices in health insurance, \"it becomes too much for consumers to look at and analyze and really absorb. So you're better off having a smaller number of choices to plan on and pick from.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Scheffler and his co-authors say that the Affordable Care Act marketplaces provide a \"natural laboratory\" to continue studying the effects of competition among hospitals and insurers.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Newly Pregnant? You May Not Want to Tell Covered California",
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"content": "\u003cp>Lynn Kersey has some advice for pregnant women who bought health insurance policies from Covered California and want to keep them: Don’t report your pregnancy to the agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">1,900 pregnant women across the state were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California\u003c/aside>\n\u003cp>“It’s not a requirement ... and it’s actually worse to do so,” said Kersey, executive director of Maternal and Child Health Access, an advocacy group based in Los Angeles County.\u003c/p>\n\u003cp>Why? Two of Kersey’s clients with Covered California health plans recently were thrown into Medi-Cal -- the state’s health program for low-income residents -- without their consent or prior notice after they reported their pregnancies to the state’s health insurance exchange.\u003c/p>\n\u003cp>The two women are among about 1,900 across the state who were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California. The snafu was triggered by a recent policy change in Medi-Cal eligibility.\u003c/p>\n\u003cp>“One of the women missed a month of prenatal care,” Kersey said. “She was told she couldn’t be seen when she went to see her doctor.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Covered California acknowledged the problem, casting part of the blame on its computer system.\u003c/p>\n\u003cp>\u003cstrong>Similar Problem with Healthcare.gov\u003c/strong>\u003c/p>\n\u003cp>“We didn’t implement this as well as it should have been implemented,” said Amy Palmer, the agency’s director of communications.\u003c/p>\n\u003cp>That computer glitch will be fixed, but not until September, Palmer said.\u003c/p>\n\u003cp>A similar problem is affecting some pregnant women who purchased their plans through \u003ca href=\"https://www.healthcare.gov/\" target=\"_blank\">HealthCare.gov\u003c/a>, the federal health insurance exchange that serves people in 38 states, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.\u003c/p>\n\u003cp>“The computer system was basically immediately transitioning them to Medicaid when they reported their pregnancies to HealthCare.gov,\" Solomon said. “They should have the choice and they’re not getting it.”\u003c/p>\n\u003cp>Plan cancellations without notice or consent have been a persistent problem for some Covered California enrollees since 2014. In some cases, people are terminated from their plans unexpectedly. In others, they are transferred to Medi-Cal without prior notice. It’s unclear -- even to Covered California -- how widespread the problem is.\u003c/p>\n\u003cp>The situation for the pregnant California women can be traced to a recent policy change.\u003c/p>\n\u003cp>Usually, consumers are placed in either Covered California or Medi-Cal based on their income, with no choice in the matter, even though they can enroll in Medi-Cal via the Covered California website.\u003c/p>\n\u003cp>But the rules are different for some pregnant women whose household income falls between 138 percent and 213 percent of the federal poverty level, or roughly $22,100 to $34,100 for a family of two.\u003c/p>\n\u003cp>Before last October pregnant women in that income range technically had a choice between Medi-Cal and Covered California, though often they were not informed of the choice, said Lucy Quacinella, a San Francisco attorney and health care advocate for working families.\u003c/p>\n\u003cp>Now, under an October 2015 policy change, \u003cem>women who are pregnant at the time they apply\u003c/em> for health coverage and fall into this income bracket will automatically be placed into Medi-Cal, she said.\u003c/p>\n\u003cp>Women in the income range who already have Covered California plans \u003cem>before they become pregnant\u003c/em> are now supposed to be given the choice to remain in their subsidized plans -- which have out-of-pocket costs such as co-pays and deductibles -- or move to Medi-Cal, which is free.\u003c/p>\n\u003cp>The idea is to allow them to keep their existing Covered California providers if they want, Quacinella said.\u003c/p>\n\u003cp>But the Covered California computer system wasn’t programmed to give them the choice, and some pregnant women were moved immediately into Medi-Cal.\u003c/p>\n\u003cp>“They didn’t receive notice. They just knew from one day to the next that their Covered California insurance didn’t work anymore,” Quacinella said. “It’s very stressful, very confusing.”\u003c/p>\n\u003cp>\u003cstrong>May Be Easier to Find a Doctor with Covered California...\u003c/strong>\u003c/p>\n\u003cp>Although Medi-Cal is free, some women find it’s easier to get a doctor if they have private insurance. And because Covered California and Medi-Cal provider networks don’t always overlap, some of the women could no longer see the doctors with whom they had established relationships, Quacinella said.\u003c/p>\n\u003cp>“For some women, continuity of care is critical,” she said. “They don’t want to lose their providers.”\u003c/p>\n\u003cp>\u003cstrong>... But Medi-Cal is Free to Consumers\u003c/strong>\u003c/p>\n\u003cp>But after the initial shock, some women will consider the move to Medi-Cal a “blessing” because it’s cheaper, Quacinella said.\u003c/p>\n\u003cp>“Even with tax credits and cost-sharing reductions, it’s really hard for some families to afford the Covered California premiums or for pregnant women to afford a hospital’s labor and delivery charge,” she said.\u003c/p>\n\u003cp>That was the case for Kersey’s clients, who initially were distressed by the sudden loss of their Covered California plans but later decided to stay in Medi-Cal.\u003c/p>\n\u003cp>“One of our clients desperately wanted to get back into Covered California, but ultimately was fine with Medi-Cal, knowing there’s no delivery cost,” Kersey said.\u003c/p>\n\u003cp>Covered California has trained its customer service reps, insurance agents and other enrollers to explain to pregnant consumers that reporting a pregnancy could trigger a switch to Medi-Cal, Palmer said.\u003c/p>\n\u003cp>However, until the computer fix later this year, some women who report their pregnancy through the Covered California website still will be moved without a choice, she confirmed. These women can get their Covered California plans back, retroactive to the date they reported their pregnancies by calling Covered California’s customer service center at 800-300-1506.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Consumers should feel confident that their coverage continues,” Palmer said. “No consumer should be concerned about accessing care while they are pregnant for fear they do not have health coverage. They do.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lynn Kersey has some advice for pregnant women who bought health insurance policies from Covered California and want to keep them: Don’t report your pregnancy to the agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">1,900 pregnant women across the state were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California\u003c/aside>\n\u003cp>“It’s not a requirement ... and it’s actually worse to do so,” said Kersey, executive director of Maternal and Child Health Access, an advocacy group based in Los Angeles County.\u003c/p>\n\u003cp>Why? Two of Kersey’s clients with Covered California health plans recently were thrown into Medi-Cal -- the state’s health program for low-income residents -- without their consent or prior notice after they reported their pregnancies to the state’s health insurance exchange.\u003c/p>\n\u003cp>The two women are among about 1,900 across the state who were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California. The snafu was triggered by a recent policy change in Medi-Cal eligibility.\u003c/p>\n\u003cp>“One of the women missed a month of prenatal care,” Kersey said. “She was told she couldn’t be seen when she went to see her doctor.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Covered California acknowledged the problem, casting part of the blame on its computer system.\u003c/p>\n\u003cp>\u003cstrong>Similar Problem with Healthcare.gov\u003c/strong>\u003c/p>\n\u003cp>“We didn’t implement this as well as it should have been implemented,” said Amy Palmer, the agency’s director of communications.\u003c/p>\n\u003cp>That computer glitch will be fixed, but not until September, Palmer said.\u003c/p>\n\u003cp>A similar problem is affecting some pregnant women who purchased their plans through \u003ca href=\"https://www.healthcare.gov/\" target=\"_blank\">HealthCare.gov\u003c/a>, the federal health insurance exchange that serves people in 38 states, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.\u003c/p>\n\u003cp>“The computer system was basically immediately transitioning them to Medicaid when they reported their pregnancies to HealthCare.gov,\" Solomon said. “They should have the choice and they’re not getting it.”\u003c/p>\n\u003cp>Plan cancellations without notice or consent have been a persistent problem for some Covered California enrollees since 2014. In some cases, people are terminated from their plans unexpectedly. In others, they are transferred to Medi-Cal without prior notice. It’s unclear -- even to Covered California -- how widespread the problem is.\u003c/p>\n\u003cp>The situation for the pregnant California women can be traced to a recent policy change.\u003c/p>\n\u003cp>Usually, consumers are placed in either Covered California or Medi-Cal based on their income, with no choice in the matter, even though they can enroll in Medi-Cal via the Covered California website.\u003c/p>\n\u003cp>But the rules are different for some pregnant women whose household income falls between 138 percent and 213 percent of the federal poverty level, or roughly $22,100 to $34,100 for a family of two.\u003c/p>\n\u003cp>Before last October pregnant women in that income range technically had a choice between Medi-Cal and Covered California, though often they were not informed of the choice, said Lucy Quacinella, a San Francisco attorney and health care advocate for working families.\u003c/p>\n\u003cp>Now, under an October 2015 policy change, \u003cem>women who are pregnant at the time they apply\u003c/em> for health coverage and fall into this income bracket will automatically be placed into Medi-Cal, she said.\u003c/p>\n\u003cp>Women in the income range who already have Covered California plans \u003cem>before they become pregnant\u003c/em> are now supposed to be given the choice to remain in their subsidized plans -- which have out-of-pocket costs such as co-pays and deductibles -- or move to Medi-Cal, which is free.\u003c/p>\n\u003cp>The idea is to allow them to keep their existing Covered California providers if they want, Quacinella said.\u003c/p>\n\u003cp>But the Covered California computer system wasn’t programmed to give them the choice, and some pregnant women were moved immediately into Medi-Cal.\u003c/p>\n\u003cp>“They didn’t receive notice. They just knew from one day to the next that their Covered California insurance didn’t work anymore,” Quacinella said. “It’s very stressful, very confusing.”\u003c/p>\n\u003cp>\u003cstrong>May Be Easier to Find a Doctor with Covered California...\u003c/strong>\u003c/p>\n\u003cp>Although Medi-Cal is free, some women find it’s easier to get a doctor if they have private insurance. And because Covered California and Medi-Cal provider networks don’t always overlap, some of the women could no longer see the doctors with whom they had established relationships, Quacinella said.\u003c/p>\n\u003cp>“For some women, continuity of care is critical,” she said. “They don’t want to lose their providers.”\u003c/p>\n\u003cp>\u003cstrong>... But Medi-Cal is Free to Consumers\u003c/strong>\u003c/p>\n\u003cp>But after the initial shock, some women will consider the move to Medi-Cal a “blessing” because it’s cheaper, Quacinella said.\u003c/p>\n\u003cp>“Even with tax credits and cost-sharing reductions, it’s really hard for some families to afford the Covered California premiums or for pregnant women to afford a hospital’s labor and delivery charge,” she said.\u003c/p>\n\u003cp>That was the case for Kersey’s clients, who initially were distressed by the sudden loss of their Covered California plans but later decided to stay in Medi-Cal.\u003c/p>\n\u003cp>“One of our clients desperately wanted to get back into Covered California, but ultimately was fine with Medi-Cal, knowing there’s no delivery cost,” Kersey said.\u003c/p>\n\u003cp>Covered California has trained its customer service reps, insurance agents and other enrollers to explain to pregnant consumers that reporting a pregnancy could trigger a switch to Medi-Cal, Palmer said.\u003c/p>\n\u003cp>However, until the computer fix later this year, some women who report their pregnancy through the Covered California website still will be moved without a choice, she confirmed. These women can get their Covered California plans back, retroactive to the date they reported their pregnancies by calling Covered California’s customer service center at 800-300-1506.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Consumers should feel confident that their coverage continues,” Palmer said. “No consumer should be concerned about accessing care while they are pregnant for fear they do not have health coverage. They do.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Moving into a realm usually reserved for health care regulators, \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\">the California health marketplace Thursday unveiled sweeping reforms\u003c/a> to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers.\u003c/p>\n\u003cp>The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation.\u003c/p>\n\u003cp>Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.\u003c/p>\n\u003cp>The plan, to be implemented over seven years, is based on a \u003ca href=\"http://khn.org/news/hhs-pledges-to-quicken-pace-toward-quality-based-medicare-payments/\" target=\"_blank\">similar strategy pursued by the federal agency\u003c/a> that oversees the government-run Medicaid and Medicare health insurance programs.\u003c/p>\n\u003cp>The California Hospital Association, in a statement issued late Thursday, said it supported the exchange’s decision to phase in the plan incrementally.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The exchange, known as Covered California, will also \u003ca href=\"http://californiahealthline.org/news/california-insurance-marketplace-wants-to-kick-out-poor-performing-hospitals/\" target=\"_blank\">require health plans to identify hospitals and doctors that are performing poorly\u003c/a> on a variety of quality metrics or charging too much for care. The plans must dump the providers from their networks as early as 2019 if they don’t mend their ways. The plans could choose not to cut the hospitals or doctors, but they would have to explain in writing why, and detail what the providers are doing to address their deficiencies.\u003c/p>\n\u003cp>“Covered California’s mission is not just getting patients health insurance; it’s about improving the quality of the health care delivery system,” Peter V. Lee, the exchange’s executive, said in a written statement. “We are creating a market that rewards quality over quantity.”\u003c/p>\n\u003cp>Some doctors have noted that provider networks in many of the health plans sold by Covered California are already thin and warned that cutting the networks even more would only exacerbate the problem. And, they say, some hospitals and physicians might balk at the stringent new requirements and decline to participate in Covered California networks.\u003c/p>\n\u003cp>The insurers are not happy about transparency provisions that involve disclosing the rates they negotiate with their providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.\u003c/p>\n\u003cp>But Covered California officials believe that scrutinizing the negotiated rates will help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a medical procedure.\u003c/p>\n\u003cp>Nicole Evans, spokeswoman for the California Association of Health Plans, said that in some rural areas, where hospitals are few and far between, eliminating even one that is deemed to be underperforming might seriously compromise access to medical care.\u003c/p>\n\u003cp>“Or maybe one of them didn’t score as well on one quality measure but other quality measures are higher,” she said.\u003c/p>\n\u003cp>Evans added, though, that she was pleased Covered California would at least allow exceptions to this rule.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Among other elements of Covered California’s contract overhaul:\u003c/p>\n\u003cul>\n\u003cli>Health plans must assign a primary care doctor to enrollees within 30 days of coverage.\u003c/li>\n\u003cli>Health plans and doctors must share data to better track and treat patients with chronic conditions such as diabetes.\u003c/li>\n\u003cli>Plans are obliged to monitor and reduce health disparities among all their patients, starting with four major conditions: diabetes, hypertension, asthma and depression.\u003c/li>\n\u003cli>They also are required to better manage the price of high-end pharmaceuticals and aid consumers in reducing the cost of expensive drug treatments.\u003c/li>\n\u003cli>The health plans must help consumers better understand their diseases and treatment choices — and their share of the costs for those treatments.\u003c/li>\n\u003c/ul>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Moving into a realm usually reserved for health care regulators, \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\">the California health marketplace Thursday unveiled sweeping reforms\u003c/a> to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers.\u003c/p>\n\u003cp>The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation.\u003c/p>\n\u003cp>Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.\u003c/p>\n\u003cp>The plan, to be implemented over seven years, is based on a \u003ca href=\"http://khn.org/news/hhs-pledges-to-quicken-pace-toward-quality-based-medicare-payments/\" target=\"_blank\">similar strategy pursued by the federal agency\u003c/a> that oversees the government-run Medicaid and Medicare health insurance programs.\u003c/p>\n\u003cp>The California Hospital Association, in a statement issued late Thursday, said it supported the exchange’s decision to phase in the plan incrementally.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The exchange, known as Covered California, will also \u003ca href=\"http://californiahealthline.org/news/california-insurance-marketplace-wants-to-kick-out-poor-performing-hospitals/\" target=\"_blank\">require health plans to identify hospitals and doctors that are performing poorly\u003c/a> on a variety of quality metrics or charging too much for care. The plans must dump the providers from their networks as early as 2019 if they don’t mend their ways. The plans could choose not to cut the hospitals or doctors, but they would have to explain in writing why, and detail what the providers are doing to address their deficiencies.\u003c/p>\n\u003cp>“Covered California’s mission is not just getting patients health insurance; it’s about improving the quality of the health care delivery system,” Peter V. Lee, the exchange’s executive, said in a written statement. “We are creating a market that rewards quality over quantity.”\u003c/p>\n\u003cp>Some doctors have noted that provider networks in many of the health plans sold by Covered California are already thin and warned that cutting the networks even more would only exacerbate the problem. And, they say, some hospitals and physicians might balk at the stringent new requirements and decline to participate in Covered California networks.\u003c/p>\n\u003cp>The insurers are not happy about transparency provisions that involve disclosing the rates they negotiate with their providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.\u003c/p>\n\u003cp>But Covered California officials believe that scrutinizing the negotiated rates will help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a medical procedure.\u003c/p>\n\u003cp>Nicole Evans, spokeswoman for the California Association of Health Plans, said that in some rural areas, where hospitals are few and far between, eliminating even one that is deemed to be underperforming might seriously compromise access to medical care.\u003c/p>\n\u003cp>“Or maybe one of them didn’t score as well on one quality measure but other quality measures are higher,” she said.\u003c/p>\n\u003cp>Evans added, though, that she was pleased Covered California would at least allow exceptions to this rule.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Among other elements of Covered California’s contract overhaul:\u003c/p>\n\u003cul>\n\u003cli>Health plans must assign a primary care doctor to enrollees within 30 days of coverage.\u003c/li>\n\u003cli>Health plans and doctors must share data to better track and treat patients with chronic conditions such as diabetes.\u003c/li>\n\u003cli>Plans are obliged to monitor and reduce health disparities among all their patients, starting with four major conditions: diabetes, hypertension, asthma and depression.\u003c/li>\n\u003cli>They also are required to better manage the price of high-end pharmaceuticals and aid consumers in reducing the cost of expensive drug treatments.\u003c/li>\n\u003cli>The health plans must help consumers better understand their diseases and treatment choices — and their share of the costs for those treatments.\u003c/li>\n\u003c/ul>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California's Obamacare Marketplace Aims To Kick Out Poor-Performing Hospitals",
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"content": "\u003cp>California's insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a \u003ca href=\"http://hbex.coveredca.com/stakeholders/plan-management/PDFs/2017_QHP_Issuer_Contract_Attachment_7_3_4_2016_Redline.pdf\">novel proposal\u003c/a> that is drawing heavy fire from medical providers and insurers.\u003c/p>\n\u003cp>The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.\u003c/p>\n\u003cp>\"The first few years were about getting people in the door for coverage,\" said Lee, a key figure in the rollout of the federal health law. \"We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don't want to throw anyone out, but we don't want to pay for bad quality care either.\"\u003c/p>\n\u003cp>It appears to be the first proposal of its kind in the country. The exchange's five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital \"outliers\" on cost and quality starting in 2018. Medical groups and doctors would be rated after that.\u003c/p>\n\u003cp>Providers who don't measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By 2019, health plans would be expected to expel poor performers from their exchange networks.\u003c/p>\n\u003cp>The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.\u003c/p>\n\u003cp>Health insurers, normally at odds with providers, have joined them in the fight. The insurers are balking at the prospect of disclosing their negotiated rates with providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.\u003c/p>\n\u003cp>But scrutinizing the negotiated rates would help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a surgery or imaging test.\u003c/p>\n\u003cp>Lee said it's time for the exchange to move beyond enrollment and flex its market power on behalf of its 1.5 million members. He said insurers haven't been tough enough on hospitals and doctors.\u003c/p>\n\u003cp>Other public exchanges or large employers could try to replicate the idea, putting more pressure on providers and insurers. Lee has shared his proposal with other state marketplaces, government officials and employer groups to promote similar efforts.\u003c/p>\n\u003cp>Still, there are limits to this strategy. Exceptions would be granted if excluding a hospital or doctor from a network meant an area wouldn't have a sufficient number of providers. Insurers could appeal and offer other reasons for keeping a provider in the network.\u003c/p>\n\u003cp>\"California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat,\" said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. \"There may be a dominant hospital system that's charging through the nose, but without them you don't have an adequate network. It will be interesting to see how Covered California threads that needle.\"\u003c/p>\n\u003cp>The composition of networks has typically been left up to insurers. Until now, most of the discussion has centered on the proliferation of narrow networks, with a limited range of providers, sold under the Affordable Care Act as a way to hold down rates. A \u003ca href=\"http://ldi.upenn.edu/sites/default/files/rte/state-narrow-networks.pdf\">study\u003c/a> in 2015 found that 75 percent of Covered California plans had narrow physician networks, with more restricted choices than all but three other states.\u003c/p>\n\u003cp>\"I don't know of anyone even close to trying this,\" said Dan Polsky, the study's author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. \"I applaud Covered California for being bold to improve quality and reduce costs, but I worry about the implementation.\"\u003c/p>\n\u003cp>Polsky said measuring quality can be complicated, and steps must be taken to ensure hospitals and doctors aren't penalized for treating sicker patients or serving lower-income areas. Most quality-boosting efforts use financial bonuses and penalties rather than exclusion.\u003c/p>\n\u003cp>Under the Covered California plan, hospitals would be judged on a wide range of performance and safety measures, from rates of readmission and hospital-acquired infections to adverse drug events. The exchange said it will draw on existing measures already tracked by Medicare and other groups, and it will work with hospitals, consumer advocates and other experts over the next 18 months to finalize the details.\u003c/p>\n\u003cp>The California Hospital Association said the exchange is moving too fast and acting too much like a regulator.\u003c/p>\n\u003cp>\"The devil is in the details, and the rapidity of this concerns us,\" said Dr. David Perrott, chief medical officer at the state hospital trade group. \"We understand value-based purchasing is here in some form and we do not oppose that. But Covered California is charging ahead with this assessment and trying to figure out the answers when it hasn't been worked out.\"\u003c/p>\n\u003cp>California physicians warn that the exchange's proposal could further reduce networks that are already too thin for patients.\u003c/p>\n\u003cp>\"Right now, one of the biggest problems in healthcare is limited access to specialty care. This allows more narrowing of the networks under spurious guidelines,\" said Dr. Ted Mazer, a board member of the California Medical Association and a head and neck surgeon in San Diego.\u003c/p>\n\u003cp>Charles Bacchi, chief executive of the California Association of Health Plans, predicted that Covered California's idea will backfire, discouraging hospitals and doctors from participating in the exchange and driving up premiums as a result.\u003c/p>\n\u003cp>\"It's the right goal but the wrong approach,\" Bacchi said. \"Covered California is proposing a top-down, arbitrary measurement system that carries a big stick. This can make it difficult for health plans and providers to work together constructively.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes \u003ca href=\"http://californiahealthline.org/news/california-insurance-marketplace-wants-to-kick-out-poor-performing-hospitals/\" target=\"_blank\">California Healthline\u003c/a>, a service of the California HealthCare Foundation. Follow Chad Terhune on Twitter: \u003ca href=\"https://twitter.com/chadterhune\">@chadterhune\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News.\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California's insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a \u003ca href=\"http://hbex.coveredca.com/stakeholders/plan-management/PDFs/2017_QHP_Issuer_Contract_Attachment_7_3_4_2016_Redline.pdf\">novel proposal\u003c/a> that is drawing heavy fire from medical providers and insurers.\u003c/p>\n\u003cp>The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.\u003c/p>\n\u003cp>\"The first few years were about getting people in the door for coverage,\" said Lee, a key figure in the rollout of the federal health law. \"We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don't want to throw anyone out, but we don't want to pay for bad quality care either.\"\u003c/p>\n\u003cp>It appears to be the first proposal of its kind in the country. The exchange's five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital \"outliers\" on cost and quality starting in 2018. Medical groups and doctors would be rated after that.\u003c/p>\n\u003cp>Providers who don't measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By 2019, health plans would be expected to expel poor performers from their exchange networks.\u003c/p>\n\u003cp>The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.\u003c/p>\n\u003cp>Health insurers, normally at odds with providers, have joined them in the fight. The insurers are balking at the prospect of disclosing their negotiated rates with providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.\u003c/p>\n\u003cp>But scrutinizing the negotiated rates would help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a surgery or imaging test.\u003c/p>\n\u003cp>Lee said it's time for the exchange to move beyond enrollment and flex its market power on behalf of its 1.5 million members. He said insurers haven't been tough enough on hospitals and doctors.\u003c/p>\n\u003cp>Other public exchanges or large employers could try to replicate the idea, putting more pressure on providers and insurers. Lee has shared his proposal with other state marketplaces, government officials and employer groups to promote similar efforts.\u003c/p>\n\u003cp>Still, there are limits to this strategy. Exceptions would be granted if excluding a hospital or doctor from a network meant an area wouldn't have a sufficient number of providers. Insurers could appeal and offer other reasons for keeping a provider in the network.\u003c/p>\n\u003cp>\"California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat,\" said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. \"There may be a dominant hospital system that's charging through the nose, but without them you don't have an adequate network. It will be interesting to see how Covered California threads that needle.\"\u003c/p>\n\u003cp>The composition of networks has typically been left up to insurers. Until now, most of the discussion has centered on the proliferation of narrow networks, with a limited range of providers, sold under the Affordable Care Act as a way to hold down rates. A \u003ca href=\"http://ldi.upenn.edu/sites/default/files/rte/state-narrow-networks.pdf\">study\u003c/a> in 2015 found that 75 percent of Covered California plans had narrow physician networks, with more restricted choices than all but three other states.\u003c/p>\n\u003cp>\"I don't know of anyone even close to trying this,\" said Dan Polsky, the study's author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. \"I applaud Covered California for being bold to improve quality and reduce costs, but I worry about the implementation.\"\u003c/p>\n\u003cp>Polsky said measuring quality can be complicated, and steps must be taken to ensure hospitals and doctors aren't penalized for treating sicker patients or serving lower-income areas. Most quality-boosting efforts use financial bonuses and penalties rather than exclusion.\u003c/p>\n\u003cp>Under the Covered California plan, hospitals would be judged on a wide range of performance and safety measures, from rates of readmission and hospital-acquired infections to adverse drug events. The exchange said it will draw on existing measures already tracked by Medicare and other groups, and it will work with hospitals, consumer advocates and other experts over the next 18 months to finalize the details.\u003c/p>\n\u003cp>The California Hospital Association said the exchange is moving too fast and acting too much like a regulator.\u003c/p>\n\u003cp>\"The devil is in the details, and the rapidity of this concerns us,\" said Dr. David Perrott, chief medical officer at the state hospital trade group. \"We understand value-based purchasing is here in some form and we do not oppose that. But Covered California is charging ahead with this assessment and trying to figure out the answers when it hasn't been worked out.\"\u003c/p>\n\u003cp>California physicians warn that the exchange's proposal could further reduce networks that are already too thin for patients.\u003c/p>\n\u003cp>\"Right now, one of the biggest problems in healthcare is limited access to specialty care. This allows more narrowing of the networks under spurious guidelines,\" said Dr. Ted Mazer, a board member of the California Medical Association and a head and neck surgeon in San Diego.\u003c/p>\n\u003cp>Charles Bacchi, chief executive of the California Association of Health Plans, predicted that Covered California's idea will backfire, discouraging hospitals and doctors from participating in the exchange and driving up premiums as a result.\u003c/p>\n\u003cp>\"It's the right goal but the wrong approach,\" Bacchi said. \"Covered California is proposing a top-down, arbitrary measurement system that carries a big stick. This can make it difficult for health plans and providers to work together constructively.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes \u003ca href=\"http://californiahealthline.org/news/california-insurance-marketplace-wants-to-kick-out-poor-performing-hospitals/\" target=\"_blank\">California Healthline\u003c/a>, a service of the California HealthCare Foundation. Follow Chad Terhune on Twitter: \u003ca href=\"https://twitter.com/chadterhune\">@chadterhune\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News.\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Many Dislike Health Care System But Are Pleased With Their Own Care",
"title": "Many Dislike Health Care System But Are Pleased With Their Own Care",
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"content": "\u003cp>The United States has the most advanced health care in the world. There are gleaming medical centers across the country where doctors cure cancers, transplant organs and bring people back from near death.\u003c/p>\n\u003cp>But a \u003ca href=\"http://www.npr.org/sections/health-shots/2016/02/29/467980734/health-quality-an-issue-for-poor-2-years-into-obamacare-poll-finds\" target=\"_blank\">poll\u003c/a> conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health shows that only one-third of Americans say the health care they receive is \"excellent.\" Even fewer people are impressed with the system as a whole.\u003c/p>\n\u003cp>\"When you're talking about health care, we have this amazing kind of schizophrenia about our system,\" says \u003ca href=\"https://www.apha.org/about-apha/executive-board-and-staff/apha-executive-board/georges-c-benjamin-md-facp-fnapa-facep-hon-frsph\" target=\"_blank\">Dr. Georges Benjamin\u003c/a>, executive director of the American Public Health Association.\u003c/p>\n\u003cp>The split in thinking shows up in the poll numbers.\u003c/p>\n\u003cp>Much the way people hate Congress but love their own representatives, people like the care they receive while complaining about the system. About 80 percent say they get good or excellent care. But 42 percent rate the health care system in their state as fair or poor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We deliver the best medicine and nursing on the planet, no question about it. But it requires a lot of things,\" Benjamin says.\u003c/p>\n\u003cp>Things like an insurance card, filling out lots of forms, paying copays and deductibles, and running from doctor to lab to imaging center.\u003c/p>\n\u003cp>The system is wildly complex and hard to navigate, and can be very frustrating. Benjamin says it's this process of getting health care that people hate.\u003c/p>\n\u003cp>Just ask Cheryl Vaun, one of our poll respondents.\u003c/p>\n\u003cp>The 57-year-old from Albany, Ore., has a low opinion of the health care system after spending years trying to help her daughter who fell suddenly ill as a teenager.\u003c/p>\n\u003cp>The 16-year-old gained 30 pounds in about a month. She had migraines and her muscles would seize up in pain.\u003c/p>\n\u003cp>Vaun and her daughter went from doctor to doctor repeating the same tests and procedures. When doctors couldn't figure out what was wrong, they offered Vaun's daughter antidepressants.\u003c/p>\n\u003cp>\"We were pretty upset,\" she says. \"My daughter was devastated because obviously she's suffering all of these health issues and it was a bit terrifying.\"\u003c/p>\n\u003cp>Vaun's daughter was finally diagnosed with acute anemia.\u003c/p>\n\u003cp>If the problem had been caught earlier, Vaun believes her daughter could have recovered. Instead it has become a chronic condition that leaves her tired and weak. The treatment is iron pills or injections, which are hard on her system and leave her sick to her stomach.\u003c/p>\n\u003cp>Repeat tests, multiple doctor visits and lack of results erode people's faith in their care, says \u003ca href=\"http://www.allhealth.org/aboutus_staff.asp\" target=\"_blank\">Sarah Dash\u003c/a>, vice president for health policy at the \u003ca href=\"http://www.allhealth.org/\" target=\"_blank\">Alliance for Health Reform\u003c/a> in Washington, D.C.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-154912\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM.png\" alt=\"Screen Shot 2016-02-29 at 10.49.16 AM\" width=\"819\" height=\"355\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM.png 819w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-400x173.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-800x347.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-768x333.png 768w\" sizes=\"(max-width: 819px) 100vw, 819px\">\u003c/p>\n\u003cp>\"Health care hasn't always been designed with the needs and efficiency of the patient in mind,\" Dash says. \"It's designed for the various doctors and the health care system.\"\u003c/p>\n\u003cp>The poll, conducted from September to November, also shows that quality of care can depend heavily on a patient's income.\u003c/p>\n\u003cp>Adults with incomes below $25,000 a year are about three times as likely as higher income people — 34 percent versus 13 percent — to say the health care they personally receive is only fair or poor.\u003c/p>\n\u003cp>William Dale Coger, 52, is one of them. The carpenter from Oak Hill, W.Va., says he's been unable to get help for his back, which he injured about 15 years ago while hauling pipe out of a well on his property.\u003c/p>\n\u003cp>His pain, mild at first, has gotten worse over the years. These days, he struggles to get out of bed in the morning and finds his left leg is unstable and his left foot goes numb.\u003c/p>\n\u003cp>\"It's gotten to the point that this pain travels clear up my back into my shoulder blade into my left side of my neck and gives me migraine headaches sometimes into the left side of my head,\" Coger says.\u003c/p>\n\u003cp>He's on disability and Medicaid.\u003c/p>\n\u003cp>Coger sees doctors at a local clinic, but he says they don't take his back trouble seriously. They recommend exercise and offer ibuprofen. He thinks surgery would be able to help him but says doctors at the clinic refuse to order an MRI.\u003c/p>\n\u003cp>\"I want to be cured,\" he says. \"I don't want pills. I don't like pills.\"\u003c/p>\n\u003cp>Benjamin of the APHA says Coger and his doctors don't seem to have the same goal. They're managing his pain; he wants to get back to work.\u003c/p>\n\u003cp>\"It can be really frustrating if you don't understand the end goal of your care,\" Benjamin says.\u003c/p>\n\u003cp>Dash says the Affordable Care Act includes lots of\u003ca href=\"http://www.hlc.org/wp-content/uploads/2010/08/ACA-Pilot-Programs-and-Demonstration-Projects-Summary.pdf\" target=\"_blank\"> pilot projects\u003c/a> to improve how patients get care — and to make it cheaper. But those changes come slowly in a system that today is wildly complex.\u003c/p>\n\u003cp>And for most people, the law seems to have changed little.\u003c/p>\n\u003cp>The NPR poll shows 74 percent of people believe their health care has stayed about the same since the ACA was implemented. And for the minority who've seen a change, about 14 percent say their care is better while 9 percent say it's worse.\u003c/p>\n\u003cp>And most think the law has had no direct impact on them.\u003c/p>\n\u003cp>Even if they didn't buy a plan through the exchange, people have more insurance benefits than they did before. They get free screenings like mammograms and colonoscopies. Birth control is free. And they can still buy insurance even if they have a pre-existing medical condition.\u003c/p>\n\u003cp>Most people aren't aware of that, though. Our poll shows only 1 in 6 adults think their benefits have increased in the past two years, and 12 percent believe they've declined.\u003c/p>\n\u003cp>And many people still don't like the law.\u003c/p>\n\u003cp>Ivan Rivera, 29, from Miami, says he is opposed to Obamacare and is angry that he's required to get insurance.\u003c/p>\n\u003cp>He says he works hard, takes care of his own health and doesn't want to have to subsidize coverage for others.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We're paying for other people,\" he says. \"People that are not working. People who are not pulling their own weight.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Many+Dislike+Health+Care+System+But+Are+Pleased+With+Their+Own+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The United States has the most advanced health care in the world. There are gleaming medical centers across the country where doctors cure cancers, transplant organs and bring people back from near death.\u003c/p>\n\u003cp>But a \u003ca href=\"http://www.npr.org/sections/health-shots/2016/02/29/467980734/health-quality-an-issue-for-poor-2-years-into-obamacare-poll-finds\" target=\"_blank\">poll\u003c/a> conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health shows that only one-third of Americans say the health care they receive is \"excellent.\" Even fewer people are impressed with the system as a whole.\u003c/p>\n\u003cp>\"When you're talking about health care, we have this amazing kind of schizophrenia about our system,\" says \u003ca href=\"https://www.apha.org/about-apha/executive-board-and-staff/apha-executive-board/georges-c-benjamin-md-facp-fnapa-facep-hon-frsph\" target=\"_blank\">Dr. Georges Benjamin\u003c/a>, executive director of the American Public Health Association.\u003c/p>\n\u003cp>The split in thinking shows up in the poll numbers.\u003c/p>\n\u003cp>Much the way people hate Congress but love their own representatives, people like the care they receive while complaining about the system. About 80 percent say they get good or excellent care. But 42 percent rate the health care system in their state as fair or poor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We deliver the best medicine and nursing on the planet, no question about it. But it requires a lot of things,\" Benjamin says.\u003c/p>\n\u003cp>Things like an insurance card, filling out lots of forms, paying copays and deductibles, and running from doctor to lab to imaging center.\u003c/p>\n\u003cp>The system is wildly complex and hard to navigate, and can be very frustrating. Benjamin says it's this process of getting health care that people hate.\u003c/p>\n\u003cp>Just ask Cheryl Vaun, one of our poll respondents.\u003c/p>\n\u003cp>The 57-year-old from Albany, Ore., has a low opinion of the health care system after spending years trying to help her daughter who fell suddenly ill as a teenager.\u003c/p>\n\u003cp>The 16-year-old gained 30 pounds in about a month. She had migraines and her muscles would seize up in pain.\u003c/p>\n\u003cp>Vaun and her daughter went from doctor to doctor repeating the same tests and procedures. When doctors couldn't figure out what was wrong, they offered Vaun's daughter antidepressants.\u003c/p>\n\u003cp>\"We were pretty upset,\" she says. \"My daughter was devastated because obviously she's suffering all of these health issues and it was a bit terrifying.\"\u003c/p>\n\u003cp>Vaun's daughter was finally diagnosed with acute anemia.\u003c/p>\n\u003cp>If the problem had been caught earlier, Vaun believes her daughter could have recovered. Instead it has become a chronic condition that leaves her tired and weak. The treatment is iron pills or injections, which are hard on her system and leave her sick to her stomach.\u003c/p>\n\u003cp>Repeat tests, multiple doctor visits and lack of results erode people's faith in their care, says \u003ca href=\"http://www.allhealth.org/aboutus_staff.asp\" target=\"_blank\">Sarah Dash\u003c/a>, vice president for health policy at the \u003ca href=\"http://www.allhealth.org/\" target=\"_blank\">Alliance for Health Reform\u003c/a> in Washington, D.C.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-154912\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM.png\" alt=\"Screen Shot 2016-02-29 at 10.49.16 AM\" width=\"819\" height=\"355\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM.png 819w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-400x173.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-800x347.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Screen-Shot-2016-02-29-at-10.49.16-AM-768x333.png 768w\" sizes=\"(max-width: 819px) 100vw, 819px\">\u003c/p>\n\u003cp>\"Health care hasn't always been designed with the needs and efficiency of the patient in mind,\" Dash says. \"It's designed for the various doctors and the health care system.\"\u003c/p>\n\u003cp>The poll, conducted from September to November, also shows that quality of care can depend heavily on a patient's income.\u003c/p>\n\u003cp>Adults with incomes below $25,000 a year are about three times as likely as higher income people — 34 percent versus 13 percent — to say the health care they personally receive is only fair or poor.\u003c/p>\n\u003cp>William Dale Coger, 52, is one of them. The carpenter from Oak Hill, W.Va., says he's been unable to get help for his back, which he injured about 15 years ago while hauling pipe out of a well on his property.\u003c/p>\n\u003cp>His pain, mild at first, has gotten worse over the years. These days, he struggles to get out of bed in the morning and finds his left leg is unstable and his left foot goes numb.\u003c/p>\n\u003cp>\"It's gotten to the point that this pain travels clear up my back into my shoulder blade into my left side of my neck and gives me migraine headaches sometimes into the left side of my head,\" Coger says.\u003c/p>\n\u003cp>He's on disability and Medicaid.\u003c/p>\n\u003cp>Coger sees doctors at a local clinic, but he says they don't take his back trouble seriously. They recommend exercise and offer ibuprofen. He thinks surgery would be able to help him but says doctors at the clinic refuse to order an MRI.\u003c/p>\n\u003cp>\"I want to be cured,\" he says. \"I don't want pills. I don't like pills.\"\u003c/p>\n\u003cp>Benjamin of the APHA says Coger and his doctors don't seem to have the same goal. They're managing his pain; he wants to get back to work.\u003c/p>\n\u003cp>\"It can be really frustrating if you don't understand the end goal of your care,\" Benjamin says.\u003c/p>\n\u003cp>Dash says the Affordable Care Act includes lots of\u003ca href=\"http://www.hlc.org/wp-content/uploads/2010/08/ACA-Pilot-Programs-and-Demonstration-Projects-Summary.pdf\" target=\"_blank\"> pilot projects\u003c/a> to improve how patients get care — and to make it cheaper. But those changes come slowly in a system that today is wildly complex.\u003c/p>\n\u003cp>And for most people, the law seems to have changed little.\u003c/p>\n\u003cp>The NPR poll shows 74 percent of people believe their health care has stayed about the same since the ACA was implemented. And for the minority who've seen a change, about 14 percent say their care is better while 9 percent say it's worse.\u003c/p>\n\u003cp>And most think the law has had no direct impact on them.\u003c/p>\n\u003cp>Even if they didn't buy a plan through the exchange, people have more insurance benefits than they did before. They get free screenings like mammograms and colonoscopies. Birth control is free. And they can still buy insurance even if they have a pre-existing medical condition.\u003c/p>\n\u003cp>Most people aren't aware of that, though. Our poll shows only 1 in 6 adults think their benefits have increased in the past two years, and 12 percent believe they've declined.\u003c/p>\n\u003cp>And many people still don't like the law.\u003c/p>\n\u003cp>Ivan Rivera, 29, from Miami, says he is opposed to Obamacare and is angry that he's required to get insurance.\u003c/p>\n\u003cp>He says he works hard, takes care of his own health and doesn't want to have to subsidize coverage for others.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We're paying for other people,\" he says. \"People that are not working. People who are not pulling their own weight.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Many+Dislike+Health+Care+System+But+Are+Pleased+With+Their+Own+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Your Obamacare Tax Form May Have Errors. Here's Help.",
"title": "Your Obamacare Tax Form May Have Errors. Here's Help.",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Millions of Californians will receive Obamacare-related tax forms this year for the first time — if they haven’t already — including 13 million people who had Medi-Cal coverage in 2015.\u003c/p>\n\u003cp>These forms, called 1095s will help you prove to the Tax Man you had health insurance last year and don’t owe the Obamacare tax penalty for being uninsured.\u003c/p>\n\u003cp>Or, ahem, they might not.\u003c/p>\n\u003cp>Last year, tens of thousands of Californians \u003ca href=\"http://centerforhealthreporting.org/article/obamacares-tax-time-lessons\" target=\"_blank\">received incorrect 1095s\u003c/a> from Covered California and struggled with the agency’s resolution process. Covered California pledges to do better this year.\u003c/p>\n\u003cp>But already, some Medi-Cal and Covered California enrollees are discovering errors, and they will have to wait for fixes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I received forms from both Covered California and Medi-Cal that were both completely inaccurate,” says Aimee Roolvink, 44, of Glendora.\u003c/p>\n\u003cp>“Good luck trying to file your taxes with forms that have inconsistent numbers.”\u003c/p>\n\u003cp>Today, I’ll explain who will receive the forms and what to do if they contain inaccuracies.\u003c/p>\n\u003cp>Let’s start with three points:\u003c/p>\n\u003cul>\n\u003cli>If you had a health plan through an insurance exchange such as Covered California last year, you must have a correct 1095-A form in hand to complete your taxes.\u003c/li>\n\u003cli>Most others, who had insurance from employers, the open market or government programs such as Medicare or Medi-Cal, will receive a 1095-B or 1095-C form. \u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals\" target=\"_blank\">You don’t need these in hand to do your taxes\u003c/a>.\u003c/li>\n\u003cli>If you had insurance from multiple sources last year, you may receive more than one 1095.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>1095-A\u003c/strong>\u003c/p>\n\u003cp>This form, which comes from health insurance exchanges, like Covered California, lists the amount of tax credits you received to help pay your premiums.\u003c/p>\n\u003cp>“In terms of taxes, these forms are the most critical,” says Debra Hammer of Intuit TurboTax.\u003c/p>\n\u003cp>Why?\u003c/p>\n\u003cp>When you enrolled in your plan, you were asked to estimate your 2015 income, which determined your federal tax credits. (Many people refer to these as \"subsidies.\") When you complete your taxes this year, you’ll have to report whether your actual income varied from your estimate.\u003c/p>\n\u003cp>Since most of you received your tax credits in advance, you may either owe or be owed money if there’s a difference.\u003c/p>\n\u003cp>So, if you find mistakes on your form, request corrections quickly.\u003c/p>\n\u003cp>For errors in your personal information — name, birthdate, Social Security Number or address — call Covered California at 800-300-1506.\u003c/p>\n\u003cp>If there’s a mistake in the amount of tax credits you received or which months you were covered, or if your form is missing household members, fill out a \u003ca href=\"https://forms.nintex.com/FormHost.aspx?id=FV63pH13AmOIN5ru6fPkreV5UeQCEdouFwhQpns6P1Bz2VdwzdHA8fVj71PmkluZw3PUHu7yCU4PLT5_auIlAG-pY1CcHP2O5_pxPl2dI6LAOdQvQ-9QE2dQhmCGu9RM&TZOffset=480&TZStdOffset=-480&HasDST=true\" target=\"_blank\">dispute form online\u003c/a> or call the same phone number to have the form filled out for you. You can find the dispute form via \u003ca href=\"http://www.coveredca.com/members/\" target=\"_blank\">www.CoveredCA.com/members\u003c/a>.\u003c/p>\n\u003cp>The agency says it will issue a corrected 1095-A within 60 days of submission, though it blew the deadline for many consumers last year.\u003c/p>\n\u003cp>\u003cstrong>1095-B and 1095-C\u003c/strong>\u003c/p>\n\u003cp>1095-B forms are distributed by government-sponsored health programs (like Medicare and Medi-Cal), some employers and health insurance companies for policies purchased outside exchanges.\u003c/p>\n\u003cp>1095-C forms are issued by large employers and generally follow the same rules as 1095-Bs.\u003c/p>\n\u003cp>\u003ca href=\"https://www.irs.gov/uac/Recent-Development-2015-12-29-2015-Forms-1095B-1094B-1095C-and-1094C\" target=\"_blank\">The IRS has extended to March 31\u003c/a> the deadline for sending the B and C forms to you.\u003c/p>\n\u003cp>These forms are primarily informational and show which months you had coverage.\u003c/p>\n\u003cp>If you have a B or C form and had insurance all of last year, you can just check a box on your tax return, Hammer says. If you didn’t, you may owe a tax penalty — \u003ca href=\"http://centerforhealthreporting.org/article/how-dodge-obamacare-tax-penalty-legally\" target=\"_blank\">unless you qualify for one of Obamacare’s many exemptions\u003c/a>.\u003c/p>\n\u003cp>But you still need to make sure your forms are accurate, because the information is transmitted to the IRS, she says.\u003c/p>\n\u003cp>The Department of Health Care Services (DHCS), which administers Medi-Cal, is among the agencies sending out 1095-B forms for the first time. The department has established a toll-free help line (844-253-0883) that received more than 11,000 calls in January and more than 23,000 since November.\u003c/p>\n\u003cp>Confusingly, that phone number isn’t for people who discover mistakes on their forms. For that, you must\u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx\" target=\"_blank\"> contact your county Medi-Cal office \u003c/a>to request a correction.\u003c/p>\n\u003cp>If you receive\u003ca href=\"https://www.ssa.gov/ssi/text-over-ussi.htm\" target=\"_blank\"> Supplemental Security Income \u003c/a>(SSI) or \u003ca href=\"http://www.cdss.ca.gov/agedblinddisabled/pg1422.htm\" target=\"_blank\">State Supplementary Payment \u003c/a>(SSP) benefits, you must contact the Social Security Administration to update your information before you request a corrected form from your county, the department says.\u003c/p>\n\u003cp>Some large counties have dedicated phone lines to handle changes to Medi-Cal cases, which may include 1095 form corrections, says Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California. Ask if your county is one.\u003c/p>\n\u003cp>But don’t expect quick action.\u003c/p>\n\u003cp>“In order to give the client … the revised information, the county needs to either be able to submit a request for a reprint to the state or print it out directly,” Senderling-McDonald says.\u003c/p>\n\u003cp>Counties can’t do that yet because the state computer system “has not been programmed to allow for reprints to be done,” she says.\u003c/p>\n\u003cp>That changes March 1 for information reportable to the IRS, says Tony Cava, DHCS spokesman. After that date, corrected forms will be mailed to consumers within 30 days of a request for fixes.\u003c/p>\n\u003cp>For information not reportable to the IRS, such as errors in personal information, replacement forms will be available starting April 1, he says.\u003c/p>\n\u003cp>Since that’s just two weeks before the tax filing deadline, it’s important to remember you can file your taxes while you await corrections to B and C forms.\u003c/p>\n\u003cp>“If you believe you had Medi-Cal for 10 months of the year, go ahead and fill out your tax form showing 10 months,” says Jen Flory, senior attorney at the Western Center on Law & Poverty.\u003c/p>\n\u003cp>If you’re among the Medi-Cal recipients who don’t have to file taxes because you earned less than the\u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Calculating-the-Payment\" target=\"_blank\"> tax filing threshold,\u003c/a> you still don’t have to file even if you receive a 1095-B form, Flory added. (However, you must file taxes if you receive a 1095-A, she noted.)\u003c/p>\n\u003cp>Roolvink, the Glendora resident, submitted her Covered California dispute form in January and has spent dozens of hours on the phone trying to reach someone in her county Medi-Cal office. She’s still waiting for corrections to both 1095 forms.\u003c/p>\n\u003cp>Her forms showed that her husband and two daughters were on Medi-Cal when they actually had Covered California plans, she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“To say this is a problem is really an understatement,” she says. “It’s been a nightmare.”\u003c/p>\n\n",
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"excerpt": "Under the health law, you need to prove to the IRS you had health insurance. Seems easy? Not necessarily.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Millions of Californians will receive Obamacare-related tax forms this year for the first time — if they haven’t already — including 13 million people who had Medi-Cal coverage in 2015.\u003c/p>\n\u003cp>These forms, called 1095s will help you prove to the Tax Man you had health insurance last year and don’t owe the Obamacare tax penalty for being uninsured.\u003c/p>\n\u003cp>Or, ahem, they might not.\u003c/p>\n\u003cp>Last year, tens of thousands of Californians \u003ca href=\"http://centerforhealthreporting.org/article/obamacares-tax-time-lessons\" target=\"_blank\">received incorrect 1095s\u003c/a> from Covered California and struggled with the agency’s resolution process. Covered California pledges to do better this year.\u003c/p>\n\u003cp>But already, some Medi-Cal and Covered California enrollees are discovering errors, and they will have to wait for fixes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I received forms from both Covered California and Medi-Cal that were both completely inaccurate,” says Aimee Roolvink, 44, of Glendora.\u003c/p>\n\u003cp>“Good luck trying to file your taxes with forms that have inconsistent numbers.”\u003c/p>\n\u003cp>Today, I’ll explain who will receive the forms and what to do if they contain inaccuracies.\u003c/p>\n\u003cp>Let’s start with three points:\u003c/p>\n\u003cul>\n\u003cli>If you had a health plan through an insurance exchange such as Covered California last year, you must have a correct 1095-A form in hand to complete your taxes.\u003c/li>\n\u003cli>Most others, who had insurance from employers, the open market or government programs such as Medicare or Medi-Cal, will receive a 1095-B or 1095-C form. \u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals\" target=\"_blank\">You don’t need these in hand to do your taxes\u003c/a>.\u003c/li>\n\u003cli>If you had insurance from multiple sources last year, you may receive more than one 1095.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>1095-A\u003c/strong>\u003c/p>\n\u003cp>This form, which comes from health insurance exchanges, like Covered California, lists the amount of tax credits you received to help pay your premiums.\u003c/p>\n\u003cp>“In terms of taxes, these forms are the most critical,” says Debra Hammer of Intuit TurboTax.\u003c/p>\n\u003cp>Why?\u003c/p>\n\u003cp>When you enrolled in your plan, you were asked to estimate your 2015 income, which determined your federal tax credits. (Many people refer to these as \"subsidies.\") When you complete your taxes this year, you’ll have to report whether your actual income varied from your estimate.\u003c/p>\n\u003cp>Since most of you received your tax credits in advance, you may either owe or be owed money if there’s a difference.\u003c/p>\n\u003cp>So, if you find mistakes on your form, request corrections quickly.\u003c/p>\n\u003cp>For errors in your personal information — name, birthdate, Social Security Number or address — call Covered California at 800-300-1506.\u003c/p>\n\u003cp>If there’s a mistake in the amount of tax credits you received or which months you were covered, or if your form is missing household members, fill out a \u003ca href=\"https://forms.nintex.com/FormHost.aspx?id=FV63pH13AmOIN5ru6fPkreV5UeQCEdouFwhQpns6P1Bz2VdwzdHA8fVj71PmkluZw3PUHu7yCU4PLT5_auIlAG-pY1CcHP2O5_pxPl2dI6LAOdQvQ-9QE2dQhmCGu9RM&TZOffset=480&TZStdOffset=-480&HasDST=true\" target=\"_blank\">dispute form online\u003c/a> or call the same phone number to have the form filled out for you. You can find the dispute form via \u003ca href=\"http://www.coveredca.com/members/\" target=\"_blank\">www.CoveredCA.com/members\u003c/a>.\u003c/p>\n\u003cp>The agency says it will issue a corrected 1095-A within 60 days of submission, though it blew the deadline for many consumers last year.\u003c/p>\n\u003cp>\u003cstrong>1095-B and 1095-C\u003c/strong>\u003c/p>\n\u003cp>1095-B forms are distributed by government-sponsored health programs (like Medicare and Medi-Cal), some employers and health insurance companies for policies purchased outside exchanges.\u003c/p>\n\u003cp>1095-C forms are issued by large employers and generally follow the same rules as 1095-Bs.\u003c/p>\n\u003cp>\u003ca href=\"https://www.irs.gov/uac/Recent-Development-2015-12-29-2015-Forms-1095B-1094B-1095C-and-1094C\" target=\"_blank\">The IRS has extended to March 31\u003c/a> the deadline for sending the B and C forms to you.\u003c/p>\n\u003cp>These forms are primarily informational and show which months you had coverage.\u003c/p>\n\u003cp>If you have a B or C form and had insurance all of last year, you can just check a box on your tax return, Hammer says. If you didn’t, you may owe a tax penalty — \u003ca href=\"http://centerforhealthreporting.org/article/how-dodge-obamacare-tax-penalty-legally\" target=\"_blank\">unless you qualify for one of Obamacare’s many exemptions\u003c/a>.\u003c/p>\n\u003cp>But you still need to make sure your forms are accurate, because the information is transmitted to the IRS, she says.\u003c/p>\n\u003cp>The Department of Health Care Services (DHCS), which administers Medi-Cal, is among the agencies sending out 1095-B forms for the first time. The department has established a toll-free help line (844-253-0883) that received more than 11,000 calls in January and more than 23,000 since November.\u003c/p>\n\u003cp>Confusingly, that phone number isn’t for people who discover mistakes on their forms. For that, you must\u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx\" target=\"_blank\"> contact your county Medi-Cal office \u003c/a>to request a correction.\u003c/p>\n\u003cp>If you receive\u003ca href=\"https://www.ssa.gov/ssi/text-over-ussi.htm\" target=\"_blank\"> Supplemental Security Income \u003c/a>(SSI) or \u003ca href=\"http://www.cdss.ca.gov/agedblinddisabled/pg1422.htm\" target=\"_blank\">State Supplementary Payment \u003c/a>(SSP) benefits, you must contact the Social Security Administration to update your information before you request a corrected form from your county, the department says.\u003c/p>\n\u003cp>Some large counties have dedicated phone lines to handle changes to Medi-Cal cases, which may include 1095 form corrections, says Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California. Ask if your county is one.\u003c/p>\n\u003cp>But don’t expect quick action.\u003c/p>\n\u003cp>“In order to give the client … the revised information, the county needs to either be able to submit a request for a reprint to the state or print it out directly,” Senderling-McDonald says.\u003c/p>\n\u003cp>Counties can’t do that yet because the state computer system “has not been programmed to allow for reprints to be done,” she says.\u003c/p>\n\u003cp>That changes March 1 for information reportable to the IRS, says Tony Cava, DHCS spokesman. After that date, corrected forms will be mailed to consumers within 30 days of a request for fixes.\u003c/p>\n\u003cp>For information not reportable to the IRS, such as errors in personal information, replacement forms will be available starting April 1, he says.\u003c/p>\n\u003cp>Since that’s just two weeks before the tax filing deadline, it’s important to remember you can file your taxes while you await corrections to B and C forms.\u003c/p>\n\u003cp>“If you believe you had Medi-Cal for 10 months of the year, go ahead and fill out your tax form showing 10 months,” says Jen Flory, senior attorney at the Western Center on Law & Poverty.\u003c/p>\n\u003cp>If you’re among the Medi-Cal recipients who don’t have to file taxes because you earned less than the\u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Calculating-the-Payment\" target=\"_blank\"> tax filing threshold,\u003c/a> you still don’t have to file even if you receive a 1095-B form, Flory added. (However, you must file taxes if you receive a 1095-A, she noted.)\u003c/p>\n\u003cp>Roolvink, the Glendora resident, submitted her Covered California dispute form in January and has spent dozens of hours on the phone trying to reach someone in her county Medi-Cal office. She’s still waiting for corrections to both 1095 forms.\u003c/p>\n\u003cp>Her forms showed that her husband and two daughters were on Medi-Cal when they actually had Covered California plans, she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Blue Shield Jumps Anthem for Top Choice on Covered California",
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"content": "\u003cp>For the first time in three years, Blue Shield of California leads enrollment in the state’s insurance exchange while Oscar, a closely watched newcomer, experienced a slow start.\u003c/p>\n\u003cp>The Covered California exchange said it won’t release enrollment figures by company until later this month, and insurers declined to share specifics until then. But interviews with industry officials indicate some insurers, such as Blue Shield and Molina Healthcare Inc., picked up more business while others lost ground during the Affordable Care Act’s third open enrollment.\u003c/p>\n\u003cp>Until now, Anthem Inc. had led Obamacare enrollment in California with 30 percent share of the market. But now rival Blue Shield has jumped ahead.\u003c/p>\n\u003cp>“Our competitive position did improve,” said Ken Wood, senior vice president of consumer markets at San Francisco-based Blue Shield. “A better price position meant better retention and more new enrollment.”\u003c/p>\n\u003cp>A spokesman for Anthem declined to discuss the company’s California results ahead of the exchange’s announcement. But last month, the company said its Obamacare enrollment in California and 13 other states was 30 percent lower than expected and rivals’ lower rates were one reason. Anthem Blue Cross is California’s largest for-profit insurer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We aren’t experiencing the overall market growth on the public exchanges that we projected when we laid out our five-year plan and unsustainable pricing in some markets is hurting our historic market share,” Anthem Chief Executive Joseph Swedish said during a Jan. 27 conference call with analysts and investors.\u003c/p>\n\u003cp>Last week, Covered California said about 425,000 new enrollees had picked out coverage but more last-minute applicants were being counted. Nearly 1.2 million consumers had renewed their policies, bringing enrollment to about 1.6 million.\u003c/p>\n\u003cp>Enrollment totals will increase some as many people rushed to beat the Jan. 31 sign-up deadline. But the final tally will likely drop because some people don’t pay their initial premium or they find coverage elsewhere.\u003c/p>\n\u003cp>The California exchange added two new insurers for this year — Oscar and UnitedHealth Group Inc. — but neither garnered much enrollment, according to sources who spoke on the condition of anonymity.\u003c/p>\n\u003cp>Both Oscar and UnitedHealth are only selling policies in a limited number of regions and each insurer had less than 1,000 enrollees by early January.\u003c/p>\n\u003cp>Covered California had denied UnitedHealth’s bid to sell statewide during 2016 and instead limited the insurer to five of the state’s 19 rating regions, primarily rural counties in Northern California. Then in November, the company announced heavy losses on individual policies across the country, and it cut back on marketing of exchange coverage companywide.\u003c/p>\n\u003cp>Oscar, on the other hand, blanketed Southern California with ads touting its high-tech, customer friendly approach to healthcare. But its initial sales in Los Angeles and Orange counties were modest, according to sources who saw preliminary enrollment totals.\u003c/p>\n\u003cp>The New York company was a relative unknown in California and going up against established insurers with strong name recognition and existing networks of doctors and hospitals. The company hasn’t commented on its California enrollment, but overall it covers more than 125,000 people in New York, New Jersey, Texas and California.\u003c/p>\n\u003cp>“We are thrilled by the reaction we have received entering the California marketplace this year,” Oscar Chief Executive Mario Schlosser said in a statement. “Our priority is to provide simple, intuitive healthcare for our new members and we look forward to continued expansion and growth throughout the state.”\u003c/p>\n\u003cp>HMO giant Kaiser Permanente appears on track to remain in third place in Covered California, behind Blue Shield and Anthem. Molina, based in Long Beach, also made substantial gains during open enrollment after a smaller presence the first two years, according to people familiar with the market.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said the exchange plans to release detailed data on enrollment by health plans and ethnicity later this month. The state spent $29 million on marketing during the recent open enrollment to attract the uninsured and persuade existing enrollees to renew.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most of us are healthy. But you need to remind people just because you didn’t use your insurance it’s still something you need,” Lee said. “Health insurance marketplaces need to be constant sales and renewal machines.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For the first time in three years, Blue Shield of California leads enrollment in the state’s insurance exchange while Oscar, a closely watched newcomer, experienced a slow start.\u003c/p>\n\u003cp>The Covered California exchange said it won’t release enrollment figures by company until later this month, and insurers declined to share specifics until then. But interviews with industry officials indicate some insurers, such as Blue Shield and Molina Healthcare Inc., picked up more business while others lost ground during the Affordable Care Act’s third open enrollment.\u003c/p>\n\u003cp>Until now, Anthem Inc. had led Obamacare enrollment in California with 30 percent share of the market. But now rival Blue Shield has jumped ahead.\u003c/p>\n\u003cp>“Our competitive position did improve,” said Ken Wood, senior vice president of consumer markets at San Francisco-based Blue Shield. “A better price position meant better retention and more new enrollment.”\u003c/p>\n\u003cp>A spokesman for Anthem declined to discuss the company’s California results ahead of the exchange’s announcement. But last month, the company said its Obamacare enrollment in California and 13 other states was 30 percent lower than expected and rivals’ lower rates were one reason. Anthem Blue Cross is California’s largest for-profit insurer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We aren’t experiencing the overall market growth on the public exchanges that we projected when we laid out our five-year plan and unsustainable pricing in some markets is hurting our historic market share,” Anthem Chief Executive Joseph Swedish said during a Jan. 27 conference call with analysts and investors.\u003c/p>\n\u003cp>Last week, Covered California said about 425,000 new enrollees had picked out coverage but more last-minute applicants were being counted. Nearly 1.2 million consumers had renewed their policies, bringing enrollment to about 1.6 million.\u003c/p>\n\u003cp>Enrollment totals will increase some as many people rushed to beat the Jan. 31 sign-up deadline. But the final tally will likely drop because some people don’t pay their initial premium or they find coverage elsewhere.\u003c/p>\n\u003cp>The California exchange added two new insurers for this year — Oscar and UnitedHealth Group Inc. — but neither garnered much enrollment, according to sources who spoke on the condition of anonymity.\u003c/p>\n\u003cp>Both Oscar and UnitedHealth are only selling policies in a limited number of regions and each insurer had less than 1,000 enrollees by early January.\u003c/p>\n\u003cp>Covered California had denied UnitedHealth’s bid to sell statewide during 2016 and instead limited the insurer to five of the state’s 19 rating regions, primarily rural counties in Northern California. Then in November, the company announced heavy losses on individual policies across the country, and it cut back on marketing of exchange coverage companywide.\u003c/p>\n\u003cp>Oscar, on the other hand, blanketed Southern California with ads touting its high-tech, customer friendly approach to healthcare. But its initial sales in Los Angeles and Orange counties were modest, according to sources who saw preliminary enrollment totals.\u003c/p>\n\u003cp>The New York company was a relative unknown in California and going up against established insurers with strong name recognition and existing networks of doctors and hospitals. The company hasn’t commented on its California enrollment, but overall it covers more than 125,000 people in New York, New Jersey, Texas and California.\u003c/p>\n\u003cp>“We are thrilled by the reaction we have received entering the California marketplace this year,” Oscar Chief Executive Mario Schlosser said in a statement. “Our priority is to provide simple, intuitive healthcare for our new members and we look forward to continued expansion and growth throughout the state.”\u003c/p>\n\u003cp>HMO giant Kaiser Permanente appears on track to remain in third place in Covered California, behind Blue Shield and Anthem. Molina, based in Long Beach, also made substantial gains during open enrollment after a smaller presence the first two years, according to people familiar with the market.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said the exchange plans to release detailed data on enrollment by health plans and ethnicity later this month. The state spent $29 million on marketing during the recent open enrollment to attract the uninsured and persuade existing enrollees to renew.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most of us are healthy. But you need to remind people just because you didn’t use your insurance it’s still something you need,” Lee said. “Health insurance marketplaces need to be constant sales and renewal machines.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>More than 425,000 Californians have signed up on the state’s health insurance exchange — with nearly 100,000 rushing to enroll in the last four days before the 2016 open enrollment period ended Jan. 31, officials said Thursday.\u003c/p>\n\u003cp>The exchange, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a>, had estimated it would attract between 295,000 and 450,000 new enrollees during its third open enrollment season since the Affordable Care Act took effect. In addition to the new enrollees, about 1.15 million existing consumers re-upped this year, officials said, for a total of about 1.57 million.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said about 37 percent of the new enrollees are young adults aged 18-34, up from 34 percent from last year. That’s good news for exchange officials, because younger, healthier adults help subsidize coverage for older Californians.\u003c/p>\n\u003cp>“We continue to have a broad and healthy mix of those signing up for coverage … which means better rates and a more stable system, both for all of our enrollees, and for the entire individual health insurance marketplace in California,” Lee said.\u003c/p>\n\u003cp>Lee declined to provide additional information on the ethnic and demographic breakdown of enrollees or the plans they chose, saying the numbers were still being analyzed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The number of enrollees could still grow a bit this year, because the state last week extended the enrollment deadline for people who had officially begun the process by Jan. 31. Lee said “tens of thousands” of Californians are in that group.\u003c/p>\n\u003cp>With the end of open enrollment for 2016, consumers in California and nationwide can sign up for Affordable Care Act insurance only if they encounter a life-altering event such as having a baby, getting married or losing employer-based insurance. The next open enrollment period, for coverage in 2017, will start in November.\u003c/p>\n\u003cp>Most people who fail to sign up by the deadline face tax penalties of $695 per adult, plus $347.50 per child, or 2.5 percent of family income in excess of 2015 income tax filing thresholds. Since Covered California launched, the exchange has served more than 2 million people, Lee said. Of the consumers who have left the exchange, about 85 percent found other insurance options, including through their jobs, he said.\u003c/p>\n\u003cp>Still, California’s health insurance exchange \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/11/02/covered-california-targets-african-americans-latinos-in-obamacare-open-enrollment/\" target=\"_blank\">has struggled\u003c/a> to reach the state’s remaining uninsured, particularly Latinos and African-Americans.\u003c/p>\n\u003cp>About 2.4 percent of the exchange’s approximately 1.3 million enrollees are African-American. That’s only about half of the blacks considered eligible for subsidies because of their income. Another 30 percent are Latino, although 37 percent are considered eligible for subsidies, according to \u003ca href=\"http://hbex.coveredca.com/data-research/library/Active-Membership-Slides.pdf\" target=\"_blank\">Covered California data\u003c/a>.\u003c/p>\n\u003cp>When the 2016 open enrollment period started in November, the exchange \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/11/02/covered-california-targets-african-americans-latinos-in-obamacare-open-enrollment/\" target=\"_blank\">promised deeper outreach\u003c/a> in those communities, including more targeted advertising, events and storefront enrollment centers.\u003c/p>\n\u003cp>Concerns also remain about Covered California’s ability to rein in insurance costs, especially for consumers who make too much money to qualify for subsidies or Medi-Cal but not enough to afford full-fare premiums. Lee said that Covered California consumers saw an average 4 percent rate increase in 2016, slightly lower than in 2015. Nationally, however, the increase was higher: Obamacare premiums for “benchmark” insurance plans were expected to rise by \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-26-2.html\" target=\"_blank\">an average of 7.5 percent\u003c/a>, according to federal data.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But because consumers can change plans during open enrollment, those who switched to the lowest-cost plan in their area could lower their premiums by an average of 4.5 percent this year, Lee said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than 425,000 Californians have signed up on the state’s health insurance exchange — with nearly 100,000 rushing to enroll in the last four days before the 2016 open enrollment period ended Jan. 31, officials said Thursday.\u003c/p>\n\u003cp>The exchange, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a>, had estimated it would attract between 295,000 and 450,000 new enrollees during its third open enrollment season since the Affordable Care Act took effect. In addition to the new enrollees, about 1.15 million existing consumers re-upped this year, officials said, for a total of about 1.57 million.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said about 37 percent of the new enrollees are young adults aged 18-34, up from 34 percent from last year. That’s good news for exchange officials, because younger, healthier adults help subsidize coverage for older Californians.\u003c/p>\n\u003cp>“We continue to have a broad and healthy mix of those signing up for coverage … which means better rates and a more stable system, both for all of our enrollees, and for the entire individual health insurance marketplace in California,” Lee said.\u003c/p>\n\u003cp>Lee declined to provide additional information on the ethnic and demographic breakdown of enrollees or the plans they chose, saying the numbers were still being analyzed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The number of enrollees could still grow a bit this year, because the state last week extended the enrollment deadline for people who had officially begun the process by Jan. 31. Lee said “tens of thousands” of Californians are in that group.\u003c/p>\n\u003cp>With the end of open enrollment for 2016, consumers in California and nationwide can sign up for Affordable Care Act insurance only if they encounter a life-altering event such as having a baby, getting married or losing employer-based insurance. The next open enrollment period, for coverage in 2017, will start in November.\u003c/p>\n\u003cp>Most people who fail to sign up by the deadline face tax penalties of $695 per adult, plus $347.50 per child, or 2.5 percent of family income in excess of 2015 income tax filing thresholds. Since Covered California launched, the exchange has served more than 2 million people, Lee said. Of the consumers who have left the exchange, about 85 percent found other insurance options, including through their jobs, he said.\u003c/p>\n\u003cp>Still, California’s health insurance exchange \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/11/02/covered-california-targets-african-americans-latinos-in-obamacare-open-enrollment/\" target=\"_blank\">has struggled\u003c/a> to reach the state’s remaining uninsured, particularly Latinos and African-Americans.\u003c/p>\n\u003cp>About 2.4 percent of the exchange’s approximately 1.3 million enrollees are African-American. That’s only about half of the blacks considered eligible for subsidies because of their income. Another 30 percent are Latino, although 37 percent are considered eligible for subsidies, according to \u003ca href=\"http://hbex.coveredca.com/data-research/library/Active-Membership-Slides.pdf\" target=\"_blank\">Covered California data\u003c/a>.\u003c/p>\n\u003cp>When the 2016 open enrollment period started in November, the exchange \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/11/02/covered-california-targets-african-americans-latinos-in-obamacare-open-enrollment/\" target=\"_blank\">promised deeper outreach\u003c/a> in those communities, including more targeted advertising, events and storefront enrollment centers.\u003c/p>\n\u003cp>Concerns also remain about Covered California’s ability to rein in insurance costs, especially for consumers who make too much money to qualify for subsidies or Medi-Cal but not enough to afford full-fare premiums. Lee said that Covered California consumers saw an average 4 percent rate increase in 2016, slightly lower than in 2015. Nationally, however, the increase was higher: Obamacare premiums for “benchmark” insurance plans were expected to rise by \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-26-2.html\" target=\"_blank\">an average of 7.5 percent\u003c/a>, according to federal data.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But because consumers can change plans during open enrollment, those who switched to the lowest-cost plan in their area could lower their premiums by an average of 4.5 percent this year, Lee said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Chief Rips UnitedHealth for Blaming Woes on Obamacare",
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"content": "\u003cp>Amid growing questions over the future of insurance exchanges, the head of California’s marketplace said the nation’s largest health insurer should take responsibility for nearly $1 billion in losses and stop blaming the federal health law.\u003c/p>\n\u003cp>In a blistering critique, Covered California’s executive director, Peter Lee, said UnitedHealth Group Inc. made a series of blunders on rates and networks that led to a $475 million loss last year on individual policies across the country. The company estimates a similar exchange-related loss of $500 million for this year.\u003c/p>\n\u003cp>“Instead of saying we screwed up, they said Obamacare is the problem and we may not play any more,” Lee said in an interview with California Healthline. “It was giving an excuse to Wall Street and throwing the Affordable Care Act under the bus.”\u003c/p>\n\u003cp>Lee, a staunch defender of the health law and a former official in the Obama administration, has tangled with UnitedHealth in the past. He knocked the company for sitting out the launch of Obamacare in 2014, then welcomed UnitedHealth into Covered California for 2016.\u003c/p>\n\u003cp>But now, he said, the company is “driving me bonkers” because it has “fed this political frenzy that Obamacare doesn’t work. It’s total spin and unanchored in reality.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A company spokesman declined to comment on Lee’s criticism, and referred to UnitedHealth’s previous statements on the exchange business.\u003c/p>\n\u003cp>During a Nov. 19 conference call with analysts, UnitedHealth’s CEO Stephen Hemsley said: “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself… I think that basically is an industry-wide proposition.”\u003c/p>\n\u003cp>An Urban Institute report issued last week, however, found that some of UnitedHealth’s troubles may have been self-inflicted. The company’s premiums were substantially higher than its competitors in many of the largest U.S. markets. The insurer also offered broader provider networks that tend to attract sicker customers who incur big medical bills.\u003c/p>\n\u003cp>In November, UnitedHealth surprised analysts and health-policy experts with its steep losses and said it might leave the exchanges altogether, just after expanding into new states. The sudden reversal prompted questions about the sustainability of the government-run marketplaces, the linchpin of President Obama’s signature law.\u003c/p>\n\u003cp>UnitedHealth reiterated its dour outlook for the exchange market when it announced quarterly results Jan. 19. The company said it has seen an influx of sicker patients during special enrollment, fewer healthy people signing up and costs rising as a result.\u003c/p>\n\u003cp>UnitedHealth ended last year with about 500,000 customers in the public exchanges, and it expects membership to grow to about 800,000 during the recent open enrollment. It has said it will decide by mid-year whether to continue selling in Obamacare marketplaces.\u003c/p>\n\u003cp>Other major insurers have expressed similar concerns about doing business in the public exchanges, albeit with less red ink than UnitedHealth.\u003c/p>\n\u003cp>Anthem Inc., the nation’s second-largest health insurer, said last week that its exchange enrollment in California and 13 other states was running about 30 percent below expectations, but the business was still slightly profitable. Anthem ended last year with 791,000 exchange members.\u003c/p>\n\u003cp>Monday, insurance giant Aetna Inc. said it lost up to $140 million, or a negative margin of 3 to 4 percent, on individual coverage last year. It has 1 million members with individual policies, about 75 percent of them on public exchanges. It said it expects to break even this year, however.\u003c/p>\n\u003cp>“Our individual commercial business ended the year with improved results,” Aetna’s chief executive, Mark Bertolini, said Monday during an earnings conference call. “Despite our improved finish, this business remained unprofitable in 2015 and we continue to have serious concerns about the sustainability of the public exchanges.”\u003c/p>\n\u003cp>Ana Gupte, a healthcare analyst at Leerink Partners, said UnitedHealth and other insurers have valid complaints about the exchange market. But she acknowledged that UnitedHealth’s decision to sit out the exchanges during the first year in 2014 may have hurt the company, too.\u003c/p>\n\u003cp>“United was newer to the marketplaces than other companies, and the other guys incorporated lessons learned,” she said. “But there are broader issues. There are some changes needed from a policy perspective so all of these players can remain in the market for 2017.”\u003c/p>\n\u003cp>Gupte cited the need for federal officials to tighten the rules for special enrollment and revisit a risk adjustment program that compensates insurers for taking on costlier patients.\u003c/p>\n\u003cp>In response to industry criticism, the Obama administration is taking steps to prevent the misuse of special enrollment so people can’t wait to sign up until they need care. Special enrollment is designed for people who lose coverage or need to make a change because of an event in their life, such as moving, getting married or having a child.\u003c/p>\n\u003cp>Insurance markets can’t function properly without enough healthy customers paying premiums, which are used to cover expenses incurred by sicker policyholders. The three-month open enrollment period for the federal and state exchanges just ended Jan. 31. California extended its deadline to Feb. 6 for people who already had begun the sign-up process by Sunday.\u003c/p>\n\u003cp>John Holahan, a health-policy researcher at the Urban Institute, said the Obama administration does need to impose stricter rules for special enrollment. He also said concerns over affordability have hampered enrollment since some middle-class consumers and young, healthy people are put off by high premiums and large deductibles.\u003c/p>\n\u003cp>“But I haven’t seen anything that shows the exchanges are really in trouble,” Holahan said. “That doesn’t mean every insurer is going to make it. Some companies don’t make it, and that isn’t a sign markets are unsustainable.”\u003c/p>\n\u003cp>The U.S. Department of Health and Human Services expects about 10 million people to be enrolled in federal and state exchanges at the end of 2016. That’s far below previous government forecasts.\u003c/p>\n\u003cp>UnitedHealth sat out Covered California for the first two years before joining in several rural areas. Lee said both sides will be analyzing whether the company returns for 2017. As an active purchaser, Covered California can decide whether or not to contract with certain health plans and allow them on the state exchange.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“United will be looking at what their prospects are in California,” Lee said. “We will be looking at United as a plan to see if they offer good value for Californians. It’s to be determined on both ends.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Amid growing questions over the future of insurance exchanges, the head of California’s marketplace said the nation’s largest health insurer should take responsibility for nearly $1 billion in losses and stop blaming the federal health law.\u003c/p>\n\u003cp>In a blistering critique, Covered California’s executive director, Peter Lee, said UnitedHealth Group Inc. made a series of blunders on rates and networks that led to a $475 million loss last year on individual policies across the country. The company estimates a similar exchange-related loss of $500 million for this year.\u003c/p>\n\u003cp>“Instead of saying we screwed up, they said Obamacare is the problem and we may not play any more,” Lee said in an interview with California Healthline. “It was giving an excuse to Wall Street and throwing the Affordable Care Act under the bus.”\u003c/p>\n\u003cp>Lee, a staunch defender of the health law and a former official in the Obama administration, has tangled with UnitedHealth in the past. He knocked the company for sitting out the launch of Obamacare in 2014, then welcomed UnitedHealth into Covered California for 2016.\u003c/p>\n\u003cp>But now, he said, the company is “driving me bonkers” because it has “fed this political frenzy that Obamacare doesn’t work. It’s total spin and unanchored in reality.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A company spokesman declined to comment on Lee’s criticism, and referred to UnitedHealth’s previous statements on the exchange business.\u003c/p>\n\u003cp>During a Nov. 19 conference call with analysts, UnitedHealth’s CEO Stephen Hemsley said: “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself… I think that basically is an industry-wide proposition.”\u003c/p>\n\u003cp>An Urban Institute report issued last week, however, found that some of UnitedHealth’s troubles may have been self-inflicted. The company’s premiums were substantially higher than its competitors in many of the largest U.S. markets. The insurer also offered broader provider networks that tend to attract sicker customers who incur big medical bills.\u003c/p>\n\u003cp>In November, UnitedHealth surprised analysts and health-policy experts with its steep losses and said it might leave the exchanges altogether, just after expanding into new states. The sudden reversal prompted questions about the sustainability of the government-run marketplaces, the linchpin of President Obama’s signature law.\u003c/p>\n\u003cp>UnitedHealth reiterated its dour outlook for the exchange market when it announced quarterly results Jan. 19. The company said it has seen an influx of sicker patients during special enrollment, fewer healthy people signing up and costs rising as a result.\u003c/p>\n\u003cp>UnitedHealth ended last year with about 500,000 customers in the public exchanges, and it expects membership to grow to about 800,000 during the recent open enrollment. It has said it will decide by mid-year whether to continue selling in Obamacare marketplaces.\u003c/p>\n\u003cp>Other major insurers have expressed similar concerns about doing business in the public exchanges, albeit with less red ink than UnitedHealth.\u003c/p>\n\u003cp>Anthem Inc., the nation’s second-largest health insurer, said last week that its exchange enrollment in California and 13 other states was running about 30 percent below expectations, but the business was still slightly profitable. Anthem ended last year with 791,000 exchange members.\u003c/p>\n\u003cp>Monday, insurance giant Aetna Inc. said it lost up to $140 million, or a negative margin of 3 to 4 percent, on individual coverage last year. It has 1 million members with individual policies, about 75 percent of them on public exchanges. It said it expects to break even this year, however.\u003c/p>\n\u003cp>“Our individual commercial business ended the year with improved results,” Aetna’s chief executive, Mark Bertolini, said Monday during an earnings conference call. “Despite our improved finish, this business remained unprofitable in 2015 and we continue to have serious concerns about the sustainability of the public exchanges.”\u003c/p>\n\u003cp>Ana Gupte, a healthcare analyst at Leerink Partners, said UnitedHealth and other insurers have valid complaints about the exchange market. But she acknowledged that UnitedHealth’s decision to sit out the exchanges during the first year in 2014 may have hurt the company, too.\u003c/p>\n\u003cp>“United was newer to the marketplaces than other companies, and the other guys incorporated lessons learned,” she said. “But there are broader issues. There are some changes needed from a policy perspective so all of these players can remain in the market for 2017.”\u003c/p>\n\u003cp>Gupte cited the need for federal officials to tighten the rules for special enrollment and revisit a risk adjustment program that compensates insurers for taking on costlier patients.\u003c/p>\n\u003cp>In response to industry criticism, the Obama administration is taking steps to prevent the misuse of special enrollment so people can’t wait to sign up until they need care. Special enrollment is designed for people who lose coverage or need to make a change because of an event in their life, such as moving, getting married or having a child.\u003c/p>\n\u003cp>Insurance markets can’t function properly without enough healthy customers paying premiums, which are used to cover expenses incurred by sicker policyholders. The three-month open enrollment period for the federal and state exchanges just ended Jan. 31. California extended its deadline to Feb. 6 for people who already had begun the sign-up process by Sunday.\u003c/p>\n\u003cp>John Holahan, a health-policy researcher at the Urban Institute, said the Obama administration does need to impose stricter rules for special enrollment. He also said concerns over affordability have hampered enrollment since some middle-class consumers and young, healthy people are put off by high premiums and large deductibles.\u003c/p>\n\u003cp>“But I haven’t seen anything that shows the exchanges are really in trouble,” Holahan said. “That doesn’t mean every insurer is going to make it. Some companies don’t make it, and that isn’t a sign markets are unsustainable.”\u003c/p>\n\u003cp>The U.S. Department of Health and Human Services expects about 10 million people to be enrolled in federal and state exchanges at the end of 2016. That’s far below previous government forecasts.\u003c/p>\n\u003cp>UnitedHealth sat out Covered California for the first two years before joining in several rural areas. Lee said both sides will be analyzing whether the company returns for 2017. As an active purchaser, Covered California can decide whether or not to contract with certain health plans and allow them on the state exchange.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“United will be looking at what their prospects are in California,” Lee said. “We will be looking at United as a plan to see if they offer good value for Californians. It’s to be determined on both ends.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Open enrollment for 2016 ends Sunday for those who buy health plans from Covered California or other state exchanges.\u003c/p>\n\u003cp>But if you don’t act by the deadline, are you completely out of luck?\u003c/p>\n\u003cp>Not necessarily. If you lose your job, have a new child in the family or experience another qualifying life event, you are likely eligible for a special-enrollment period during the year.\u003c/p>\n\u003cp>Another option is a short-term health plan.\u003c/p>\n\u003cp>These plans last less than a year, have lower premiums than regular ones and often come with beefier doctor and hospital networks.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For some people — especially those who are young, healthy and don’t qualify for a tax credit from Covered California or other health insurance marketplace — short-term plans might make financial sense, even though they don’t shield you from the Obamacare tax penalty.\u003c/p>\n\u003cp>“Depending on your age and income level, you could get one of these plans, pay the uninsured tax penalty and still pay less than if you had purchased” a comprehensive plan, says Kev Coleman, head of research and data for \u003ca href=\"https://www.healthpocket.com/\" target=\"_blank\">HealthPocket\u003c/a>, a health insurance comparison website based in Mountain View.\u003c/p>\n\u003cp>If this sounds too good to be true, it probably is for most people.\u003c/p>\n\u003cp>Short-term plans won’t cover your pre-existing conditions and they don’t offer coverage for certain medical services.\u003c/p>\n\u003cp>“If you get cancer or something really serious, you’re going to want really robust health insurance,” says Nate Purpura, vice president of consumer affairs for \u003ca href=\"https://www.ehealthinsurance.com/\" target=\"_blank\">eHealth.com\u003c/a>, a private online health insurance marketplace also based in Mountain View. “And you don’t want to pay the tax penalty.”\u003c/p>\n\u003cp>Before the Affordable Care Act (ACA) took effect, short-term plans -- also called “\u003ca href=\"https://www.agilehealthinsurance.com/term-health-insurance/health-insurance-learning-center/what-is-term-health-insurance\" target=\"_blank\">term health insurance\u003c/a>\" -- were purchased primarily by people between jobs, by those waiting for their new job-based insurance to kick in or by recent college graduates.\u003c/p>\n\u003cp>“They were designed to be transitional coverage, not a permanent type of insurance product,” Purpura says.\u003c/p>\n\u003cp>But since the law’s major provisions took effect in 2014, eHealth and other insurance retailers report that sales of short-term plans are picking up. Affordability is the biggest selling point, they say.\u003c/p>\n\u003cp>If your income doesn’t qualify you for a tax credit to help pay for insurance from \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> (or another health insurance exchange), premiums can be expensive. Even with a subsidy, you still may owe hundreds each month for coverage.\u003c/p>\n\u003cp>“There are several million people nationally who don’t get subsidies. That’s basically the growth engine for the term health insurance market,” Coleman says.\u003c/p>\n\u003cp>The tax penalty hasn’t deterred some people from signing up for short-term plans, especially the young and healthy: 18- to 34-year-olds accounted for more than half the buyers of short-term plans last year at both eHealth and \u003ca href=\"https://www.agilehealthinsurance.com/\" target=\"_blank\">AgileHealthInsurance.com\u003c/a>, another Mountain view-based company, which sells only short-term health insurance plans.\u003c/p>\n\u003cp>“The biggest demographic is millennials,” says Sam Gibbs, Agile’s executive director. That is, the same young and healthy people considered key to the stability and success of the ACA’s health insurance exchanges.\u003c/p>\n\u003cp>George Goldman, a 22-year-old Century City resident, dropped his regular health insurance plan early last year because he was paying $300 a month for coverage he didn’t think he needed.\u003c/p>\n\u003cp>“It was a financial decision,” he says. “I don’t care if I’m fined.”\u003c/p>\n\u003cp>Later in the year, however, Goldman became nervous without coverage and purchased a short-term plan from eHealth for the final months of 2015. It cost a little over $200 a month, and covered a visit to the emergency room.\u003c/p>\n\u003cp>This year, he enrolled in a regular health plan again because he thought he was taking on too much risk. “It’s still a financial burden, but when you need it, you need it,” he says.\u003c/p>\n\u003cp>Before you try a short-term plan, consider the pros and cons:\u003c/p>\n\u003cp>\u003cstrong>PROS\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>You can buy them any time of year.\u003c/li>\n\u003cli>Their premiums are generally lower than major medical insurance plans. The average premium for short-term plans sold by eHealth in California last year was $177 per month, Purpura says.\u003c/li>\n\u003cli>They may have broader networks of doctors and hospitals than some plans available from exchanges.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>CONS\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>They won’t accept you if you have pre-existing conditions, or if they do, they won’t cover them.\u003c/li>\n\u003cli>They may not cover benefits such as maternity care, preventive services or prescription drugs. Some may offer drug or dental discount plans, but those aren’t the same as insurance.\u003c/li>\n\u003cli>They last less than a year and you have to reapply at the end of each term. There’s no guarantee you’ll be accepted again, especially if you got seriously ill while you had coverage.\u003c/li>\n\u003c/ul>\n\u003cp>“Term health insurance isn’t good for someone who has chronic health conditions or who takes expensive medications,” Coleman says.\u003c/p>\n\u003cp>If you think it will be cheaper to buy a short-term plan and pay the ACA tax, make sure you’re using the correct equation.\u003c/p>\n\u003cp>\u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Calculating-the-Payment\" target=\"_blank\">For the 2016 tax year\u003c/a>, the tax penalty grows to $695 per adult or 2.5 percent of annual household income, \u003cem>whichever is greater\u003c/em>. “\u003ca href=\"https://californiahealthline.wordpress.com/news/more-time-to-avoid-the-obamacare-tax-penalty/\" target=\"_blank\">Whichever is greater\u003c/a>” means you could owe thousands of dollars.\u003c/p>\n\u003cp>In general, health consumer advocates warn against short-term plans and urge you to see if you qualify for a \u003ca href=\"http://www.lifescript.com/health/centers/health_care/navigating_the_system/8_ways_to_get_health_insurance_even_if_you_missed_open_enrollment.aspx\" target=\"_blank\">special-enrollment period\u003c/a> to get a full-fledged plan. Though the federal government says it will \u003ca href=\"http://khn.org/morning-breakout/after-insurer-outcry-feds-offer-rules-to-rein-in-special-enrollment-sign-ups/\" target=\"_blank\">tighten the rules\u003c/a> governing special-enrollment periods, many of you still will qualify if you have legitimate qualifying life events.\u003c/p>\n\u003cp>“If you have an alternative to get regular health insurance, certainly try that first,” urges Cheryl Fish-Parcham, private insurance program director for \u003ca href=\"http://familiesusa.org/\" target=\"_blank\">Families USA\u003c/a>.\u003c/p>\n\u003cp>Finally, if you do have short-term insurance and aren’t happy with the level of care or service, contact the plan first. If you’re still having trouble, reach out to the \u003ca href=\"http://www.insurance.ca.gov/\" target=\"_blank\">California Department of Insurance\u003c/a> (800-927-4357).\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California HealthCare Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Open enrollment for 2016 ends Sunday for those who buy health plans from Covered California or other state exchanges.\u003c/p>\n\u003cp>But if you don’t act by the deadline, are you completely out of luck?\u003c/p>\n\u003cp>Not necessarily. If you lose your job, have a new child in the family or experience another qualifying life event, you are likely eligible for a special-enrollment period during the year.\u003c/p>\n\u003cp>Another option is a short-term health plan.\u003c/p>\n\u003cp>These plans last less than a year, have lower premiums than regular ones and often come with beefier doctor and hospital networks.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For some people — especially those who are young, healthy and don’t qualify for a tax credit from Covered California or other health insurance marketplace — short-term plans might make financial sense, even though they don’t shield you from the Obamacare tax penalty.\u003c/p>\n\u003cp>“Depending on your age and income level, you could get one of these plans, pay the uninsured tax penalty and still pay less than if you had purchased” a comprehensive plan, says Kev Coleman, head of research and data for \u003ca href=\"https://www.healthpocket.com/\" target=\"_blank\">HealthPocket\u003c/a>, a health insurance comparison website based in Mountain View.\u003c/p>\n\u003cp>If this sounds too good to be true, it probably is for most people.\u003c/p>\n\u003cp>Short-term plans won’t cover your pre-existing conditions and they don’t offer coverage for certain medical services.\u003c/p>\n\u003cp>“If you get cancer or something really serious, you’re going to want really robust health insurance,” says Nate Purpura, vice president of consumer affairs for \u003ca href=\"https://www.ehealthinsurance.com/\" target=\"_blank\">eHealth.com\u003c/a>, a private online health insurance marketplace also based in Mountain View. “And you don’t want to pay the tax penalty.”\u003c/p>\n\u003cp>Before the Affordable Care Act (ACA) took effect, short-term plans -- also called “\u003ca href=\"https://www.agilehealthinsurance.com/term-health-insurance/health-insurance-learning-center/what-is-term-health-insurance\" target=\"_blank\">term health insurance\u003c/a>\" -- were purchased primarily by people between jobs, by those waiting for their new job-based insurance to kick in or by recent college graduates.\u003c/p>\n\u003cp>“They were designed to be transitional coverage, not a permanent type of insurance product,” Purpura says.\u003c/p>\n\u003cp>But since the law’s major provisions took effect in 2014, eHealth and other insurance retailers report that sales of short-term plans are picking up. Affordability is the biggest selling point, they say.\u003c/p>\n\u003cp>If your income doesn’t qualify you for a tax credit to help pay for insurance from \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> (or another health insurance exchange), premiums can be expensive. Even with a subsidy, you still may owe hundreds each month for coverage.\u003c/p>\n\u003cp>“There are several million people nationally who don’t get subsidies. That’s basically the growth engine for the term health insurance market,” Coleman says.\u003c/p>\n\u003cp>The tax penalty hasn’t deterred some people from signing up for short-term plans, especially the young and healthy: 18- to 34-year-olds accounted for more than half the buyers of short-term plans last year at both eHealth and \u003ca href=\"https://www.agilehealthinsurance.com/\" target=\"_blank\">AgileHealthInsurance.com\u003c/a>, another Mountain view-based company, which sells only short-term health insurance plans.\u003c/p>\n\u003cp>“The biggest demographic is millennials,” says Sam Gibbs, Agile’s executive director. That is, the same young and healthy people considered key to the stability and success of the ACA’s health insurance exchanges.\u003c/p>\n\u003cp>George Goldman, a 22-year-old Century City resident, dropped his regular health insurance plan early last year because he was paying $300 a month for coverage he didn’t think he needed.\u003c/p>\n\u003cp>“It was a financial decision,” he says. “I don’t care if I’m fined.”\u003c/p>\n\u003cp>Later in the year, however, Goldman became nervous without coverage and purchased a short-term plan from eHealth for the final months of 2015. It cost a little over $200 a month, and covered a visit to the emergency room.\u003c/p>\n\u003cp>This year, he enrolled in a regular health plan again because he thought he was taking on too much risk. “It’s still a financial burden, but when you need it, you need it,” he says.\u003c/p>\n\u003cp>Before you try a short-term plan, consider the pros and cons:\u003c/p>\n\u003cp>\u003cstrong>PROS\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>You can buy them any time of year.\u003c/li>\n\u003cli>Their premiums are generally lower than major medical insurance plans. The average premium for short-term plans sold by eHealth in California last year was $177 per month, Purpura says.\u003c/li>\n\u003cli>They may have broader networks of doctors and hospitals than some plans available from exchanges.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>CONS\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>They won’t accept you if you have pre-existing conditions, or if they do, they won’t cover them.\u003c/li>\n\u003cli>They may not cover benefits such as maternity care, preventive services or prescription drugs. Some may offer drug or dental discount plans, but those aren’t the same as insurance.\u003c/li>\n\u003cli>They last less than a year and you have to reapply at the end of each term. There’s no guarantee you’ll be accepted again, especially if you got seriously ill while you had coverage.\u003c/li>\n\u003c/ul>\n\u003cp>“Term health insurance isn’t good for someone who has chronic health conditions or who takes expensive medications,” Coleman says.\u003c/p>\n\u003cp>If you think it will be cheaper to buy a short-term plan and pay the ACA tax, make sure you’re using the correct equation.\u003c/p>\n\u003cp>\u003ca href=\"https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Calculating-the-Payment\" target=\"_blank\">For the 2016 tax year\u003c/a>, the tax penalty grows to $695 per adult or 2.5 percent of annual household income, \u003cem>whichever is greater\u003c/em>. “\u003ca href=\"https://californiahealthline.wordpress.com/news/more-time-to-avoid-the-obamacare-tax-penalty/\" target=\"_blank\">Whichever is greater\u003c/a>” means you could owe thousands of dollars.\u003c/p>\n\u003cp>In general, health consumer advocates warn against short-term plans and urge you to see if you qualify for a \u003ca href=\"http://www.lifescript.com/health/centers/health_care/navigating_the_system/8_ways_to_get_health_insurance_even_if_you_missed_open_enrollment.aspx\" target=\"_blank\">special-enrollment period\u003c/a> to get a full-fledged plan. Though the federal government says it will \u003ca href=\"http://khn.org/morning-breakout/after-insurer-outcry-feds-offer-rules-to-rein-in-special-enrollment-sign-ups/\" target=\"_blank\">tighten the rules\u003c/a> governing special-enrollment periods, many of you still will qualify if you have legitimate qualifying life events.\u003c/p>\n\u003cp>“If you have an alternative to get regular health insurance, certainly try that first,” urges Cheryl Fish-Parcham, private insurance program director for \u003ca href=\"http://familiesusa.org/\" target=\"_blank\">Families USA\u003c/a>.\u003c/p>\n\u003cp>Finally, if you do have short-term insurance and aren’t happy with the level of care or service, contact the plan first. If you’re still having trouble, reach out to the \u003ca href=\"http://www.insurance.ca.gov/\" target=\"_blank\">California Department of Insurance\u003c/a> (800-927-4357).\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California HealthCare Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Farming Industry Balks at Obamacare Requirements",
"title": "Farming Industry Balks at Obamacare Requirements",
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"content": "\u003cp>Obamacare is throwing the agricultural industry into a tailspin. Farm labor contractors who must now offer their workers health insurance are complaining loudly about the cost in their already low-margin business.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No, no, no. My margin is 10 percent. And I have to increase expenses 10 percent? Well, that doesn’t work.'\u003ccite>Jesse Sandoval, farm labor contractor\u003c/cite>\u003c/aside>\n\u003cp>Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore: about \u003ca href=\"http://www.ers.usda.gov/topics/farm-economy/farm-labor/background.aspx\" target=\"_blank\">half of the farm labor workforce\u003c/a> in the U.S. is undocumented.\u003c/p>\n\u003cp>“There’s definitely going to be some repercussions to it,” says Jesse Sandoval, a farm labor contractor based in Stockton. \"I think there’s going to be some things that cannot be ignored.\"\u003c/p>\n\u003cp>Sandoval came to an educational conference for farm labor contractors -- essentially staffing agencies for field workers -- held at the San Joaquin County Agricultural Center in Stockton last fall. Men with broad shoulders, wearing denim jackets and cowboy hats, sat in the audience, listening to lectures on a litany of laws and rules regulating their industry, including Obamacare's employer mandate.\u003c/p>\n\u003cp>Last year, employers with 100 or more full-time employees had to offer health insurance to their workers or pay a stiff penalty. This year, employers with 50 to 99 full-time employees must comply.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/243903827\" 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>Sandoval has about 100 workers on his payroll. When farmers need a crew to pick cherries or pumpkins or asparagus, they call him to send the workers. He needs to offer insurance this year, and he's smarting at the price tag. At $300 a month per employee, he's looking at a $30,000 monthly bill.\u003c/p>\n\u003cp>“Yeah, no. No, no, no,” Sandoval says about absorbing that into his budget. “The numbers aren't there. My margin is 10 percent. And I have to increase expenses 10 percent? Well, that doesn't work.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"pxRkcuCqePJ1SkL5fHgzAqVTxkQMmNhi\"]So, like a lot of contractors, he’s passing the bill onto the farmers, who in turn are passing the bill onto the farmworkers. Under the Affordable Care Act, employees can be asked to contribute 9.5 percent of their income toward health premiums.\u003c/p>\n\u003cp>But for farmworkers who pick oranges or peaches for $10 an hour, that’s still too much.\u003c/p>\n\u003cp>Agostin Garcia says the two contractors he works for near Fresno offered him insurance directly. But when he saw the price tag, he turned them both down.\u003c/p>\n\u003cp>“For me, I’m the only one in my house who works. There’s five of us in the family,” he says in Spanish. “It just wouldn’t work. Either I pay for health insurance, or I pay the rent and utilities.”\u003c/p>\n\u003cp>Garcia says only a fraction of his co-workers have signed up for coverage. He says when farm labor contractors hand out packets explaining the coverage, the page where workers reject it is right on top.\u003c/p>\n\u003cp>“I think they do it intentionally,” Garcia says. “They comply with the laws, by saying, ‘I offered.’ But they know that nobody’s going to accept it, they know that nobody’s going to pay those amounts.”\u003c/p>\n\u003cp>The cost isn’t the only thing about Obamacare stressing people out in the ag industry. Some are worried about immigration problems. Employers have to file new health care forms with the IRS for all their workers, whether they accept the insurance or not.\u003c/p>\n\u003cp>Kaya Bromley, an attorney who advises employers in the farming industry about the Affordable Care Act, says the health law will make it harder for contractors to turn a blind eye when workers give them fraudulent documents.\u003c/p>\n\u003cp>“Now that there’s more transparency because of all of the reporting, I think we're going to have a lot more data on how many illegal or undocumented workers we have,” she says.\u003c/p>\n\u003cp>Among the contractors she consults for, Bromley has seen a range of quasi-legal and even illegal strategies to sidestep the health law.\u003c/p>\n\u003cp>“I have heard of employees who are choosing to opt out because they want to fly under the radar. I have also heard of employers who are urging the opt-out or at least encouraging it,” she says. “And I warn all of them that they are going to be in big trouble.”\u003c/p>\n\u003cp>But it’s still early. There’s been no enforcement yet. The feds haven’t made an example of anyone, Bromley says, and so employers are ignoring the fact that they could face penalties that run several thousand dollars per employee.\u003c/p>\n\u003cp>“It’s huge. And no one’s talking about the enormity of it,” she says. “When it plays out, and the penalties start getting assessed, that's when people will start having religion about it.”\u003c/p>\n\u003cp>Farm labor contractors say they’re stuck in a Catch-22. The Affordable Care Act doesn’t cover undocumented immigrants, but contractors will get fined if they don’t offer them coverage. Contractors aren’t supposed to hire undocumented workers, but the president and Congress can't agree on what to do about the massive number of immigrants living and working here illegally.\u003c/p>\n\u003cp>How are contractors supposed to comply with the new health care law when the feds are deadlocked over how to update the immigration system?\u003c/p>\n\u003cp>“Our government, all they do is talk about it. They don’t fix anything, they make everything worse,” says Golinda Vela Chavez, who helps run a labor contracting company in Salinas.\u003c/p>\n\u003cp>Her company started offering their employees insurance last year, at no cost to the workers, and she says, still, more than half of them turned down the coverage.\u003c/p>\n\u003cp>This year, the company has to start filing the paperwork with the IRS and she says it's been a nightmare.\u003c/p>\n\u003cp>“They don’t try to help you, they want to get you,” she says. “They implement all these things, because they want to get you!”\u003c/p>\n\u003cp>Ofelia Reyes just wants peace of mind. She’s has been harvesting nectarines and tying grapevines in fields near Fresno for 20 years. She recently had a breast cancer scare. None of the contractors she works for have offered her insurance.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“No, never. No one’s ever offered me anything,” she says in Spanish. \"All they say is, ‘Hurry up! Your ladder is waiting for you. Your co-workers are already over there.’ That’s how we live.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Obamacare is throwing the agricultural industry into a tailspin. Farm labor contractors who must now offer their workers health insurance are complaining loudly about the cost in their already low-margin business.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No, no, no. My margin is 10 percent. And I have to increase expenses 10 percent? Well, that doesn’t work.'\u003ccite>Jesse Sandoval, farm labor contractor\u003c/cite>\u003c/aside>\n\u003cp>Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore: about \u003ca href=\"http://www.ers.usda.gov/topics/farm-economy/farm-labor/background.aspx\" target=\"_blank\">half of the farm labor workforce\u003c/a> in the U.S. is undocumented.\u003c/p>\n\u003cp>“There’s definitely going to be some repercussions to it,” says Jesse Sandoval, a farm labor contractor based in Stockton. \"I think there’s going to be some things that cannot be ignored.\"\u003c/p>\n\u003cp>Sandoval came to an educational conference for farm labor contractors -- essentially staffing agencies for field workers -- held at the San Joaquin County Agricultural Center in Stockton last fall. Men with broad shoulders, wearing denim jackets and cowboy hats, sat in the audience, listening to lectures on a litany of laws and rules regulating their industry, including Obamacare's employer mandate.\u003c/p>\n\u003cp>Last year, employers with 100 or more full-time employees had to offer health insurance to their workers or pay a stiff penalty. This year, employers with 50 to 99 full-time employees must comply.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\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/243903827&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/243903827'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Sandoval has about 100 workers on his payroll. When farmers need a crew to pick cherries or pumpkins or asparagus, they call him to send the workers. He needs to offer insurance this year, and he's smarting at the price tag. At $300 a month per employee, he's looking at a $30,000 monthly bill.\u003c/p>\n\u003cp>“Yeah, no. No, no, no,” Sandoval says about absorbing that into his budget. “The numbers aren't there. My margin is 10 percent. And I have to increase expenses 10 percent? Well, that doesn't work.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>So, like a lot of contractors, he’s passing the bill onto the farmers, who in turn are passing the bill onto the farmworkers. Under the Affordable Care Act, employees can be asked to contribute 9.5 percent of their income toward health premiums.\u003c/p>\n\u003cp>But for farmworkers who pick oranges or peaches for $10 an hour, that’s still too much.\u003c/p>\n\u003cp>Agostin Garcia says the two contractors he works for near Fresno offered him insurance directly. But when he saw the price tag, he turned them both down.\u003c/p>\n\u003cp>“For me, I’m the only one in my house who works. There’s five of us in the family,” he says in Spanish. “It just wouldn’t work. Either I pay for health insurance, or I pay the rent and utilities.”\u003c/p>\n\u003cp>Garcia says only a fraction of his co-workers have signed up for coverage. He says when farm labor contractors hand out packets explaining the coverage, the page where workers reject it is right on top.\u003c/p>\n\u003cp>“I think they do it intentionally,” Garcia says. “They comply with the laws, by saying, ‘I offered.’ But they know that nobody’s going to accept it, they know that nobody’s going to pay those amounts.”\u003c/p>\n\u003cp>The cost isn’t the only thing about Obamacare stressing people out in the ag industry. Some are worried about immigration problems. Employers have to file new health care forms with the IRS for all their workers, whether they accept the insurance or not.\u003c/p>\n\u003cp>Kaya Bromley, an attorney who advises employers in the farming industry about the Affordable Care Act, says the health law will make it harder for contractors to turn a blind eye when workers give them fraudulent documents.\u003c/p>\n\u003cp>“Now that there’s more transparency because of all of the reporting, I think we're going to have a lot more data on how many illegal or undocumented workers we have,” she says.\u003c/p>\n\u003cp>Among the contractors she consults for, Bromley has seen a range of quasi-legal and even illegal strategies to sidestep the health law.\u003c/p>\n\u003cp>“I have heard of employees who are choosing to opt out because they want to fly under the radar. I have also heard of employers who are urging the opt-out or at least encouraging it,” she says. “And I warn all of them that they are going to be in big trouble.”\u003c/p>\n\u003cp>But it’s still early. There’s been no enforcement yet. The feds haven’t made an example of anyone, Bromley says, and so employers are ignoring the fact that they could face penalties that run several thousand dollars per employee.\u003c/p>\n\u003cp>“It’s huge. And no one’s talking about the enormity of it,” she says. “When it plays out, and the penalties start getting assessed, that's when people will start having religion about it.”\u003c/p>\n\u003cp>Farm labor contractors say they’re stuck in a Catch-22. The Affordable Care Act doesn’t cover undocumented immigrants, but contractors will get fined if they don’t offer them coverage. Contractors aren’t supposed to hire undocumented workers, but the president and Congress can't agree on what to do about the massive number of immigrants living and working here illegally.\u003c/p>\n\u003cp>How are contractors supposed to comply with the new health care law when the feds are deadlocked over how to update the immigration system?\u003c/p>\n\u003cp>“Our government, all they do is talk about it. They don’t fix anything, they make everything worse,” says Golinda Vela Chavez, who helps run a labor contracting company in Salinas.\u003c/p>\n\u003cp>Her company started offering their employees insurance last year, at no cost to the workers, and she says, still, more than half of them turned down the coverage.\u003c/p>\n\u003cp>This year, the company has to start filing the paperwork with the IRS and she says it's been a nightmare.\u003c/p>\n\u003cp>“They don’t try to help you, they want to get you,” she says. “They implement all these things, because they want to get you!”\u003c/p>\n\u003cp>Ofelia Reyes just wants peace of mind. She’s has been harvesting nectarines and tying grapevines in fields near Fresno for 20 years. She recently had a breast cancer scare. None of the contractors she works for have offered her insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“No, never. No one’s ever offered me anything,” she says in Spanish. \"All they say is, ‘Hurry up! Your ladder is waiting for you. Your co-workers are already over there.’ That’s how we live.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "To Avoid Obamacare, Some Fast Food Restaurants Cut Staff Hours. Did It Work?",
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"content": "\u003cp>At a Burger King off Highway 99 in the Central Valley, half a dozen workers in black uniforms scurry around, grabbing packets of ketchup, stuffing paper bags with French fries.\u003c/p>\n\u003cp>“Number 22! Two barbecue, two ketchup,” one worker says, handing an order to a customer through the drive-thru window.\u003c/p>\n\u003cp>Tiana Mua has worked here almost a year. She’s part time, but she’d like to be full time.\u003c/p>\n\u003cp>“Cause I want to become independent,” she says.\u003c/p>\n\u003cp>But at this Burger King, only the managers are full time. Mua says it’s like that at fast food joints all over town. It’s hard to get full time work.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“They’re cutting back on all the jobs, and a lot of people have been let go,” she says.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/243706979\" 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>One reason is the local economy is bad. People aren’t eating out as much, and sales are down. So restaurants can’t afford a robust staff.\u003c/p>\n\u003cp>But there’s another reason that might explain why fast food employees aren’t getting more hours: Obamacare.\u003c/p>\n\u003cp>Starting January 1, businesses with 50 or more full time employees must offer health insurance to all full time staff or pay a hefty fine. Employers with 100 or more workers had to start offering coverage last year. But smaller businesses that operate on lower margins, especially restaurants, complained loudly about the cost. And some fast food franchise owners, figured out a way to avoid paying for coverage: just make everyone part time.\u003c/p>\n\u003cp>Nearly 60 percent of small franchise business owners said they would make personnel changes like this to avoid hitting the 50 employee threshhold, according to a \u003ca href=\"https://www.uschamber.com/report/presentation-findings-national-research-conducted-among-business-decision-makers\">2013 U.S. Chamber of Commerce survey\u003c/a>.\u003c/p>\n\u003cp>[contextly_sidebar id=\"IXLLCVOZiAev3kR4Ny3nEMwYmTK7EQb4\"]But, some of those restaurant owners who cut hours to sidestep the health law –- now regret it, says Kaya Bromley, an attorney who consults with employers on how to comply with the Affordable Care Act, and author of The Employers’ Guide to Obamacare.\u003c/p>\n\u003cp>“A lot of the fast food franchisees that did this are now coming back and saying, it was a great idea for reducing the number of people that I have to offer benefits, but now I can't run my restaurants,” she says.\u003c/p>\n\u003cp>They tell her it’s been a nightmare trying to manage a part time staff.\u003c/p>\n\u003cp>“Because you’ve got people who are less loyal, you’ve got people who are less skilled who don’t understand the business, and there’s more turnover,” she says.\u003c/p>\n\u003cp>So, Bromley has seen a lot of those restaurants reverse course.\u003c/p>\n\u003cp>“So they’re backtracking, saying, ‘It’s worth it to me to have a full of time staff of people in every restaurant and offer them benefits,’”she says. “Employers think that there’s a shortcut here or there, and then they realize, yeah, that shortcut really hurt me more than it helped me.”\u003c/p>\n\u003cp>The people hurt most by all the workforce management gymnastics are the people at the bottom of the restaurant pecking order who want to advance, but can’t, says Angelo Amador, vice president of labor and workforce policy for the National Restaurant Association.\u003c/p>\n\u003cp>“Someone who’s working part time, but wants more hours so they can move up the ladder, they can’t get the hours,” he says. “It ends up taking out that middle rung of employees.”\u003c/p>\n\u003cp>Obamacare has made restaurants less flexible, he says, mainly because it defines full time work as 30 hours a week or more. Amador says most other laws restaurants have to comply with, like overtime pay, define full time as 40 hours. He thinks the Affordable Care Act should be changed for consistency.\u003c/p>\n\u003cp>“It would be much easier if we could have one definition of full time,” he says.\u003c/p>\n\u003cp>Silvia Campos is relieved that she’s allowed to keep as many workers full time as she can at the Carl’s Junior she manages in Chowchilla.\u003c/p>\n\u003cp>“It’s a small town. For me, it’s hard to find a really good employee,” she says. “We have employees, and for some reason, they don’t like it and go. So it’s really hard to keep good people.”\u003c/p>\n\u003cp>But Campos says some workers don’t want more hours. They get subsidized health care through Covered California, the state’s health insurance marketplace, or free coverage through Medi-Cal. If their income gets too high, they lose eligibility for public benefits.\u003c/p>\n\u003cp>“We try but some people, they don’t want the full time,” she says. “They say no, keep me on part time and that’s good with me.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The company does offer insurance, at a cost of about $300 a month, according to the workers. But some of them say they’re better off making less money and getting their coverage free from the state.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At a Burger King off Highway 99 in the Central Valley, half a dozen workers in black uniforms scurry around, grabbing packets of ketchup, stuffing paper bags with French fries.\u003c/p>\n\u003cp>“Number 22! Two barbecue, two ketchup,” one worker says, handing an order to a customer through the drive-thru window.\u003c/p>\n\u003cp>Tiana Mua has worked here almost a year. She’s part time, but she’d like to be full time.\u003c/p>\n\u003cp>“Cause I want to become independent,” she says.\u003c/p>\n\u003cp>But at this Burger King, only the managers are full time. Mua says it’s like that at fast food joints all over town. It’s hard to get full time work.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“They’re cutting back on all the jobs, and a lot of people have been let go,” she says.\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/243706979&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/243706979'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>One reason is the local economy is bad. People aren’t eating out as much, and sales are down. So restaurants can’t afford a robust staff.\u003c/p>\n\u003cp>But there’s another reason that might explain why fast food employees aren’t getting more hours: Obamacare.\u003c/p>\n\u003cp>Starting January 1, businesses with 50 or more full time employees must offer health insurance to all full time staff or pay a hefty fine. Employers with 100 or more workers had to start offering coverage last year. But smaller businesses that operate on lower margins, especially restaurants, complained loudly about the cost. And some fast food franchise owners, figured out a way to avoid paying for coverage: just make everyone part time.\u003c/p>\n\u003cp>Nearly 60 percent of small franchise business owners said they would make personnel changes like this to avoid hitting the 50 employee threshhold, according to a \u003ca href=\"https://www.uschamber.com/report/presentation-findings-national-research-conducted-among-business-decision-makers\">2013 U.S. Chamber of Commerce survey\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But, some of those restaurant owners who cut hours to sidestep the health law –- now regret it, says Kaya Bromley, an attorney who consults with employers on how to comply with the Affordable Care Act, and author of The Employers’ Guide to Obamacare.\u003c/p>\n\u003cp>“A lot of the fast food franchisees that did this are now coming back and saying, it was a great idea for reducing the number of people that I have to offer benefits, but now I can't run my restaurants,” she says.\u003c/p>\n\u003cp>They tell her it’s been a nightmare trying to manage a part time staff.\u003c/p>\n\u003cp>“Because you’ve got people who are less loyal, you’ve got people who are less skilled who don’t understand the business, and there’s more turnover,” she says.\u003c/p>\n\u003cp>So, Bromley has seen a lot of those restaurants reverse course.\u003c/p>\n\u003cp>“So they’re backtracking, saying, ‘It’s worth it to me to have a full of time staff of people in every restaurant and offer them benefits,’”she says. “Employers think that there’s a shortcut here or there, and then they realize, yeah, that shortcut really hurt me more than it helped me.”\u003c/p>\n\u003cp>The people hurt most by all the workforce management gymnastics are the people at the bottom of the restaurant pecking order who want to advance, but can’t, says Angelo Amador, vice president of labor and workforce policy for the National Restaurant Association.\u003c/p>\n\u003cp>“Someone who’s working part time, but wants more hours so they can move up the ladder, they can’t get the hours,” he says. “It ends up taking out that middle rung of employees.”\u003c/p>\n\u003cp>Obamacare has made restaurants less flexible, he says, mainly because it defines full time work as 30 hours a week or more. Amador says most other laws restaurants have to comply with, like overtime pay, define full time as 40 hours. He thinks the Affordable Care Act should be changed for consistency.\u003c/p>\n\u003cp>“It would be much easier if we could have one definition of full time,” he says.\u003c/p>\n\u003cp>Silvia Campos is relieved that she’s allowed to keep as many workers full time as she can at the Carl’s Junior she manages in Chowchilla.\u003c/p>\n\u003cp>“It’s a small town. For me, it’s hard to find a really good employee,” she says. “We have employees, and for some reason, they don’t like it and go. So it’s really hard to keep good people.”\u003c/p>\n\u003cp>But Campos says some workers don’t want more hours. They get subsidized health care through Covered California, the state’s health insurance marketplace, or free coverage through Medi-Cal. If their income gets too high, they lose eligibility for public benefits.\u003c/p>\n\u003cp>“We try but some people, they don’t want the full time,” she says. “They say no, keep me on part time and that’s good with me.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The company does offer insurance, at a cost of about $300 a month, according to the workers. But some of them say they’re better off making less money and getting their coverage free from the state.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"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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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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