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"content": "\u003cp>Transgender people are still fighting for access to crucial health services despite the Affordable Care Act’s requirement that insurance companies not deny coverage based on gender or health history.\u003c/p>\n\u003cp>The issue stems from the fact that enrollees must check a single gender box when they sign up for a plan sold on the individual or small group markets, according to advocates and health care providers.\u003c/p>\n\u003cp>“What happens is that the health insurance companies have specific codes and they put you in as female or male; you only get services that go with that code,” said Robin Maril, senior legislative counsel at the Human Rights Campaign, an advocacy group for lesbian, bisexual, gay and transgender people.\u003c/p>\n\u003cp>But someone who is transitioning from a woman to a man or vice versa might still have organs associated with the other gender, such as a uterus and breast tissue for someone born as a woman, or a prostate for someone born as a man. In addition, the transitioning process can take years, and some transgender people forego reassignment surgery because of cost or other reasons.\u003c/p>\n\u003cp>As a result, they might still need annual mammograms or pap smears even if they are transitioning to men, or prostate exams if they are transitioning to women — not to mention treatment for problems typically regarded as gender-specific. They could range from sexually-transmitted diseases to life-threatening illnesses such as cancer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The idea that you have insurance and you’re still being denied basic care is outrageous,” Maril said. She noted that before the health law, many insurance companies had exclusions barring transition-related care or care to transgender people in general, citing it as a “pre-existing condition.”\u003c/p>\n\u003cp>Under the federal health law, insurance companies selling policies in the individual or small group markets cannot deny coverage to transgender people or to those who are in the process of transitioning their sex. In addition, the administration released \u003ca href=\"http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf\" target=\"_blank\">guidance\u003c/a> in May telling insurers that they cannot deny coverage of sex-specific preventive services to transgender people. But advocates say that has not always happened in practice.\u003c/p>\n\u003cp>America’s Health Insurance Plans, a trade group, said that plans are complying with the law.\u003c/p>\n\u003cp>“Health plans want to make sure patients have access to the care they need, and this latest guidance was aligned with those efforts. Plans do cover medically necessary care and preventive services for transgender individuals,” said Clare Krusing, of AHIP.\u003c/p>\n\u003cp>United HealthCare and Cigna did not immediately respond to requests for comment. Kaiser Permanente, which is not affiliated with Kaiser Health News, said it has a process to address denials based on gender. Aetna said it has a process to cover these claims and is working to delink services from gender identification.\u003c/p>\n\u003cp>The challenges with insurers lead some transgender people to \u003ca href=\"http://digitalcommons.law.yale.edu/cgi/viewcontent.cgi?article=1192&context=yjhple\" target=\"_blank\">forego an insurance plan\u003c/a> altogether or to stick to their birth gender on their insurance ID cards.\u003c/p>\n\u003cp>Eli Strong started transitioning from female to male before passage of the Affordable Care Act, while he lived in Washington, D.C. and had employer-based coverage. In 2008, he changed all his legal identification to male, but kept his health insurance ID as female, because he had not yet gotten a hysterectomy. He didn’t want to have to fight his insurer over a gynecological exam.\u003c/p>\n\u003cp>“I was afraid that my insurance company wouldn’t cover annual exams, or anything having to do with organs that insurance companies deemed as non-male,” Strong said. “I resented having to keep my insurance marker as female because the way I saw it, that simple marker shouldn’t determine what coverage I received. What should determine my coverage is whatever organs I currently have, or conditions I am diagnosed with.”\u003c/p>\n\u003cp>Strong finally changed his insurance ID to male in 2014 after having a hysterectomy. But some of his transgender friends have not had as easy a time navigating the system. Others, he said, changed their insurance IDs to their new gender and contacted their insurance companies after a claim was denied to explain their transgender status, with limited success.\u003c/p>\n\u003cp>Insurance difficulties can create additional anxiety for people already fearful about seeking health care. Strong said that before his hysterectomy, “I put off having annual [gynecological] exams … because it was also so incredibly uncomfortable to be a bearded man in a gynecologist’s office.”\u003c/p>\n\u003cp>“Most transgender men still have a cervix, so they need a pap smear, so you have to create an environment where they feel comfortable talking about themselves,” said Harvey Makadon, director of professional education and training at Fenway Community Health, a LGBT health center in Boston.\u003c/p>\n\u003cp>Meanwhile, the insurance industry argues the responsibility for clarifying health service needs should fall to the health care provider, arguing that the doctor can explain the patient is transgender in the notes section of a submitted claim.\u003c/p>\n\u003cp>But that doesn’t always work, says Dru Levasseur of the \u003ca href=\"http://transgenderlawcenter.org/archives/1433\" target=\"_blank\">Transgender Rights Project\u003c/a> at Lambda Legal. Most insurance billing systems are automated and reproductive services like mammograms and prostate exams are flagged with a corresponding “female” or “male.”\u003c/p>\n\u003cp>Levasseur says the service is denied automatically if the gender and service don’t match. To allow payment, he and others say, an insurer could put a hold on the claim, verify it with the health care provider and then manually override the code. “The onus should be on the insurance companies,” Levasseur said.\u003c/p>\n\u003cp>Medicare already has codes that allow providers to identify the person getting, say, a pap smear or a mammogram, as transgender, which allows the claim to be processed, according to the AAPC, a trade group representing physician-based medical coders. Transgender advocates and the AAPC say the same can be done with private insurers.\u003c/p>\n\u003cp>But the gendered service claims system is there for a reason and changing it is not as easy as flipping a switch, said Andrew Naugle, a consultant at actuarial firm Milliman. The system, he explained, is part of quality control mechanisms meant to filter out treatments that shouldn’t happen, like a child being prescribed a drug not deemed safe for that age group.\u003c/p>\n\u003cp>Though there’s no reliable data quantifying the relationship between the coding issues and denials, Sarah MacCarthy, a RAND Corporation health researcher said, “there’s a lot of anecdotal evidence that it’s challenging to access services, and if even if they are accessed, they continue to be of low quality.” Some plans and providers say they are committed to changing that.\u003c/p>\n\u003cp>Deborah Espinal, executive director of health plan policy at Kaiser Permanente, said her organization is intent on removing barriers to care. “We see many patients in transition that have a need for preventive services that cross genders, and we work to ensure that KP is both socially and medically sensitive to our transgender members before, during and after their transition,” Espinal said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Advocates say their goal is to add new categories, such as ”transgender man,” or “transgender woman,” into insurance application forms, as well as into research, to get a more accurate picture of the number of transgender people, how many are denied coverage and how these denials affect health outcomes.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The idea that you have insurance and you’re still being denied basic care is outrageous,” Maril said. She noted that before the health law, many insurance companies had exclusions barring transition-related care or care to transgender people in general, citing it as a “pre-existing condition.”\u003c/p>\n\u003cp>Under the federal health law, insurance companies selling policies in the individual or small group markets cannot deny coverage to transgender people or to those who are in the process of transitioning their sex. In addition, the administration released \u003ca href=\"http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf\" target=\"_blank\">guidance\u003c/a> in May telling insurers that they cannot deny coverage of sex-specific preventive services to transgender people. But advocates say that has not always happened in practice.\u003c/p>\n\u003cp>America’s Health Insurance Plans, a trade group, said that plans are complying with the law.\u003c/p>\n\u003cp>“Health plans want to make sure patients have access to the care they need, and this latest guidance was aligned with those efforts. Plans do cover medically necessary care and preventive services for transgender individuals,” said Clare Krusing, of AHIP.\u003c/p>\n\u003cp>United HealthCare and Cigna did not immediately respond to requests for comment. Kaiser Permanente, which is not affiliated with Kaiser Health News, said it has a process to address denials based on gender. Aetna said it has a process to cover these claims and is working to delink services from gender identification.\u003c/p>\n\u003cp>The challenges with insurers lead some transgender people to \u003ca href=\"http://digitalcommons.law.yale.edu/cgi/viewcontent.cgi?article=1192&context=yjhple\" target=\"_blank\">forego an insurance plan\u003c/a> altogether or to stick to their birth gender on their insurance ID cards.\u003c/p>\n\u003cp>Eli Strong started transitioning from female to male before passage of the Affordable Care Act, while he lived in Washington, D.C. and had employer-based coverage. In 2008, he changed all his legal identification to male, but kept his health insurance ID as female, because he had not yet gotten a hysterectomy. He didn’t want to have to fight his insurer over a gynecological exam.\u003c/p>\n\u003cp>“I was afraid that my insurance company wouldn’t cover annual exams, or anything having to do with organs that insurance companies deemed as non-male,” Strong said. “I resented having to keep my insurance marker as female because the way I saw it, that simple marker shouldn’t determine what coverage I received. What should determine my coverage is whatever organs I currently have, or conditions I am diagnosed with.”\u003c/p>\n\u003cp>Strong finally changed his insurance ID to male in 2014 after having a hysterectomy. But some of his transgender friends have not had as easy a time navigating the system. Others, he said, changed their insurance IDs to their new gender and contacted their insurance companies after a claim was denied to explain their transgender status, with limited success.\u003c/p>\n\u003cp>Insurance difficulties can create additional anxiety for people already fearful about seeking health care. Strong said that before his hysterectomy, “I put off having annual [gynecological] exams … because it was also so incredibly uncomfortable to be a bearded man in a gynecologist’s office.”\u003c/p>\n\u003cp>“Most transgender men still have a cervix, so they need a pap smear, so you have to create an environment where they feel comfortable talking about themselves,” said Harvey Makadon, director of professional education and training at Fenway Community Health, a LGBT health center in Boston.\u003c/p>\n\u003cp>Meanwhile, the insurance industry argues the responsibility for clarifying health service needs should fall to the health care provider, arguing that the doctor can explain the patient is transgender in the notes section of a submitted claim.\u003c/p>\n\u003cp>But that doesn’t always work, says Dru Levasseur of the \u003ca href=\"http://transgenderlawcenter.org/archives/1433\" target=\"_blank\">Transgender Rights Project\u003c/a> at Lambda Legal. Most insurance billing systems are automated and reproductive services like mammograms and prostate exams are flagged with a corresponding “female” or “male.”\u003c/p>\n\u003cp>Levasseur says the service is denied automatically if the gender and service don’t match. To allow payment, he and others say, an insurer could put a hold on the claim, verify it with the health care provider and then manually override the code. “The onus should be on the insurance companies,” Levasseur said.\u003c/p>\n\u003cp>Medicare already has codes that allow providers to identify the person getting, say, a pap smear or a mammogram, as transgender, which allows the claim to be processed, according to the AAPC, a trade group representing physician-based medical coders. Transgender advocates and the AAPC say the same can be done with private insurers.\u003c/p>\n\u003cp>But the gendered service claims system is there for a reason and changing it is not as easy as flipping a switch, said Andrew Naugle, a consultant at actuarial firm Milliman. The system, he explained, is part of quality control mechanisms meant to filter out treatments that shouldn’t happen, like a child being prescribed a drug not deemed safe for that age group.\u003c/p>\n\u003cp>Though there’s no reliable data quantifying the relationship between the coding issues and denials, Sarah MacCarthy, a RAND Corporation health researcher said, “there’s a lot of anecdotal evidence that it’s challenging to access services, and if even if they are accessed, they continue to be of low quality.” Some plans and providers say they are committed to changing that.\u003c/p>\n\u003cp>Deborah Espinal, executive director of health plan policy at Kaiser Permanente, said her organization is intent on removing barriers to care. “We see many patients in transition that have a need for preventive services that cross genders, and we work to ensure that KP is both socially and medically sensitive to our transgender members before, during and after their transition,” Espinal said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Advocates say their goal is to add new categories, such as ”transgender man,” or “transgender woman,” into insurance application forms, as well as into research, to get a more accurate picture of the number of transgender people, how many are denied coverage and how these denials affect health outcomes.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>About 7.5 million Americans paid an average penalty of $200 for not having health insurance in 2014 — the first year most Americans were required to have coverage under the Affordable Care Act, the \u003ca href=\"http://www.irs.gov/pub/irs-utl/CommissionerLetterlwithcharts.pdf\" target=\"_blank\">Internal Revenue Service\u003c/a> said Tuesday.\u003c/p>\n\u003cp>By contrast, 76 percent of taxpayers checked a box indicating they had qualifying insurance coverage all year. Counting another 7 million dependents who were not required to report their coverage but also filed returns, the proportion rises to 81 percent, the IRS said.\u003c/p>\n\u003cp>The government had estimated in January that from 3 million to 6 million households would have to pay a penalty: 1 percent of their annual income or $95 per adult in 2014, whichever is greater.\u003c/p>\n\u003cp>Final figures for the tax year aren’t available. The IRS has so far processed about 135 million of the estimated 150 million returns expected. IRS Commissioner John Koskinen said the agency was reporting preliminary figures because it has received “numerous requests” from members of Congress.\u003c/p>\n\u003cp>In addition to penalty totals, the IRS reported Tuesday on tax subsidies the health law provided for people who were buying coverage through the state or federal online exchanges and who qualified based on income. People had a choice of filing for credits in advance — money the government paid to their insurers — or when filing tax returns.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>About 2.7 million taxpayers claimed approximately $9 billion in subsidies, reporting an average subsidy of $3,400. About 40 percent claimed less than $2,000, 40 percent claimed $2,000 to $5,000, and 20 percent claimed $5,000 or more.\u003c/p>\n\u003cp>Among taxpayers who claimed a subsidy, about 1.6 million, or half of taxpayers who claimed or received a subsidy, had to pay money back to the government because their actual income was higher than projected when they applied for the subsidy. The average amount repaid was about $800.\u003c/p>\n\u003cp>When looking at the individual mandate, the report said the vast majority of people automatically satisfied the individual mandate because they were insured last year. Another 12 million had exemptions, including people whose incomes were too low and Native Americans.\u003c/p>\n\u003cp>In all, the IRS said it has collected $1.5 billion from the individual mandate penalty included in the health law. About 40 percent of taxpayers who paid a penalty paid less than $100.\u003c/p>\n\u003cp>About 300,000 taxpayers who made an individual mandate penalty payment should have claimed an exemption but did not, the government said. The agency is sending letters to these taxpayers telling them they generally have three years to file an amended tax return.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>More than 5 million taxpayers did not check the box on their tax form saying they had coverage, claim a health care coverage exemption, or pay a penalty. “We are analyzing these cases to determine their status,” the government said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>About 7.5 million Americans paid an average penalty of $200 for not having health insurance in 2014 — the first year most Americans were required to have coverage under the Affordable Care Act, the \u003ca href=\"http://www.irs.gov/pub/irs-utl/CommissionerLetterlwithcharts.pdf\" target=\"_blank\">Internal Revenue Service\u003c/a> said Tuesday.\u003c/p>\n\u003cp>By contrast, 76 percent of taxpayers checked a box indicating they had qualifying insurance coverage all year. Counting another 7 million dependents who were not required to report their coverage but also filed returns, the proportion rises to 81 percent, the IRS said.\u003c/p>\n\u003cp>The government had estimated in January that from 3 million to 6 million households would have to pay a penalty: 1 percent of their annual income or $95 per adult in 2014, whichever is greater.\u003c/p>\n\u003cp>Final figures for the tax year aren’t available. The IRS has so far processed about 135 million of the estimated 150 million returns expected. IRS Commissioner John Koskinen said the agency was reporting preliminary figures because it has received “numerous requests” from members of Congress.\u003c/p>\n\u003cp>In addition to penalty totals, the IRS reported Tuesday on tax subsidies the health law provided for people who were buying coverage through the state or federal online exchanges and who qualified based on income. People had a choice of filing for credits in advance — money the government paid to their insurers — or when filing tax returns.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>About 2.7 million taxpayers claimed approximately $9 billion in subsidies, reporting an average subsidy of $3,400. About 40 percent claimed less than $2,000, 40 percent claimed $2,000 to $5,000, and 20 percent claimed $5,000 or more.\u003c/p>\n\u003cp>Among taxpayers who claimed a subsidy, about 1.6 million, or half of taxpayers who claimed or received a subsidy, had to pay money back to the government because their actual income was higher than projected when they applied for the subsidy. The average amount repaid was about $800.\u003c/p>\n\u003cp>When looking at the individual mandate, the report said the vast majority of people automatically satisfied the individual mandate because they were insured last year. Another 12 million had exemptions, including people whose incomes were too low and Native Americans.\u003c/p>\n\u003cp>In all, the IRS said it has collected $1.5 billion from the individual mandate penalty included in the health law. About 40 percent of taxpayers who paid a penalty paid less than $100.\u003c/p>\n\u003cp>About 300,000 taxpayers who made an individual mandate penalty payment should have claimed an exemption but did not, the government said. The agency is sending letters to these taxpayers telling them they generally have three years to file an amended tax return.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>More than 5 million taxpayers did not check the box on their tax form saying they had coverage, claim a health care coverage exemption, or pay a penalty. “We are analyzing these cases to determine their status,” the government said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Women Are Saving Money Thanks to Increased Birth Control Coverage",
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"content": "\u003cp>Women are saving a lot of money as a result of a health law requirement that insurance cover most forms of prescription contraceptives with no additional out-of-pocket costs, according to a study released Tuesday. But the amount of those savings and the speed with which those savings occurred surprised researchers.\u003c/p>\n\u003cp>The study, in the July issue of the policy journal Health Affairs, found that the average birth control pill user saved $255 in the year after the requirement took effect. The average user of an intrauterine device (IUD) saved $248. Those savings represented a significant percentage of average out-of-pocket costs.\u003c/p>\n\u003cp>“These are healthy women and this on average is their No. 1 need from the health care system,” said Nora Becker, an MD-PhD candidate at the University of Pennsylvania and lead author of the study. “On average, these women were spending about 30 to 44 percent of their total out of pocket (health) spending just on birth control.”\u003c/p>\n\u003cp>The study looked at out-of-pocket spending from nearly 800,000 women between the ages of 13 and 45 from January 2008 through June 2013. For most plans, the requirement began Aug. 1, 2012, or Jan. 1, 2013. So-called “grandfathered” health plans, those that have not substantially changed their benefits since the health law was passed in 2010, are exempt from the mandate, as are a small subset of religious-based plans.\u003c/p>\n\u003cp>Becker said that while making birth control substantially cheaper may not increase the number of women who use it, the new requirements could well shift the type of birth control they use to longer-acting, more effective methods like the IUD. “If prior to the ACA a woman was facing $10 to $30 a month for the pill but hundreds of dollars upfront for an IUD and now both are free, we might see a different choice,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers also found that while out-of-pocket spending dropped dramatically for most types of prescription contraceptive methods — “the majority of women were paying nothing by June 2013” –spending barely budged for the vaginal ring or hormonal patch.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That could be because under the original rules, many insurers declined to make the ring or patch free, since, like pills, they are essentially hormone delivery methods. Earlier this year, the Obama administration issued a clarification saying that while insurers do not have to offer every brand of every method, they do have to cover at least one product in each category, including rings and patches.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Women are saving a lot of money as a result of a health law requirement that insurance cover most forms of prescription contraceptives with no additional out-of-pocket costs, according to a study released Tuesday. But the amount of those savings and the speed with which those savings occurred surprised researchers.\u003c/p>\n\u003cp>The study, in the July issue of the policy journal Health Affairs, found that the average birth control pill user saved $255 in the year after the requirement took effect. The average user of an intrauterine device (IUD) saved $248. Those savings represented a significant percentage of average out-of-pocket costs.\u003c/p>\n\u003cp>“These are healthy women and this on average is their No. 1 need from the health care system,” said Nora Becker, an MD-PhD candidate at the University of Pennsylvania and lead author of the study. “On average, these women were spending about 30 to 44 percent of their total out of pocket (health) spending just on birth control.”\u003c/p>\n\u003cp>The study looked at out-of-pocket spending from nearly 800,000 women between the ages of 13 and 45 from January 2008 through June 2013. For most plans, the requirement began Aug. 1, 2012, or Jan. 1, 2013. So-called “grandfathered” health plans, those that have not substantially changed their benefits since the health law was passed in 2010, are exempt from the mandate, as are a small subset of religious-based plans.\u003c/p>\n\u003cp>Becker said that while making birth control substantially cheaper may not increase the number of women who use it, the new requirements could well shift the type of birth control they use to longer-acting, more effective methods like the IUD. “If prior to the ACA a woman was facing $10 to $30 a month for the pill but hundreds of dollars upfront for an IUD and now both are free, we might see a different choice,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Researchers also found that while out-of-pocket spending dropped dramatically for most types of prescription contraceptive methods — “the majority of women were paying nothing by June 2013” –spending barely budged for the vaginal ring or hormonal patch.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That could be because under the original rules, many insurers declined to make the ring or patch free, since, like pills, they are essentially hormone delivery methods. Earlier this year, the Obama administration issued a clarification saying that while insurers do not have to offer every brand of every method, they do have to cover at least one product in each category, including rings and patches.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "U.S. Supreme Court Upholds Subsidies in Obamacare Case; Victory for Administration",
"title": "U.S. Supreme Court Upholds Subsidies in Obamacare Case; Victory for Administration",
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"content": "\u003cp>People around the country who receive financial help from the government to purchase insurance under the Affordable Care Act can breathe a sigh of relief today.\u003c/p>\n\u003cp>The U.S. Supreme Court on Thursday upheld tax subsidies for those who get their insurance through the federal Healthcare.gov exchange, in a ruling that preserves health insurance for millions of Americans.\u003c/p>\n\u003cp>The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, under the 2010 health care law.\u003c/p>\n\u003cp>The outcome is the second major victory for Obama in politically charged Supreme Court tests of his most significant domestic achievement. It came the same day the court gave the administration an unexpected victory by preserving a key tool the administration uses to fight housing bias.\u003c/p>\n\u003cp>[contextly_sidebar id=\"kbCa98wQiuPz0nn10aaLVybMRqnWcRKR\"]Chief Justice John Roberts again voted with his liberal colleagues in support of the law. Roberts also was the key vote to uphold the law in 2012. Justice Anthony Kennedy, a dissenter in 2012, was part of the majority on Thursday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,\" Roberts wrote in the majority opinion.\u003c/p>\n\u003cp>In a dissent he summarized from the bench, Justice Antonin Scalia said, \"We should start calling this law SCOTUScare.\" Using the acronym for the Supreme Court, Scalia said his colleagues have twice stepped in to save the law from what Scalia considered worthy challenges.\u003c/p>\n\u003cp>Justices Samuel Alito and Clarence Thomas joined the dissent, as they did in 2012.\u003c/p>\n\u003cp>The latest attempt to dismantle \u003ca href=\"https://www.govtrack.us/congress/bills/111/hr3590/text\" target=\"_blank\">the Affordable Care Act\u003c/a> at the Supreme Court hinged on just seven words, or maybe even two. A section of the law stipulates that premium assistance, in the form of tax credits that the federal government provides for low- and middle-income people to buy insurance, would be available to those who sign up \"through an exchange established by the State.\"\u003c/p>\n\u003cp>But 27 states, in protest of the highly contentious law popularly known as Obamacare, resisted establishing their own exchange, the online marketplace where you can shop for and purchase insurance plans. People in those states have to buy insurance through the federal website, HealthCare.gov (which, you'll probably recall, had a notoriously disastrous rollout in 2013 but performed better as time went on). In addition, 11 states rely on mixed federal-state exchanges.\u003c/p>\n\u003cp>In 2012, the IRS issued regulations making the subsidies available to those who get their insurance through the federal exchange as well as the states'. According to the plaintiffs in the SCOTUS case, that shouldn't have happened; they argued the law's language makes plain that Congress intended to limit the subsidies to those in state exchanges. The administration, congressional Democrats and 22 states retorted that it would make no sense to construct the law the way its opponents suggested.\u003c/p>\n\u003cp>The idea behind the law's structure was to decrease the number of uninsured. The law, for example, prevents insurers from denying coverage because of \"pre-existing\" health condition, it requires almost everyone to be insured, and it provides financial help to consumers who otherwise would spend too much of their paycheck on premiums.\u003c/p>\n\u003cp>The point of the last piece, the subsidies, is to keep enough people in the pool of insured to avoid triggering a so-called death spiral of declining enrollment, a growing proportion of less healthy people and premium increases by insurers.\u003c/p>\n\u003cp>Several portions of the law indicate that consumers can claim tax credits, no matter where they live. No member of Congress said that subsidies would be limited, and several states said in a separate brief to the court that they had no inkling they had to set up their own exchange for their residents to get tax credits.\u003c/p>\n\u003cp>As far as California goes, those who receive subsidies for their Obamacare insurance needn't have worried. As KQED's April Dembosky \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/22/california-unaffected-by-health-subsidy-court-case-king-v-burwell/\" target=\"_blank\">reported earlier this week\u003c/a>:\u003c/p>\n\u003cp>\u003cem>California operates its own independent state exchange, so Californians who receive subsidies to buy their coverage will keep their subsidies, no matter what the court rules, according to several analysts.\u003c/em>\u003c/p>\n\u003cp>\u003cem>“Chaos could erupt in insurance markets in other states, but California would be an island,” said Larry Levitt, health policy expert with the Kaiser Family Foundation. “The direct effects for California are zero.”\u003c/em>\u003c/p>\n\u003cp>The roiling that insurance markets in other states would have experienced would not have affected California either:\u003c/p>\n\u003cblockquote>\u003cp>“Each state has its own risk pool, so the fact that other risk pools in other states are going into death spirals, will not have any direct impact on California,” said Joel Ario, managing director at Manatt Health Solutions, a consulting firm, and former insurance commissioner in Pennsylvania and Oregon.\u003c/p>\u003c/blockquote>\n\u003cp>As for the rest of the country not in the 12 states plus Washington, D.C., that run their own exchanges, fallout would have been substantial should the subsidies have been canceled. According to the Department of Health and Human Services, more than 6 million people would have lost premium assistance in the states without their own exchange. A Kaiser Family Foundation analysis found those enrollees who receive subsidies would have faced an average effective premium increase of 287 percent.\u003c/p>\n\u003cp>Even those who don't get subsidies could have seen stratospheric increases in their premiums because of the disruption in the insurance marketplace, triggering the death spiral mentioned above. Without subsidies, many healthy people would likely forgo coverage, and if they pulled out, that would have left the risk pools disproportionately made up of sicker individuals. That would increase the cost to insurers, who would raise the price of premiums, leading to even more people pulling out, and so on.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Jon Brooks, Associated Press and NPR contributed to this report.\u003c/em>\u003c/p>\n\n",
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"excerpt": "At stake were subsidies for more than 6 million people who buy insurance through the federal exchange.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>People around the country who receive financial help from the government to purchase insurance under the Affordable Care Act can breathe a sigh of relief today.\u003c/p>\n\u003cp>The U.S. Supreme Court on Thursday upheld tax subsidies for those who get their insurance through the federal Healthcare.gov exchange, in a ruling that preserves health insurance for millions of Americans.\u003c/p>\n\u003cp>The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, under the 2010 health care law.\u003c/p>\n\u003cp>The outcome is the second major victory for Obama in politically charged Supreme Court tests of his most significant domestic achievement. It came the same day the court gave the administration an unexpected victory by preserving a key tool the administration uses to fight housing bias.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Chief Justice John Roberts again voted with his liberal colleagues in support of the law. Roberts also was the key vote to uphold the law in 2012. Justice Anthony Kennedy, a dissenter in 2012, was part of the majority on Thursday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,\" Roberts wrote in the majority opinion.\u003c/p>\n\u003cp>In a dissent he summarized from the bench, Justice Antonin Scalia said, \"We should start calling this law SCOTUScare.\" Using the acronym for the Supreme Court, Scalia said his colleagues have twice stepped in to save the law from what Scalia considered worthy challenges.\u003c/p>\n\u003cp>Justices Samuel Alito and Clarence Thomas joined the dissent, as they did in 2012.\u003c/p>\n\u003cp>The latest attempt to dismantle \u003ca href=\"https://www.govtrack.us/congress/bills/111/hr3590/text\" target=\"_blank\">the Affordable Care Act\u003c/a> at the Supreme Court hinged on just seven words, or maybe even two. A section of the law stipulates that premium assistance, in the form of tax credits that the federal government provides for low- and middle-income people to buy insurance, would be available to those who sign up \"through an exchange established by the State.\"\u003c/p>\n\u003cp>But 27 states, in protest of the highly contentious law popularly known as Obamacare, resisted establishing their own exchange, the online marketplace where you can shop for and purchase insurance plans. People in those states have to buy insurance through the federal website, HealthCare.gov (which, you'll probably recall, had a notoriously disastrous rollout in 2013 but performed better as time went on). In addition, 11 states rely on mixed federal-state exchanges.\u003c/p>\n\u003cp>In 2012, the IRS issued regulations making the subsidies available to those who get their insurance through the federal exchange as well as the states'. According to the plaintiffs in the SCOTUS case, that shouldn't have happened; they argued the law's language makes plain that Congress intended to limit the subsidies to those in state exchanges. The administration, congressional Democrats and 22 states retorted that it would make no sense to construct the law the way its opponents suggested.\u003c/p>\n\u003cp>The idea behind the law's structure was to decrease the number of uninsured. The law, for example, prevents insurers from denying coverage because of \"pre-existing\" health condition, it requires almost everyone to be insured, and it provides financial help to consumers who otherwise would spend too much of their paycheck on premiums.\u003c/p>\n\u003cp>The point of the last piece, the subsidies, is to keep enough people in the pool of insured to avoid triggering a so-called death spiral of declining enrollment, a growing proportion of less healthy people and premium increases by insurers.\u003c/p>\n\u003cp>Several portions of the law indicate that consumers can claim tax credits, no matter where they live. No member of Congress said that subsidies would be limited, and several states said in a separate brief to the court that they had no inkling they had to set up their own exchange for their residents to get tax credits.\u003c/p>\n\u003cp>As far as California goes, those who receive subsidies for their Obamacare insurance needn't have worried. As KQED's April Dembosky \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/22/california-unaffected-by-health-subsidy-court-case-king-v-burwell/\" target=\"_blank\">reported earlier this week\u003c/a>:\u003c/p>\n\u003cp>\u003cem>California operates its own independent state exchange, so Californians who receive subsidies to buy their coverage will keep their subsidies, no matter what the court rules, according to several analysts.\u003c/em>\u003c/p>\n\u003cp>\u003cem>“Chaos could erupt in insurance markets in other states, but California would be an island,” said Larry Levitt, health policy expert with the Kaiser Family Foundation. “The direct effects for California are zero.”\u003c/em>\u003c/p>\n\u003cp>The roiling that insurance markets in other states would have experienced would not have affected California either:\u003c/p>\n\u003cblockquote>\u003cp>“Each state has its own risk pool, so the fact that other risk pools in other states are going into death spirals, will not have any direct impact on California,” said Joel Ario, managing director at Manatt Health Solutions, a consulting firm, and former insurance commissioner in Pennsylvania and Oregon.\u003c/p>\u003c/blockquote>\n\u003cp>As for the rest of the country not in the 12 states plus Washington, D.C., that run their own exchanges, fallout would have been substantial should the subsidies have been canceled. According to the Department of Health and Human Services, more than 6 million people would have lost premium assistance in the states without their own exchange. A Kaiser Family Foundation analysis found those enrollees who receive subsidies would have faced an average effective premium increase of 287 percent.\u003c/p>\n\u003cp>Even those who don't get subsidies could have seen stratospheric increases in their premiums because of the disruption in the insurance marketplace, triggering the death spiral mentioned above. Without subsidies, many healthy people would likely forgo coverage, and if they pulled out, that would have left the risk pools disproportionately made up of sicker individuals. That would increase the cost to insurers, who would raise the price of premiums, leading to even more people pulling out, and so on.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Jon Brooks, Associated Press and NPR contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>While a Supreme Court decision to eliminate health care subsidies would throw most states into turmoil, whatever the court decides, there will be no direct impact on California.\u003c/p>\n\u003cp>The Court is expected to issue a ruling in \u003cem>\u003ca href=\"http://www.scotusblog.com/case-files/cases/king-v-burwell/\" target=\"_blank\">King v Burwell\u003c/a> \u003c/em>by the end of this month, \u003ca href=\"http://www.npr.org/sections/health-shots/2015/06/08/412865009/5-questions-answered-on-the-legal-challenge-to-obamacare-subsidies\" target=\"_blank\">determining whether \u003c/a>it is lawful for people who buy health insurance through a federally-run exchange to receive a subsidy to help them pay their premiums.\u003c/p>\n\u003cp>California operates its own independent state exchange, so Californians who receive subsidies to buy their coverage will keep their subsidies, no matter what the Court rules, according to several analysts.\u003c/p>\n\u003cp>“Chaos could erupt in insurance markets in other states, but California would be an island,” said Larry Levitt, health policy expert with the Kaiser Family Foundation. “The direct effects for California are zero.”\u003c/p>\n\u003cp>The consequences in the \u003ca href=\"http://khn.org/kingvburwell/understanding-this-map/\">34 states\u003c/a> that do use the federally operated marketplace, healthcare.gov, would be substantial. If the Court rules that the federal marketplace has no legal right to provide subsidies, \u003ca href=\"http://kff.org/interactive/king-v-burwell-effects/?utm_campaign=KFF:%20Health%20Reform&utm_source=hs_email&utm_medium=email&utm_content=18065079&_hsenc=p2ANqtz-8RE2lP3fM7IulfX8FCRf7tsji5Vc3mWOGgqhIGvticfUuF1BNcPrlZHo5RgkxgUX9ZquHtQ01DnD01cOCPEsPSOtK3eg&_hsmi=18065079\" target=\"_blank\">more than 6 million people\u003c/a> currently receiving subsidies would lose them almost immediately, according to an analysis from the Kaiser Family Foundation.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many people who find themselves suddenly without financial assistance to purchase health insurance -– especially healthy people –- are likely to give up their coverage altogether. That would lead to a so-called “death spiral”: if healthy people pull out of the insurance market in those states, insurers could no longer rely on their premiums to help pay the health care costs of the sick people in the risk pool. Premium prices would then go up, or, insurance companies might decide it’s impossible to do business in those conditions and could leave those states altogether. As premium prices go up, still more people will drop their coverage.\u003c/p>\n\u003cp>Again, this will not happen in California.\u003c/p>\n\u003cp>\u003cstrong>Insurance Sold State-by-State\u003c/strong>\u003c/p>\n\u003cp>“Each state has its own risk pool, so the fact that other risk pools in other states are going into death spirals, will not have any direct impact on California,” said Joel Ario, managing director at Manatt Health Solutions, a consulting firm, and former insurance commissioner in Pennsylvania and Oregon.\u003c/p>\n\u003cp>The insurance industry is regulated state-by-state, he explained. Even insurance companies that operate nationally, like Aetna, Cigna, and Anthem, must be licensed in each separate state.\u003c/p>\n\u003cp>Premium prices are also set on a state-by-state basis, and even by regions within the state. They are based on the local cost of health care and what insurers are able to negotiate with local hospitals and health care providers. (That’s why \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">premiums are so much more expensive\u003c/a> in the San Francisco Bay Area, where the hospital industry is quite consolidated, compared to Los Angeles, where there’s much more competition.)\u003c/p>\n\u003cp>But what happens outside the state -– how premiums are calculated in Florida, Texas, or other states that might lose their subsidies -– has no bearing here.\u003c/p>\n\u003cp>“The good news for people in California is insurance doesn’t cross state lines,” said Levitt.\u003c/p>\n\u003cp>\u003cstrong>Indirect Consequences\u003c/strong>\u003c/p>\n\u003cp>Still, Joel Ario suggests that there could be some longer-term, indirect ramifications for the \u003ca href=\"http://khn.org/kingvburwell/understanding-this-map/\">12 states\u003c/a>, and Washington, D.C., that run their own health exchanges.\u003c/p>\n\u003cp>“Anytime you have a major catastrophe, like a hurricane in Florida or the \u003cem>Burwell \u003c/em>case, it does affect the strength of the insurance market overall,” he said. “The weaker an insurer is, the less likely they will be competitive.”\u003c/p>\n\u003cp>Down the road, he said, it is possible that large national insurers who pull out of the individual market in states that lost subsidies, might decide to pull out of the individual market in other states that run their own exchanges. Or, insurers who decided to “wait and see” how things went in the first two years of the Affordable Care Act, might decide not to enter the individual market in any state. That would reduce competition.\u003c/p>\n\u003cp>Larry Levitt said that even that won’t happen in California.\u003c/p>\n\u003cp>“California is such a big state. Not one insurer will walk away from this market based on what’s going on in different parts of the country,” he said. “They’re not going anywhere.\"\u003c/p>\n\u003cp>Nicole Kasabian Evans of the California Association of Health Plans agreed.\u003c/p>\n\u003cp>“We’re the largest health care market in the nation,” she said. “California has embraced not just the exchange but Medicaid expansion, which makes our involvement in the Affordable Care Act even more significant and appealing to insurers.”\u003c/p>\n\u003cp>The vast majority of people who get their health coverage through Medi-Cal, California’s version of Medicaid that provides health insurance for the poor, are part of a managed care plan operated by an insurer. Both Anthem and Kaiser, for example, manage some of these plans, and are also big players on the exchange.\u003c/p>\n\u003cp>L.A. Care Health Plan, which provides coverage to low-income Los Angeles residents, covered only Medi-Cal patients before Obamacare took effect. But after, it moved into the commercial market as well, providing coverage for people who move back and forth between Medi-Cal and private coverage because of changes in their income that shift them above or below the eligibility threshold for Medi-Cal.\u003c/p>\n\u003cp>\u003cstrong>Policy Fallout\u003c/strong>\u003c/p>\n\u003cp>The lingering question for California, if the Court strikes down subsidies, is what happens when Congress starts proposing fixes. Republican lawmakers have drafted bills that would restore subsidies in states that lost them, but would also undercut key provisions of the Affordable Care Act that apply to all states, like the individual mandate that requires all people to have insurance and helps prevent death spirals.\u003c/p>\n\u003cp>“That would have an effect on the insurance market, including California,” Ario says. “But I don’t think any of those [bills] will pass.”\u003c/p>\n\u003cp>Health advocates say Democratic lawmakers would object to such proposals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It is impossible to imagine President Obama, or Democratic Congressional leaders like Nancy Pelosi of California ... agreeing to a compromise that undermines coverage and access to care in their home state,\" said Anthony Wright, executive director of Health Access.\u003c/p>\n\n",
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"excerpt": "Since California is not part of the federal marketplace, subsidies will continue, no matter what the Supreme Court rules.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>While a Supreme Court decision to eliminate health care subsidies would throw most states into turmoil, whatever the court decides, there will be no direct impact on California.\u003c/p>\n\u003cp>The Court is expected to issue a ruling in \u003cem>\u003ca href=\"http://www.scotusblog.com/case-files/cases/king-v-burwell/\" target=\"_blank\">King v Burwell\u003c/a> \u003c/em>by the end of this month, \u003ca href=\"http://www.npr.org/sections/health-shots/2015/06/08/412865009/5-questions-answered-on-the-legal-challenge-to-obamacare-subsidies\" target=\"_blank\">determining whether \u003c/a>it is lawful for people who buy health insurance through a federally-run exchange to receive a subsidy to help them pay their premiums.\u003c/p>\n\u003cp>California operates its own independent state exchange, so Californians who receive subsidies to buy their coverage will keep their subsidies, no matter what the Court rules, according to several analysts.\u003c/p>\n\u003cp>“Chaos could erupt in insurance markets in other states, but California would be an island,” said Larry Levitt, health policy expert with the Kaiser Family Foundation. “The direct effects for California are zero.”\u003c/p>\n\u003cp>The consequences in the \u003ca href=\"http://khn.org/kingvburwell/understanding-this-map/\">34 states\u003c/a> that do use the federally operated marketplace, healthcare.gov, would be substantial. If the Court rules that the federal marketplace has no legal right to provide subsidies, \u003ca href=\"http://kff.org/interactive/king-v-burwell-effects/?utm_campaign=KFF:%20Health%20Reform&utm_source=hs_email&utm_medium=email&utm_content=18065079&_hsenc=p2ANqtz-8RE2lP3fM7IulfX8FCRf7tsji5Vc3mWOGgqhIGvticfUuF1BNcPrlZHo5RgkxgUX9ZquHtQ01DnD01cOCPEsPSOtK3eg&_hsmi=18065079\" target=\"_blank\">more than 6 million people\u003c/a> currently receiving subsidies would lose them almost immediately, according to an analysis from the Kaiser Family Foundation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many people who find themselves suddenly without financial assistance to purchase health insurance -– especially healthy people –- are likely to give up their coverage altogether. That would lead to a so-called “death spiral”: if healthy people pull out of the insurance market in those states, insurers could no longer rely on their premiums to help pay the health care costs of the sick people in the risk pool. Premium prices would then go up, or, insurance companies might decide it’s impossible to do business in those conditions and could leave those states altogether. As premium prices go up, still more people will drop their coverage.\u003c/p>\n\u003cp>Again, this will not happen in California.\u003c/p>\n\u003cp>\u003cstrong>Insurance Sold State-by-State\u003c/strong>\u003c/p>\n\u003cp>“Each state has its own risk pool, so the fact that other risk pools in other states are going into death spirals, will not have any direct impact on California,” said Joel Ario, managing director at Manatt Health Solutions, a consulting firm, and former insurance commissioner in Pennsylvania and Oregon.\u003c/p>\n\u003cp>The insurance industry is regulated state-by-state, he explained. Even insurance companies that operate nationally, like Aetna, Cigna, and Anthem, must be licensed in each separate state.\u003c/p>\n\u003cp>Premium prices are also set on a state-by-state basis, and even by regions within the state. They are based on the local cost of health care and what insurers are able to negotiate with local hospitals and health care providers. (That’s why \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">premiums are so much more expensive\u003c/a> in the San Francisco Bay Area, where the hospital industry is quite consolidated, compared to Los Angeles, where there’s much more competition.)\u003c/p>\n\u003cp>But what happens outside the state -– how premiums are calculated in Florida, Texas, or other states that might lose their subsidies -– has no bearing here.\u003c/p>\n\u003cp>“The good news for people in California is insurance doesn’t cross state lines,” said Levitt.\u003c/p>\n\u003cp>\u003cstrong>Indirect Consequences\u003c/strong>\u003c/p>\n\u003cp>Still, Joel Ario suggests that there could be some longer-term, indirect ramifications for the \u003ca href=\"http://khn.org/kingvburwell/understanding-this-map/\">12 states\u003c/a>, and Washington, D.C., that run their own health exchanges.\u003c/p>\n\u003cp>“Anytime you have a major catastrophe, like a hurricane in Florida or the \u003cem>Burwell \u003c/em>case, it does affect the strength of the insurance market overall,” he said. “The weaker an insurer is, the less likely they will be competitive.”\u003c/p>\n\u003cp>Down the road, he said, it is possible that large national insurers who pull out of the individual market in states that lost subsidies, might decide to pull out of the individual market in other states that run their own exchanges. Or, insurers who decided to “wait and see” how things went in the first two years of the Affordable Care Act, might decide not to enter the individual market in any state. That would reduce competition.\u003c/p>\n\u003cp>Larry Levitt said that even that won’t happen in California.\u003c/p>\n\u003cp>“California is such a big state. Not one insurer will walk away from this market based on what’s going on in different parts of the country,” he said. “They’re not going anywhere.\"\u003c/p>\n\u003cp>Nicole Kasabian Evans of the California Association of Health Plans agreed.\u003c/p>\n\u003cp>“We’re the largest health care market in the nation,” she said. “California has embraced not just the exchange but Medicaid expansion, which makes our involvement in the Affordable Care Act even more significant and appealing to insurers.”\u003c/p>\n\u003cp>The vast majority of people who get their health coverage through Medi-Cal, California’s version of Medicaid that provides health insurance for the poor, are part of a managed care plan operated by an insurer. Both Anthem and Kaiser, for example, manage some of these plans, and are also big players on the exchange.\u003c/p>\n\u003cp>L.A. Care Health Plan, which provides coverage to low-income Los Angeles residents, covered only Medi-Cal patients before Obamacare took effect. But after, it moved into the commercial market as well, providing coverage for people who move back and forth between Medi-Cal and private coverage because of changes in their income that shift them above or below the eligibility threshold for Medi-Cal.\u003c/p>\n\u003cp>\u003cstrong>Policy Fallout\u003c/strong>\u003c/p>\n\u003cp>The lingering question for California, if the Court strikes down subsidies, is what happens when Congress starts proposing fixes. Republican lawmakers have drafted bills that would restore subsidies in states that lost them, but would also undercut key provisions of the Affordable Care Act that apply to all states, like the individual mandate that requires all people to have insurance and helps prevent death spirals.\u003c/p>\n\u003cp>“That would have an effect on the insurance market, including California,” Ario says. “But I don’t think any of those [bills] will pass.”\u003c/p>\n\u003cp>Health advocates say Democratic lawmakers would object to such proposals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It is impossible to imagine President Obama, or Democratic Congressional leaders like Nancy Pelosi of California ... agreeing to a compromise that undermines coverage and access to care in their home state,\" said Anthony Wright, executive director of Health Access.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Congressional Budget Office: 24 Million More Uninsured if Obamacare Repealed",
"title": "Congressional Budget Office: 24 Million More Uninsured if Obamacare Repealed",
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"content": "\u003cp>A nonpartisan government study says repealing President Barack Obama's signature health care law would modestly increase the budget deficit and the number of uninsured Americans would rise by more than 20 million.\u003c/p>\n\u003cp>The report from the Congressional Budget Office comes ahead of a highly anticipated Supreme Court ruling that could have a major impact on the Affordable Care Act, nullifying health insurance subsidies for some 6 million people in more than 30 states. The budget analysts said that would add a host of new uncertainties to their estimates. The Supreme Court ruling would not affect California's ACA exchange, called Covered California.\u003c/p>\n\u003caside class=\"pullquote alignright\">Meanwhile, a SCOTUS ruling that would affect some 6 million Obamacare enrollees in 30 states, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/22/california-unaffected-by-health-subsidy-court-case-king-v-burwell/\" target=\"_blank\">but not California\u003c/a>, is expected next week.\u003c/aside>\n\u003cp>Republicans now in control of both chambers of Congress say they are not backing away from their promise to repeal \"Obamacare.\"\u003c/p>\n\u003cp>But repealing the law's spending cuts and tax increases would add $137 billion to the federal deficit over the coming decade, CBO said in the report issued Friday, even though almost $1.7 trillion in coverage costs would disappear. Repeal would reduce deficits in the first few years but increase them steadily as time goes on.\u003c/p>\n\u003cp>Repeal would up the number of uninsured people by about 24 million people, and the share of U.S. adults with health insurance would drop from roughly 90 percent now to about 82 percent, the report said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On the other side of the balance sheet, the report says that completely repealing the law would, on average, boost the economy by 0.7 percent a year after the start of the '20s. That's mostly because more people would enter the workforce or work more hours to make up for the lack of government health care subsidies.\u003c/p>\n\u003cp>But the positive economic effects of repeal would fade over time, the budget agency said, offset by the increased budget deficits. Repeal of the excise tax on high-cost plans is a major reason why deficits would increase in later years, because more and more plans would be hit by this \"Cadillac tax.\"\u003c/p>\n\u003cp>The CBO provides lawmakers with nonpartisan budget and economic analysis. Republicans controlling Congress have increasingly asked the office to incorporate a broader range of potential economic consequences of major legislation into its work, and Friday's report is the first major study released since GOP appointee Keith Hall took over as CBO director. CBO analysts always caution that their studies of legislation can be uncertain, especially over many years.\u003c/p>\n\u003cp>Previously, CBO analyses would not have taken into account such a broad range of economic consequences. The agency said that using its earlier approach would have resulted in a bigger estimated impact on the deficit, an increase of $353 billion over the coming decade. Adding the economic factors cuts the repeal's effect on the deficit by more than half over 10 years, the report says.\u003c/p>\n\u003cp>The budget scorekeepers also offered a cautionary note to Congress: Obama's law is by now so enmeshed with the health care system that uprooting it would create its own issues.\u003c/p>\n\u003cp>\"Implementing a repeal of the ACA would present major challenges,\" the report said. \"In the five years since its enactment, nearly every key provision of the law has taken effect and has been incorporated into final rules and other administrative actions. Undoing the ACA would thus be quite complicated.\"\u003c/p>\n\u003cp>Unwinding changes to Medicare would be particularly difficult, the CBO said.\u003c/p>\n\u003cp>The health care law offers subsidized private health insurance policies to people who don't have access to coverage on the job, along with an expanded version of Medicaid geared to low-income adults, in states that have accepted the expansion.\u003c/p>\n\u003cp>If the law is repealed, about 18 million fewer people would have individual health insurance policies, and about 14 million fewer people would be covered under Medicaid, the report said. Gains in employer coverage would partially offset those losses, with 8 million more covered through job based insurance.\u003c/p>\n\u003cp>About 30 million people are still uninsured, even after two full years of coverage expansion under the law.\u003c/p>\n\u003cp>The study comes as Washington awaits the Supreme Court's decision on subsidies.\u003c/p>\n\u003cp>In a twist, the budget office suggested that if those subsidies are curtailed, it would reduce the projected savings from repealing the rest of the law. That's because the government would not be spending money to subsidize coverage in the affected states.\u003c/p>\n\u003cp>Conservatives who brought the lawsuit say the law's literal wording prevents the federal government from subsidizing private health insurance premiums in states that failed to set up their own insurance markets. Most have not done so, reflecting continued political opposition to the program. The administration argues that the law intended subsidies to be available in all states.\u003c/p>\n\u003cp>The Supreme Court is expected to issue the decision by the end of June.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Republicans in control of the House and Senate have said that if the court strikes down subsidies in the mostly GOP-held states that would be affected, they would try to advance legislation to ease the immediate effect on people who would lose coverage.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A nonpartisan government study says repealing President Barack Obama's signature health care law would modestly increase the budget deficit and the number of uninsured Americans would rise by more than 20 million.\u003c/p>\n\u003cp>The report from the Congressional Budget Office comes ahead of a highly anticipated Supreme Court ruling that could have a major impact on the Affordable Care Act, nullifying health insurance subsidies for some 6 million people in more than 30 states. The budget analysts said that would add a host of new uncertainties to their estimates. The Supreme Court ruling would not affect California's ACA exchange, called Covered California.\u003c/p>\n\u003caside class=\"pullquote alignright\">Meanwhile, a SCOTUS ruling that would affect some 6 million Obamacare enrollees in 30 states, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/22/california-unaffected-by-health-subsidy-court-case-king-v-burwell/\" target=\"_blank\">but not California\u003c/a>, is expected next week.\u003c/aside>\n\u003cp>Republicans now in control of both chambers of Congress say they are not backing away from their promise to repeal \"Obamacare.\"\u003c/p>\n\u003cp>But repealing the law's spending cuts and tax increases would add $137 billion to the federal deficit over the coming decade, CBO said in the report issued Friday, even though almost $1.7 trillion in coverage costs would disappear. Repeal would reduce deficits in the first few years but increase them steadily as time goes on.\u003c/p>\n\u003cp>Repeal would up the number of uninsured people by about 24 million people, and the share of U.S. adults with health insurance would drop from roughly 90 percent now to about 82 percent, the report said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On the other side of the balance sheet, the report says that completely repealing the law would, on average, boost the economy by 0.7 percent a year after the start of the '20s. That's mostly because more people would enter the workforce or work more hours to make up for the lack of government health care subsidies.\u003c/p>\n\u003cp>But the positive economic effects of repeal would fade over time, the budget agency said, offset by the increased budget deficits. Repeal of the excise tax on high-cost plans is a major reason why deficits would increase in later years, because more and more plans would be hit by this \"Cadillac tax.\"\u003c/p>\n\u003cp>The CBO provides lawmakers with nonpartisan budget and economic analysis. Republicans controlling Congress have increasingly asked the office to incorporate a broader range of potential economic consequences of major legislation into its work, and Friday's report is the first major study released since GOP appointee Keith Hall took over as CBO director. CBO analysts always caution that their studies of legislation can be uncertain, especially over many years.\u003c/p>\n\u003cp>Previously, CBO analyses would not have taken into account such a broad range of economic consequences. The agency said that using its earlier approach would have resulted in a bigger estimated impact on the deficit, an increase of $353 billion over the coming decade. Adding the economic factors cuts the repeal's effect on the deficit by more than half over 10 years, the report says.\u003c/p>\n\u003cp>The budget scorekeepers also offered a cautionary note to Congress: Obama's law is by now so enmeshed with the health care system that uprooting it would create its own issues.\u003c/p>\n\u003cp>\"Implementing a repeal of the ACA would present major challenges,\" the report said. \"In the five years since its enactment, nearly every key provision of the law has taken effect and has been incorporated into final rules and other administrative actions. Undoing the ACA would thus be quite complicated.\"\u003c/p>\n\u003cp>Unwinding changes to Medicare would be particularly difficult, the CBO said.\u003c/p>\n\u003cp>The health care law offers subsidized private health insurance policies to people who don't have access to coverage on the job, along with an expanded version of Medicaid geared to low-income adults, in states that have accepted the expansion.\u003c/p>\n\u003cp>If the law is repealed, about 18 million fewer people would have individual health insurance policies, and about 14 million fewer people would be covered under Medicaid, the report said. Gains in employer coverage would partially offset those losses, with 8 million more covered through job based insurance.\u003c/p>\n\u003cp>About 30 million people are still uninsured, even after two full years of coverage expansion under the law.\u003c/p>\n\u003cp>The study comes as Washington awaits the Supreme Court's decision on subsidies.\u003c/p>\n\u003cp>In a twist, the budget office suggested that if those subsidies are curtailed, it would reduce the projected savings from repealing the rest of the law. That's because the government would not be spending money to subsidize coverage in the affected states.\u003c/p>\n\u003cp>Conservatives who brought the lawsuit say the law's literal wording prevents the federal government from subsidizing private health insurance premiums in states that failed to set up their own insurance markets. Most have not done so, reflecting continued political opposition to the program. The administration argues that the law intended subsidies to be available in all states.\u003c/p>\n\u003cp>The Supreme Court is expected to issue the decision by the end of June.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Republicans in control of the House and Senate have said that if the court strikes down subsidies in the mostly GOP-held states that would be affected, they would try to advance legislation to ease the immediate effect on people who would lose coverage.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>For many Californians, the Affordable Care Act isn’t.\u003c/p>\n\u003cp>You’re not alone if you can’t afford your health insurance obligations, whether you’re struggling to pay your monthly premium or facing thousands of dollars in out-of-pocket costs.\u003c/p>\n\u003cp>“There are days when I can’t sleep, thinking ‘How am I going to do this?’” says Maria Chavez, a Whittier resident with a $625 monthly premium for a subsidized \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> plan for herself, her husband and one of her children.\u003c/p>\n\u003cp>Chavez is an example of how the cost of health insurance can still be ruinous despite the advent of the “Affordable” Care Act. Today, I’ll be addressing the strain of front-end costs: Premiums.\u003c/p>\n\u003cp>In my next column I’ll tackle the back end, including those intimidating deductibles that must be paid before insurance actually kicks in.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Q: I have cut my family budget, canceled cable and only buy shoes for my kids when they really need them. But I still can’t afford my premium. What should I do?\u003c/strong>\u003c/p>\n\u003cp>A: A recent \u003ca href=\"http://files.kff.org/attachment/report-coverage-expansions-and-the-remaining-uninsured-a-look-at-california-during-year-one-of-aca-implementation\" target=\"_blank\">Kaiser Family Foundation survey\u003c/a> of 4,555 Californians found that 44 percent of Covered California plan holders, like Chavez, say it’s “somewhat” or “very” difficult to pay their premiums even though the vast majority of them receive tax credits that subsidize their costs.\u003c/p>\n\u003cp>Individuals and families who make between 138 and 400 percent of the \u003ca href=\"http://aspe.hhs.gov/poverty/15poverty.cfm\" target=\"_blank\">Federal Poverty Level\u003c/a> (FPL) can qualify for Covered California’s sliding-scale tax credits.\u003c/p>\n\u003cp>For instance, a family of three making between $27,700 and $80,360 would qualify.\u003c/p>\n\u003cp>Nicole Carr, a Sacramento-area insurance agent, says 5 to 10 percent of her clients canceled their health plans between last year and this year because they couldn’t afford their premiums. They did so even though Obamacare requires \u003ca href=\"http://centerforhealthreporting.org/article/how-dodge-obamacare-tax-penalty-legally\" target=\"_blank\">most people\u003c/a> to have health insurance or face a tax penalty.\u003c/p>\n\u003cp>“They realized that the tax penalty (for not having insurance) was going to be less than paying the premium – even with the subsidy,” she says.\u003c/p>\n\u003cp>Chavez, 46, says she can’t cancel her plan because her husband is sick. Chavez receives $121 in monthly tax credits, leaving a premium of $625. She’s trying to modify her home loan to make up the difference.\u003c/p>\n\u003cp>“Just thinking about it, I stress out. I have a mortgage. I have two kids in college,” she says. “This is more expensive than I expected, but I have to find a way to make it work.”\u003c/p>\n\u003cp>Of the 88 percent of Covered California plan holders who receive tax credits, about three-quarters pay less than $150 per month on their premiums after the credits are applied, says James Scullary of Covered California.\u003c/p>\n\u003cp>But he acknowledges that “health care costs are still a challenge for many Covered California consumers.”\u003c/p>\n\u003cp>One problem, Scullary and others note, is that tax credits are based on a federal standard that doesn’t account for “California’s high cost of housing, transportation and food,” he says.\u003c/p>\n\u003cp>“Living on $40,000 in San Francisco may not be the same as living on $40,000 in certain places in the Midwest,” says Rachel Garfield, the lead author of the Kaiser Family Foundation report.\u003c/p>\n\u003cp>That’s also true \u003cem>within\u003c/em> California, says Scott Graves, director of research at the California Budget & Policy Center.\u003c/p>\n\u003cp>In Imperial County on the Mexico border, a single parent with two children would have to spend $748 on a two-bedroom apartment and utilities, he says. In Marin, it’s $2,062.\u003c/p>\n\u003cp>“The official federal poverty line is not an accurate measure of a family’s economic security,” he says.\u003c/p>\n\u003cp>But premium affordability isn’t unique to Covered California. Individuals and families whose incomes exceed 400 percent of FPL receive no subsidy if they buy plans from the open market. Premiums are even higher for older people, who are charged more than younger ones.\u003c/p>\n\u003cp>Kim Zarcone, 54, of Granada Hills spends about $1,000 a month for a plan that covers her and three of her children.\u003c/p>\n\u003cp>The premium is the family’s biggest bill, bigger than the mortgage. “We’re middle class,” she says. “We never go on vacation. My kids are paying for their own college.”\u003c/p>\n\u003cp>Last year, Zarcone had to drop coverage for three months because the family couldn’t afford it, all the while praying that everyone stayed healthy.\u003c/p>\n\u003cp>“I know a lot of people are being helped,” she says. “But the Affordable Care Act is not affordable for us.”\u003c/p>\n\u003cp>I usually end my columns with multiple pieces of advice, but in this case, I only have two:\u003c/p>\n\u003col>\n\u003cli>If you’re buying insurance from Covered California or the open market, seek help from \u003ca href=\"http://www.coveredca.com/get-help/local/\" target=\"_blank\">a certified insurance agent or enrollment counselor\u003c/a>, whose services are free. They can help you price out the best plans for your situation.\u003c/li>\n\u003cli>Check to see if you’re eligible for Covered California tax credits.\u003c/li>\n\u003c/ol>\n\u003cp>I’ll have more advice next time, when I examine the other challenge to affordability: out-of-pocket costs.\u003c/p>\n\u003cp>\u003cem>Qu\u003c/em>\u003cem>esti\u003c/em>\u003cem>ons for Emily: \u003c/em>\u003ca href=\"mailto:AskEmily@usc.edu\">\u003cem>AskEmily@usc.edu\u003c/em>\u003c/a>\u003cbr>\n\u003cem>Click \u003c/em>\u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\" target=\"_blank\">\u003cem>here\u003c/em>\u003c/a>\u003cem> to find previous Ask Emily columns. \u003c/em>\u003c/p>\n\u003cp>\u003cem> \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The \u003c/em>\u003ca href=\"http://www.centerforhealthreporting.org/\" target=\"_blank\">\u003cem>CHCF Center for Health Reporting\u003c/em>\u003c/a>\u003cem> partners with news organizations to cover California health policy. Located at the \u003c/em>\u003ca href=\"http://annenberg.usc.edu/\" target=\"_blank\">\u003cem>USC Annenberg School for Communication and Journalism\u003c/em>\u003c/a>\u003cem>, it is funded by the nonpartisan \u003c/em>\u003ca href=\"http://www.chcf.org/\" target=\"_blank\">\u003cem>California HealthCare Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For many Californians, the Affordable Care Act isn’t.\u003c/p>\n\u003cp>You’re not alone if you can’t afford your health insurance obligations, whether you’re struggling to pay your monthly premium or facing thousands of dollars in out-of-pocket costs.\u003c/p>\n\u003cp>“There are days when I can’t sleep, thinking ‘How am I going to do this?’” says Maria Chavez, a Whittier resident with a $625 monthly premium for a subsidized \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> plan for herself, her husband and one of her children.\u003c/p>\n\u003cp>Chavez is an example of how the cost of health insurance can still be ruinous despite the advent of the “Affordable” Care Act. Today, I’ll be addressing the strain of front-end costs: Premiums.\u003c/p>\n\u003cp>In my next column I’ll tackle the back end, including those intimidating deductibles that must be paid before insurance actually kicks in.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Q: I have cut my family budget, canceled cable and only buy shoes for my kids when they really need them. But I still can’t afford my premium. What should I do?\u003c/strong>\u003c/p>\n\u003cp>A: A recent \u003ca href=\"http://files.kff.org/attachment/report-coverage-expansions-and-the-remaining-uninsured-a-look-at-california-during-year-one-of-aca-implementation\" target=\"_blank\">Kaiser Family Foundation survey\u003c/a> of 4,555 Californians found that 44 percent of Covered California plan holders, like Chavez, say it’s “somewhat” or “very” difficult to pay their premiums even though the vast majority of them receive tax credits that subsidize their costs.\u003c/p>\n\u003cp>Individuals and families who make between 138 and 400 percent of the \u003ca href=\"http://aspe.hhs.gov/poverty/15poverty.cfm\" target=\"_blank\">Federal Poverty Level\u003c/a> (FPL) can qualify for Covered California’s sliding-scale tax credits.\u003c/p>\n\u003cp>For instance, a family of three making between $27,700 and $80,360 would qualify.\u003c/p>\n\u003cp>Nicole Carr, a Sacramento-area insurance agent, says 5 to 10 percent of her clients canceled their health plans between last year and this year because they couldn’t afford their premiums. They did so even though Obamacare requires \u003ca href=\"http://centerforhealthreporting.org/article/how-dodge-obamacare-tax-penalty-legally\" target=\"_blank\">most people\u003c/a> to have health insurance or face a tax penalty.\u003c/p>\n\u003cp>“They realized that the tax penalty (for not having insurance) was going to be less than paying the premium – even with the subsidy,” she says.\u003c/p>\n\u003cp>Chavez, 46, says she can’t cancel her plan because her husband is sick. Chavez receives $121 in monthly tax credits, leaving a premium of $625. She’s trying to modify her home loan to make up the difference.\u003c/p>\n\u003cp>“Just thinking about it, I stress out. I have a mortgage. I have two kids in college,” she says. “This is more expensive than I expected, but I have to find a way to make it work.”\u003c/p>\n\u003cp>Of the 88 percent of Covered California plan holders who receive tax credits, about three-quarters pay less than $150 per month on their premiums after the credits are applied, says James Scullary of Covered California.\u003c/p>\n\u003cp>But he acknowledges that “health care costs are still a challenge for many Covered California consumers.”\u003c/p>\n\u003cp>One problem, Scullary and others note, is that tax credits are based on a federal standard that doesn’t account for “California’s high cost of housing, transportation and food,” he says.\u003c/p>\n\u003cp>“Living on $40,000 in San Francisco may not be the same as living on $40,000 in certain places in the Midwest,” says Rachel Garfield, the lead author of the Kaiser Family Foundation report.\u003c/p>\n\u003cp>That’s also true \u003cem>within\u003c/em> California, says Scott Graves, director of research at the California Budget & Policy Center.\u003c/p>\n\u003cp>In Imperial County on the Mexico border, a single parent with two children would have to spend $748 on a two-bedroom apartment and utilities, he says. In Marin, it’s $2,062.\u003c/p>\n\u003cp>“The official federal poverty line is not an accurate measure of a family’s economic security,” he says.\u003c/p>\n\u003cp>But premium affordability isn’t unique to Covered California. Individuals and families whose incomes exceed 400 percent of FPL receive no subsidy if they buy plans from the open market. Premiums are even higher for older people, who are charged more than younger ones.\u003c/p>\n\u003cp>Kim Zarcone, 54, of Granada Hills spends about $1,000 a month for a plan that covers her and three of her children.\u003c/p>\n\u003cp>The premium is the family’s biggest bill, bigger than the mortgage. “We’re middle class,” she says. “We never go on vacation. My kids are paying for their own college.”\u003c/p>\n\u003cp>Last year, Zarcone had to drop coverage for three months because the family couldn’t afford it, all the while praying that everyone stayed healthy.\u003c/p>\n\u003cp>“I know a lot of people are being helped,” she says. “But the Affordable Care Act is not affordable for us.”\u003c/p>\n\u003cp>I usually end my columns with multiple pieces of advice, but in this case, I only have two:\u003c/p>\n\u003col>\n\u003cli>If you’re buying insurance from Covered California or the open market, seek help from \u003ca href=\"http://www.coveredca.com/get-help/local/\" target=\"_blank\">a certified insurance agent or enrollment counselor\u003c/a>, whose services are free. They can help you price out the best plans for your situation.\u003c/li>\n\u003cli>Check to see if you’re eligible for Covered California tax credits.\u003c/li>\n\u003c/ol>\n\u003cp>I’ll have more advice next time, when I examine the other challenge to affordability: out-of-pocket costs.\u003c/p>\n\u003cp>\u003cem>Qu\u003c/em>\u003cem>esti\u003c/em>\u003cem>ons for Emily: \u003c/em>\u003ca href=\"mailto:AskEmily@usc.edu\">\u003cem>AskEmily@usc.edu\u003c/em>\u003c/a>\u003cbr>\n\u003cem>Click \u003c/em>\u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\" target=\"_blank\">\u003cem>here\u003c/em>\u003c/a>\u003cem> to find previous Ask Emily columns. \u003c/em>\u003c/p>\n\u003cp>\u003cem> \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The \u003c/em>\u003ca href=\"http://www.centerforhealthreporting.org/\" target=\"_blank\">\u003cem>CHCF Center for Health Reporting\u003c/em>\u003c/a>\u003cem> partners with news organizations to cover California health policy. Located at the \u003c/em>\u003ca href=\"http://annenberg.usc.edu/\" target=\"_blank\">\u003cem>USC Annenberg School for Communication and Journalism\u003c/em>\u003c/a>\u003cem>, it is funded by the nonpartisan \u003c/em>\u003ca href=\"http://www.chcf.org/\" target=\"_blank\">\u003cem>California HealthCare Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Turning 26? Happy 'Health Care Birthday'-- Time to Buy Health Insurance!",
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"content": "\u003cp>Under the Affordable Care Act, young people can now stay on their parents' health insurance until they turn 26. At that point, they must either get insurance through their employer or purchase it through the insurance marketplace.\u003c/p>\n\u003cp>In April, KPCC's photojournalist \u003ca href=\"https://twitter.com/mayasugarman?lang=en\">Maya Sugarman \u003c/a>reached this milestone, which she dubbed her \"health care birthday.\"\u003c/p>\n\u003cp>\"I was thinking a lot about how every birthday has its own rite of passage,\" Sugarman explains. \"When you turn 18, you buy a lottery ticket; when you turn 21, you go to a bar. And I figured, I'm turning 26 this April, I'm getting new health care.\"\u003c/p>\n\u003cp>\"I kind of joked with a lot of my friends, 'You guys, now I'm mature, because I'm on my own health care plan! I'm not on my parents' plan anymore,\" she said. \"I felt like it's a sign of maturity.\"\u003c/p>\n\u003cp>However there's a wide gulf between buying a new health insurance plan -- and actually knowing how to use it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Consider this: Just 29 percent of young adults say they feel very or somewhat confident in their understanding of health insurance terminology, according to a survey conducted by the Urban Institute and published on the \u003ca href=\"http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=105\" target=\"_blank\">Health Affairs\u003c/a> blog in December 2013.\u003c/p>\n\u003cp>Here are some tips for navigating the crazy world of health insurance, if you -- or someone you know -- are buying insurance for the first time. (And \u003ca href=\"http://www.scribd.com/doc/268192681/KPCC-s-Health-Care-Birthday-Card\" target=\"_blank\">here's\u003c/a> a birthday card, created by Sugarman, that you can share with your friends when they turn 26!)\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/268192681/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_73153\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>\u003cstrong>Consider What Type of Plan Fits Your Lifestyle, Budget\u003c/strong>\u003c/p>\n\u003cp>Whether you're buying insurance through Covered California or you're getting it through your employer, you're likely to encounter:\u003c/p>\n\u003cul>\n\u003cli>Plans with a higher monthly premium and a lower annual deductible\u003c/li>\n\u003cli>Plans with a lower monthly premium and a higher annual deductible\u003c/li>\n\u003c/ul>\n\u003cp>So which one is right for you? Gerald Kominski, director of the UCLA Center for Health Policy Research, says young people should look closely at their plan options and consider a few factors:\u003c/p>\n\u003cul>\n\u003cli>What happens when I actually go to see the doctor?\u003c/li>\n\u003cli>What happens if I need to go to the emergency room?\u003c/li>\n\u003cli>How much am I going to have to pay before my insurance starts covering a portion of my medical bill?\u003c/li>\n\u003c/ul>\n\u003cp>My KPCC colleague Take Two producer Jacob Margolis selected a higher-premium, lower-deductible plan when he turned 26 earlier this year.\u003c/p>\n\u003cp>\"I chose that one because I assumed that I'd be in the hospital more often,\" says Margolis, an avid cyclist. \"About once a year I seem to have some catastrophic bike incident.\"\u003c/p>\n\u003cp>Sugarman chose the same plan. She explains, \"I decided that I wanted to pay more every month,\" she explains, \"knowing that I could have the peace of mind that if something drastic were to happen to me, I wouldn't have to worry about the financial part of it.\"\u003c/p>\n\u003cp>When it comes to deciding between higher-premium and higher-deductible plans, a lot of young people have made similar calculations. (If these words are already making your head spin, check out KPCC's \u003ca href=\"http://www.scpr.org/news/2013/12/04/40736/faq-what-the-heck-do-all-of-those-health-insurance/\" target=\"_blank\">glossary\u003c/a> of health insurance terms.)\u003c/p>\n\u003cp>\"The young people we spoke with felt they'd rather pay a bit more each month to prevent having to pay large sums out-of-pocket, in the event that something serious did happen,\" says Christina Postlolowski, health policy manager for the advocacy group Young Invincibles.\u003c/p>\n\u003cp>She notes that in both California and nationally, young people by and large have signed up for so-called Silver Plans, and \"this was striking to see that our generation didn't just care about getting any plan, but wanted that comprehensive coverage that was going to protect their health as well as their pocketbook.\"\u003c/p>\n\u003cp>\u003cstrong>Get A Primary Care Doctor in Your Plan’s Network\u003c/strong>\u003c/p>\n\u003cp>Once you've selected an insurance plan, you need to find a primary care physician. If your longtime doctor is not in your plan's network, then you'll need to find a new one.\u003c/p>\n\u003cp>And that can be a challenge, as Sugarman learned. She called various doctors' offices and learned they weren't taking new patients or wouldn't accept her insurance.\u003c/p>\n\u003cp>\"I just found that I was running into so much red tape, that I just didn't want to do it anymore,\" she says. \"It was too complicated.\"\u003c/p>\n\u003cp>But even when you find an in-network doctor who's taking new patients, there's still more work to do. Claire Brindis, the executive director of the National Adolescent and Young Adult Health Information Center at UCSF, says young people should approach their doctor search from the perspective of a discerning consumer.\u003c/p>\n\u003cp>\"For young adults, it's really important to feel comfortable with the way that they're treated, either on the phone, or whether they can set up an appointment at their convenience through an email process,\" she says, \"So young adults need to be health consumers, to be sure that they feel positive about who they've signed up to be their provider.\"\u003c/p>\n\u003cp>Need incentive to find a primary care doctor? Once you have one, you can get an annual check-up that’s fully covered by insurance, as well as other preventive care that’s also covered, like vaccines, HIV and STI tests and depression screenings.\u003c/p>\n\u003cp>\u003cstrong>Get to Know Your Health Plan\u003c/strong>\u003c/p>\n\u003cp>Margolis wishes he'd found a primary care doctor before he left for a recent vacation in Mexico. He got sick while he was there and had to learn to navigate his new insurance plan while he was under the weather.\u003c/p>\n\u003cp>His advice? \"Get everything together early, because then you'll go on a trip to Mexico City, get some sort of weird thing that's going to need all of these blood tests, and you're going to be rushing around trying to find a doctor to take care of you,\" he says.\u003c/p>\n\u003cp>And remember: If you don't understand how your plan works, don't be afraid to ask questions!\u003c/p>\n\u003cp>Of course, you can always turn to the internet for help. Young Invincibles offers \u003ca href=\"http://younginvincibles.org/readysetenroll/\" target=\"_blank\">these answers\u003c/a> to your frequently asked questions. It's also developed a \u003ca href=\"http://app.healthyyoungamerica.org\" target=\"_blank\">mobile app\u003c/a> - called Healthy Young America - that helps you get insurance, find a doctor and calculate your discount.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>If you recently bought your own insurance for the first time, what was your experience like? What do you wish you had known in advance? Do you have questions about your plan? Let me know in the comments section below or e-mail me at Impatient@scpr.org.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Under the Affordable Care Act, young people can now stay on their parents' health insurance until they turn 26. At that point, they must either get insurance through their employer or purchase it through the insurance marketplace.\u003c/p>\n\u003cp>In April, KPCC's photojournalist \u003ca href=\"https://twitter.com/mayasugarman?lang=en\">Maya Sugarman \u003c/a>reached this milestone, which she dubbed her \"health care birthday.\"\u003c/p>\n\u003cp>\"I was thinking a lot about how every birthday has its own rite of passage,\" Sugarman explains. \"When you turn 18, you buy a lottery ticket; when you turn 21, you go to a bar. And I figured, I'm turning 26 this April, I'm getting new health care.\"\u003c/p>\n\u003cp>\"I kind of joked with a lot of my friends, 'You guys, now I'm mature, because I'm on my own health care plan! I'm not on my parents' plan anymore,\" she said. \"I felt like it's a sign of maturity.\"\u003c/p>\n\u003cp>However there's a wide gulf between buying a new health insurance plan -- and actually knowing how to use it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Consider this: Just 29 percent of young adults say they feel very or somewhat confident in their understanding of health insurance terminology, according to a survey conducted by the Urban Institute and published on the \u003ca href=\"http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=105\" target=\"_blank\">Health Affairs\u003c/a> blog in December 2013.\u003c/p>\n\u003cp>Here are some tips for navigating the crazy world of health insurance, if you -- or someone you know -- are buying insurance for the first time. (And \u003ca href=\"http://www.scribd.com/doc/268192681/KPCC-s-Health-Care-Birthday-Card\" target=\"_blank\">here's\u003c/a> a birthday card, created by Sugarman, that you can share with your friends when they turn 26!)\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/268192681/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_73153\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>\u003cstrong>Consider What Type of Plan Fits Your Lifestyle, Budget\u003c/strong>\u003c/p>\n\u003cp>Whether you're buying insurance through Covered California or you're getting it through your employer, you're likely to encounter:\u003c/p>\n\u003cul>\n\u003cli>Plans with a higher monthly premium and a lower annual deductible\u003c/li>\n\u003cli>Plans with a lower monthly premium and a higher annual deductible\u003c/li>\n\u003c/ul>\n\u003cp>So which one is right for you? Gerald Kominski, director of the UCLA Center for Health Policy Research, says young people should look closely at their plan options and consider a few factors:\u003c/p>\n\u003cul>\n\u003cli>What happens when I actually go to see the doctor?\u003c/li>\n\u003cli>What happens if I need to go to the emergency room?\u003c/li>\n\u003cli>How much am I going to have to pay before my insurance starts covering a portion of my medical bill?\u003c/li>\n\u003c/ul>\n\u003cp>My KPCC colleague Take Two producer Jacob Margolis selected a higher-premium, lower-deductible plan when he turned 26 earlier this year.\u003c/p>\n\u003cp>\"I chose that one because I assumed that I'd be in the hospital more often,\" says Margolis, an avid cyclist. \"About once a year I seem to have some catastrophic bike incident.\"\u003c/p>\n\u003cp>Sugarman chose the same plan. She explains, \"I decided that I wanted to pay more every month,\" she explains, \"knowing that I could have the peace of mind that if something drastic were to happen to me, I wouldn't have to worry about the financial part of it.\"\u003c/p>\n\u003cp>When it comes to deciding between higher-premium and higher-deductible plans, a lot of young people have made similar calculations. (If these words are already making your head spin, check out KPCC's \u003ca href=\"http://www.scpr.org/news/2013/12/04/40736/faq-what-the-heck-do-all-of-those-health-insurance/\" target=\"_blank\">glossary\u003c/a> of health insurance terms.)\u003c/p>\n\u003cp>\"The young people we spoke with felt they'd rather pay a bit more each month to prevent having to pay large sums out-of-pocket, in the event that something serious did happen,\" says Christina Postlolowski, health policy manager for the advocacy group Young Invincibles.\u003c/p>\n\u003cp>She notes that in both California and nationally, young people by and large have signed up for so-called Silver Plans, and \"this was striking to see that our generation didn't just care about getting any plan, but wanted that comprehensive coverage that was going to protect their health as well as their pocketbook.\"\u003c/p>\n\u003cp>\u003cstrong>Get A Primary Care Doctor in Your Plan’s Network\u003c/strong>\u003c/p>\n\u003cp>Once you've selected an insurance plan, you need to find a primary care physician. If your longtime doctor is not in your plan's network, then you'll need to find a new one.\u003c/p>\n\u003cp>And that can be a challenge, as Sugarman learned. She called various doctors' offices and learned they weren't taking new patients or wouldn't accept her insurance.\u003c/p>\n\u003cp>\"I just found that I was running into so much red tape, that I just didn't want to do it anymore,\" she says. \"It was too complicated.\"\u003c/p>\n\u003cp>But even when you find an in-network doctor who's taking new patients, there's still more work to do. Claire Brindis, the executive director of the National Adolescent and Young Adult Health Information Center at UCSF, says young people should approach their doctor search from the perspective of a discerning consumer.\u003c/p>\n\u003cp>\"For young adults, it's really important to feel comfortable with the way that they're treated, either on the phone, or whether they can set up an appointment at their convenience through an email process,\" she says, \"So young adults need to be health consumers, to be sure that they feel positive about who they've signed up to be their provider.\"\u003c/p>\n\u003cp>Need incentive to find a primary care doctor? Once you have one, you can get an annual check-up that’s fully covered by insurance, as well as other preventive care that’s also covered, like vaccines, HIV and STI tests and depression screenings.\u003c/p>\n\u003cp>\u003cstrong>Get to Know Your Health Plan\u003c/strong>\u003c/p>\n\u003cp>Margolis wishes he'd found a primary care doctor before he left for a recent vacation in Mexico. He got sick while he was there and had to learn to navigate his new insurance plan while he was under the weather.\u003c/p>\n\u003cp>His advice? \"Get everything together early, because then you'll go on a trip to Mexico City, get some sort of weird thing that's going to need all of these blood tests, and you're going to be rushing around trying to find a doctor to take care of you,\" he says.\u003c/p>\n\u003cp>And remember: If you don't understand how your plan works, don't be afraid to ask questions!\u003c/p>\n\u003cp>Of course, you can always turn to the internet for help. Young Invincibles offers \u003ca href=\"http://younginvincibles.org/readysetenroll/\" target=\"_blank\">these answers\u003c/a> to your frequently asked questions. It's also developed a \u003ca href=\"http://app.healthyyoungamerica.org\" target=\"_blank\">mobile app\u003c/a> - called Healthy Young America - that helps you get insurance, find a doctor and calculate your discount.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>I’m filled with dread every time I open my mailbox to find an “\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">Explanation of Benefits\u003c/a>” from my health insurer.\u003c/p>\n\u003cp>It’s bad enough when my portion of the tab is what I expected. But I virtually lose it when my bill is more than it should be.\u003c/p>\n\u003cp>A survey \u003ca href=\"http://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\">last month\u003c/a> by Consumers Union found that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\">nearly one in four Californians\u003c/a> with private insurance faces surprise medical bills, in which the insurer paid less than expected.\u003c/p>\n\u003cp>Today, I’m going to give you some very simple advice to deploy if -- and when -- you receive a surprise bill:\u003c/p>\n\u003cp>Fight it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This advice applies to people with private insurance -- purchased either on or off the Covered California marketplace -- or employer-sponsored coverage.\u003c/p>\n\u003cp>It also applies to a broad range of surprises, whether you think you were charged too much for a procedure, wrongly penalized for going out of network or otherwise incorrectly billed.\u003c/p>\n\u003cp>“At least 50 percent of the time, you will prevail,” says Wendell Potter, a former health insurance company executive and author of “\u003ca href=\"http://wendellpotter.com/deadlyspin/\" target=\"_blank\">Deadly Spin\u003c/a>,” an exposé about the health insurance industry’s practices.\u003c/p>\n\u003cp>“It’s very much worth it” to fight, he says.\u003c/p>\n\u003cp>\u003cstrong>Q: My insurance company billed me for going to an out-of-network doctor, but the same insurer told me beforehand that the doctor is in-network. What should I do?\u003c/strong>\u003c/p>\n\u003cp>A: It’s time to make some calls.\u003c/p>\n\u003cp>Many of you don’t realize you have appeal rights. Or you give up before trying.\u003c/p>\n\u003cp>In the Consumers Union survey, 40 percent of those who received surprise bills didn’t take action.\u003c/p>\n\u003cp>More than half of those said it was because they “didn’t think it would make a difference,” and 18 percent said they didn’t know how to complain.\u003c/p>\n\u003cp>“People often are intimidated by the process of trying to get their insurance company to approve something that’s been denied,” Potter says.\u003c/p>\n\u003cp>Insurance companies know it and bank on it, he says.\u003c/p>\n\u003cp>“They know that people are not very savvy when it comes to dealing with insurance companies,” he says.\u003c/p>\n\u003cp>It’s time to get savvy.\u003c/p>\n\u003cp>Start with your insurer. The Explanation of Benefits will have instructions explaining how to contest the bill, or just call the customer service number on your health insurance card.\u003c/p>\n\u003cp>Insurance companies devote entire departments to consumer appeals and urge you to take action if there’s something amiss with your bill, says Nicole Kasabian Evans of the California Association of Health Plans.\u003c/p>\n\u003cp>“If you have a concern, or something looks or feels funny, challenge it,” she says.\u003c/p>\n\u003cp>If your appeal isn’t resolved within 30 days or you’re not satisfied with the outcome, go to your regulator, says Rodger Butler, spokesman with the state Department of Managed Health Care (DMHC).\u003c/p>\n\u003cp>I wish I could tell you there’s just one regulator for everyone, but in California, we have two state departments with authority over health plans: DMHC and the Department of Insurance.\u003c/p>\n\u003cp>(To complicate matters, for \u003ca href=\"http://www.nciom.org/wp-content/uploads/2003/01/C11.pdf\" target=\"_blank\">some people with employer-sponsored insurance\u003c/a>, the U.S. Department of Labor is the regulator.)\u003c/p>\n\u003cp>To simplify, start by calling DMHC’s Help Center at 888-466-2219. DMHC regulates the \u003ca href=\"http://stage.chcf.org/articles/2015/05/enrollment-individual-up\" target=\"_blank\">vast majority\u003c/a> of individual/family, small business and large-group health plans in the state.\u003c/p>\n\u003cp>“If you don’t know who to call, call us,” Butler says.\u003c/p>\n\u003cp>If DMHC is your regulator, you can move forward with the appeal process by phone or \u003ca href=\"http://dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForm.aspx#.VV-uBGRViko\" target=\"_blank\">file your complaint online\u003c/a> (\u003ca href=\"http://www.HealthHelp.ca.gov\" target=\"_blank\">www.HealthHelp.ca.gov\u003c/a>). If not, the Help Center can connect you to the correct regulator, Butler says.\u003c/p>\n\u003cp>If you’ve gone through that process and you’re still facing a bill, go to the doctor, hospital or other provider where you received the service and bargain, suggests Julie Silas, senior attorney at Consumers Union.\u003c/p>\n\u003cp>“It’s worth picking up the phone and seeing if you can negotiate a reduced bill or payment plan with your provider,” she says.\u003c/p>\n\u003cp>I realize that fighting your insurance company doesn’t sound pleasant, especially if you’re sick and in treatment.\u003c/p>\n\u003cp>But you have allies.\u003c/p>\n\u003cp>“We can assist in the appeal process with the insurer so that consumers don’t have to do it themselves,” says Janice Rocco, deputy commissioner at the Department of Insurance.\u003c/p>\n\u003cp>I won’t deny that fighting an insurance bill requires time, effort and probably some frustration, even if you get help. But given the complexity of the health insurance world -- and the dizzying pace of change -- you need to be active and engaged in your coverage.\u003c/p>\n\u003cp>“This is an example of the changing landscape of health care, where the consumer really needs to be their own advocate,” Kasabian Evans says.\u003c/p>\n\u003cp>Potter puts it another way: “It’s important to be a squeaky wheel.”\u003c/p>\n\u003cp>His tips:\u003c/p>\n\u003cul>\n\u003cli>Be persistent. “If you make one call and don’t make progress, call again and keep calling,” he says.\u003c/li>\n\u003cli>Be organized. Note the time and date of your calls with customer service representatives, and the name of the person you’re talking to. If you mail documents, make a copy for your files first.\u003c/li>\n\u003cli>Most insurance companies have executive teams that deal with “squeaky wheels,” Potter says. “If you send a letter to the CEO, there’s a good chance that letter will be sent to the people who are dedicated to high-profile cases,” he says.\u003c/li>\n\u003cli>If all else fails, he says, “you might hire an attorney.”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>Qu\u003c/em>\u003cem>esti\u003c/em>\u003cem>ons for Emily: \u003c/em>\u003ca href=\"mailto:AskEmily@usc.edu\">\u003cem>AskEmily@usc.edu\u003c/em>\u003c/a>\u003cbr>\n\u003cem>Click \u003c/em>\u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\">\u003cem>here\u003c/em>\u003c/a>\u003cem> to find previous Ask Emily columns. \u003c/em>\u003c/p>\n\u003cp>\u003cem> \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The \u003c/em>\u003ca href=\"http://www.centerforhealthreporting.org/\">\u003cem>CHCF Center for Health Reporting\u003c/em>\u003c/a>\u003cem> partners with news organizations to cover California health policy. Located at the \u003c/em>\u003ca href=\"http://annenberg.usc.edu/\">\u003cem>USC Annenberg School for Communication and Journalism\u003c/em>\u003c/a>\u003cem>, it is funded by the nonpartisan \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>California HealthCare Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>I’m filled with dread every time I open my mailbox to find an “\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">Explanation of Benefits\u003c/a>” from my health insurer.\u003c/p>\n\u003cp>It’s bad enough when my portion of the tab is what I expected. But I virtually lose it when my bill is more than it should be.\u003c/p>\n\u003cp>A survey \u003ca href=\"http://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\">last month\u003c/a> by Consumers Union found that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\">nearly one in four Californians\u003c/a> with private insurance faces surprise medical bills, in which the insurer paid less than expected.\u003c/p>\n\u003cp>Today, I’m going to give you some very simple advice to deploy if -- and when -- you receive a surprise bill:\u003c/p>\n\u003cp>Fight it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This advice applies to people with private insurance -- purchased either on or off the Covered California marketplace -- or employer-sponsored coverage.\u003c/p>\n\u003cp>It also applies to a broad range of surprises, whether you think you were charged too much for a procedure, wrongly penalized for going out of network or otherwise incorrectly billed.\u003c/p>\n\u003cp>“At least 50 percent of the time, you will prevail,” says Wendell Potter, a former health insurance company executive and author of “\u003ca href=\"http://wendellpotter.com/deadlyspin/\" target=\"_blank\">Deadly Spin\u003c/a>,” an exposé about the health insurance industry’s practices.\u003c/p>\n\u003cp>“It’s very much worth it” to fight, he says.\u003c/p>\n\u003cp>\u003cstrong>Q: My insurance company billed me for going to an out-of-network doctor, but the same insurer told me beforehand that the doctor is in-network. What should I do?\u003c/strong>\u003c/p>\n\u003cp>A: It’s time to make some calls.\u003c/p>\n\u003cp>Many of you don’t realize you have appeal rights. Or you give up before trying.\u003c/p>\n\u003cp>In the Consumers Union survey, 40 percent of those who received surprise bills didn’t take action.\u003c/p>\n\u003cp>More than half of those said it was because they “didn’t think it would make a difference,” and 18 percent said they didn’t know how to complain.\u003c/p>\n\u003cp>“People often are intimidated by the process of trying to get their insurance company to approve something that’s been denied,” Potter says.\u003c/p>\n\u003cp>Insurance companies know it and bank on it, he says.\u003c/p>\n\u003cp>“They know that people are not very savvy when it comes to dealing with insurance companies,” he says.\u003c/p>\n\u003cp>It’s time to get savvy.\u003c/p>\n\u003cp>Start with your insurer. The Explanation of Benefits will have instructions explaining how to contest the bill, or just call the customer service number on your health insurance card.\u003c/p>\n\u003cp>Insurance companies devote entire departments to consumer appeals and urge you to take action if there’s something amiss with your bill, says Nicole Kasabian Evans of the California Association of Health Plans.\u003c/p>\n\u003cp>“If you have a concern, or something looks or feels funny, challenge it,” she says.\u003c/p>\n\u003cp>If your appeal isn’t resolved within 30 days or you’re not satisfied with the outcome, go to your regulator, says Rodger Butler, spokesman with the state Department of Managed Health Care (DMHC).\u003c/p>\n\u003cp>I wish I could tell you there’s just one regulator for everyone, but in California, we have two state departments with authority over health plans: DMHC and the Department of Insurance.\u003c/p>\n\u003cp>(To complicate matters, for \u003ca href=\"http://www.nciom.org/wp-content/uploads/2003/01/C11.pdf\" target=\"_blank\">some people with employer-sponsored insurance\u003c/a>, the U.S. Department of Labor is the regulator.)\u003c/p>\n\u003cp>To simplify, start by calling DMHC’s Help Center at 888-466-2219. DMHC regulates the \u003ca href=\"http://stage.chcf.org/articles/2015/05/enrollment-individual-up\" target=\"_blank\">vast majority\u003c/a> of individual/family, small business and large-group health plans in the state.\u003c/p>\n\u003cp>“If you don’t know who to call, call us,” Butler says.\u003c/p>\n\u003cp>If DMHC is your regulator, you can move forward with the appeal process by phone or \u003ca href=\"http://dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForm.aspx#.VV-uBGRViko\" target=\"_blank\">file your complaint online\u003c/a> (\u003ca href=\"http://www.HealthHelp.ca.gov\" target=\"_blank\">www.HealthHelp.ca.gov\u003c/a>). If not, the Help Center can connect you to the correct regulator, Butler says.\u003c/p>\n\u003cp>If you’ve gone through that process and you’re still facing a bill, go to the doctor, hospital or other provider where you received the service and bargain, suggests Julie Silas, senior attorney at Consumers Union.\u003c/p>\n\u003cp>“It’s worth picking up the phone and seeing if you can negotiate a reduced bill or payment plan with your provider,” she says.\u003c/p>\n\u003cp>I realize that fighting your insurance company doesn’t sound pleasant, especially if you’re sick and in treatment.\u003c/p>\n\u003cp>But you have allies.\u003c/p>\n\u003cp>“We can assist in the appeal process with the insurer so that consumers don’t have to do it themselves,” says Janice Rocco, deputy commissioner at the Department of Insurance.\u003c/p>\n\u003cp>I won’t deny that fighting an insurance bill requires time, effort and probably some frustration, even if you get help. But given the complexity of the health insurance world -- and the dizzying pace of change -- you need to be active and engaged in your coverage.\u003c/p>\n\u003cp>“This is an example of the changing landscape of health care, where the consumer really needs to be their own advocate,” Kasabian Evans says.\u003c/p>\n\u003cp>Potter puts it another way: “It’s important to be a squeaky wheel.”\u003c/p>\n\u003cp>His tips:\u003c/p>\n\u003cul>\n\u003cli>Be persistent. “If you make one call and don’t make progress, call again and keep calling,” he says.\u003c/li>\n\u003cli>Be organized. Note the time and date of your calls with customer service representatives, and the name of the person you’re talking to. If you mail documents, make a copy for your files first.\u003c/li>\n\u003cli>Most insurance companies have executive teams that deal with “squeaky wheels,” Potter says. “If you send a letter to the CEO, there’s a good chance that letter will be sent to the people who are dedicated to high-profile cases,” he says.\u003c/li>\n\u003cli>If all else fails, he says, “you might hire an attorney.”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>Qu\u003c/em>\u003cem>esti\u003c/em>\u003cem>ons for Emily: \u003c/em>\u003ca href=\"mailto:AskEmily@usc.edu\">\u003cem>AskEmily@usc.edu\u003c/em>\u003c/a>\u003cbr>\n\u003cem>Click \u003c/em>\u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\">\u003cem>here\u003c/em>\u003c/a>\u003cem> to find previous Ask Emily columns. \u003c/em>\u003c/p>\n\u003cp>\u003cem> \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The \u003c/em>\u003ca href=\"http://www.centerforhealthreporting.org/\">\u003cem>CHCF Center for Health Reporting\u003c/em>\u003c/a>\u003cem> partners with news organizations to cover California health policy. Located at the \u003c/em>\u003ca href=\"http://annenberg.usc.edu/\">\u003cem>USC Annenberg School for Communication and Journalism\u003c/em>\u003c/a>\u003cem>, it is funded by the nonpartisan \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>California HealthCare Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Newly Insured Californians Wary of Costs But Embrace Coverage",
"title": "Newly Insured Californians Wary of Costs But Embrace Coverage",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Many Californians who obtained health insurance last year said they struggled to pay their premiums, although having coverage made them more confident about affording future medical care, according to a survey released Thursday.\u003c/p>\n\u003cp>Nearly half of newly insured adults in the state said it was difficult to afford the monthly premium and more than a third delayed or went without care, according to \u003ca title=\"survey\" href=\"http://kff.org/health-reform/report/coverage-expansions-and-the-remaining-uninsured-a-look-at-california-during-year-one-of-aca-implementation/?utm_campaign=KFF%3A+General&utm_source=hs_email&utm_medium=email&utm_content=17950384&_hsenc=p2ANqtz-9E1EfXAzfT1gKOvsyrLmTQOeHTZcD7TOPGiBb6ZDZ5lO31JWPgUeI3pz622RI0s30e3A00CZCcb9deDngRHLJ6rtj1iQ&_hsmi=17950384\" target=\"_blank\">the survey conducted by the Kaiser Family Foundation. \u003c/a>\u003c/p>\n\u003cp>The data highlight that health care costs continue to be a worry for many low-income Californians, even with more affordable insurance options available through Obamacare.\u003c/p>\n\u003cp>“Most of them are still in somewhat precarious financial positions,” said Rachel Garfield, senior researcher at the foundation. “Any monthly cost … can be difficult for these families to afford.”\u003c/p>\n\u003cp>Nevertheless, newly insured Californians appear to be using their coverage. Nearly 60 percent obtained at least one medical service, and almost half got a check-up, according to the survey.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Affordable Care Act allowed states to expand Medicaid and created health insurance marketplaces in which consumers could receive government financial help to purchase insurance. In California, more than 4 million people obtained coverage through Medi-Cal, the state’s version of Medicaid, and the exchange, known as Covered California.\u003c/p>\n\u003cp>“We are seeing some ongoing challenges,” Garfield said. “But the coverage is working quite well.”\u003c/p>\n\u003cp>Even though the monthly premium was seen as a burden, insured consumers reported that they didn’t have as much trouble paying other medical bills as those who remained uninsured.\u003c/p>\n\u003cp>Covered California Executive Director Peter Lee said he wasn’t surprised that health care is still expensive for consumers, both in and out of the exchange. He said it’s an issue that Covered California is continuing to work on. The insurance exchange is now negotiating 2016 rates with health plans and recently made changes so more of consumers’ medical visits are covered. “It’s not just about keeping premiums low today,” Lee said. “We have to address underlying health care costs.”\u003c/p>\n\u003cp>Lee said he was encouraged by the findings that high percentages of consumers are getting preventive treatment and that most are able to access care easily.\u003c/p>\n\u003cp>Not surprisingly, newly insured adults were more likely than those who remained uninsured to have a regular doctor and a usual place to go for health care, according to the survey. For many consumers, that place was a community health center. Health centers made a significant effort to retain patients and attract new ones, and they opened new sites statewide to meet the need.\u003c/p>\n\u003cp>Some newly insured residents, however, said they had trouble getting medical appointments because of their public or government-subsidized coverage.\u003c/p>\n\u003cp>While only 3 percent of adults with private plans said a doctor wouldn’t see them, 13 percent of those with Covered California plans and 8 percent of those with Medi-Cal said providers turned them away. In addition, about a fifth of newly insured adults changed where they went for medical care, with most citing their insurance as the reason.\u003c/p>\n\u003cp>Sarah de Guia, executive director of the California Pan-Ethnic Health Network, said the survey shows that more emphasis is needed on helping consumers understand their coverage. If people don’t know what their plans cover, they might get stuck with unexpected costs, she said. About two-thirds of newly insured Californians said they understood what their plan covered, compared to about 80 percent of those who had insurance previously, the study reported.\u003c/p>\n\u003cp>Researchers recommended additional education and outreach to those remaining uninsured about their options and to the newly insured about their plans and insurance in general.\u003c/p>\n\u003cp>The statewide survey, funded by the Blue Shield of California Foundation, was based on interviews conducted with 4,555 adults in late 2014. The margin of sampling error was plus or minus two percentage points.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Many Californians who obtained health insurance last year said they struggled to pay their premiums, although having coverage made them more confident about affording future medical care, according to a survey released Thursday.\u003c/p>\n\u003cp>Nearly half of newly insured adults in the state said it was difficult to afford the monthly premium and more than a third delayed or went without care, according to \u003ca title=\"survey\" href=\"http://kff.org/health-reform/report/coverage-expansions-and-the-remaining-uninsured-a-look-at-california-during-year-one-of-aca-implementation/?utm_campaign=KFF%3A+General&utm_source=hs_email&utm_medium=email&utm_content=17950384&_hsenc=p2ANqtz-9E1EfXAzfT1gKOvsyrLmTQOeHTZcD7TOPGiBb6ZDZ5lO31JWPgUeI3pz622RI0s30e3A00CZCcb9deDngRHLJ6rtj1iQ&_hsmi=17950384\" target=\"_blank\">the survey conducted by the Kaiser Family Foundation. \u003c/a>\u003c/p>\n\u003cp>The data highlight that health care costs continue to be a worry for many low-income Californians, even with more affordable insurance options available through Obamacare.\u003c/p>\n\u003cp>“Most of them are still in somewhat precarious financial positions,” said Rachel Garfield, senior researcher at the foundation. “Any monthly cost … can be difficult for these families to afford.”\u003c/p>\n\u003cp>Nevertheless, newly insured Californians appear to be using their coverage. Nearly 60 percent obtained at least one medical service, and almost half got a check-up, according to the survey.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Affordable Care Act allowed states to expand Medicaid and created health insurance marketplaces in which consumers could receive government financial help to purchase insurance. In California, more than 4 million people obtained coverage through Medi-Cal, the state’s version of Medicaid, and the exchange, known as Covered California.\u003c/p>\n\u003cp>“We are seeing some ongoing challenges,” Garfield said. “But the coverage is working quite well.”\u003c/p>\n\u003cp>Even though the monthly premium was seen as a burden, insured consumers reported that they didn’t have as much trouble paying other medical bills as those who remained uninsured.\u003c/p>\n\u003cp>Covered California Executive Director Peter Lee said he wasn’t surprised that health care is still expensive for consumers, both in and out of the exchange. He said it’s an issue that Covered California is continuing to work on. The insurance exchange is now negotiating 2016 rates with health plans and recently made changes so more of consumers’ medical visits are covered. “It’s not just about keeping premiums low today,” Lee said. “We have to address underlying health care costs.”\u003c/p>\n\u003cp>Lee said he was encouraged by the findings that high percentages of consumers are getting preventive treatment and that most are able to access care easily.\u003c/p>\n\u003cp>Not surprisingly, newly insured adults were more likely than those who remained uninsured to have a regular doctor and a usual place to go for health care, according to the survey. For many consumers, that place was a community health center. Health centers made a significant effort to retain patients and attract new ones, and they opened new sites statewide to meet the need.\u003c/p>\n\u003cp>Some newly insured residents, however, said they had trouble getting medical appointments because of their public or government-subsidized coverage.\u003c/p>\n\u003cp>While only 3 percent of adults with private plans said a doctor wouldn’t see them, 13 percent of those with Covered California plans and 8 percent of those with Medi-Cal said providers turned them away. In addition, about a fifth of newly insured adults changed where they went for medical care, with most citing their insurance as the reason.\u003c/p>\n\u003cp>Sarah de Guia, executive director of the California Pan-Ethnic Health Network, said the survey shows that more emphasis is needed on helping consumers understand their coverage. If people don’t know what their plans cover, they might get stuck with unexpected costs, she said. About two-thirds of newly insured Californians said they understood what their plan covered, compared to about 80 percent of those who had insurance previously, the study reported.\u003c/p>\n\u003cp>Researchers recommended additional education and outreach to those remaining uninsured about their options and to the newly insured about their plans and insurance in general.\u003c/p>\n\u003cp>The statewide survey, funded by the Blue Shield of California Foundation, was based on interviews conducted with 4,555 adults in late 2014. The margin of sampling error was plus or minus two percentage points.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Sometimes Mikkel Lawrence gets up in the morning, eats breakfast, and then heads straight back to bed for a nap.\u003c/p>\n\u003cp>“I get really bad tired spells. It’s like you \u003cem>have\u003c/em> to go to sleep,” he says.\u003c/p>\n\u003cp>This is one of the symptoms of Hepatitis C, a virus that damages the liver. Most people who have it don’t have any symptoms, sometimes for decades. But for some people like Lawrence, waves of intense fatigue hit several times a day.\u003c/p>\n\u003cp>“It takes away probably three or four hours of my waking day,” he says.\u003c/p>\n\u003cp>There’s also an increased risk of liver cancer or liver failure. So when Lawrence heard last year that there was a new drug regimen that could cure his disease, he went straight to his insurance company.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The first thing they did, of course, was deny it,” he says.\u003c/p>\n\u003cp>But the real problem, once he did get approval, was the price tag. Each pill costs $1,000.\u003c/p>\n\u003cp>“The first quote I got was $140,000, and I would be responsible for $14,000 of it,” he remembers.\u003c/p>\n\u003cp>Lawrence is a retired middle school teacher. He lives on Social Security. There was just no way he could come up with $14,000 on his own.\u003c/p>\n\u003cp>“I went to everybody I knew of,” he says, “and fussed and fumed and all that stuff.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/206549879\" 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>Eventually, Lawrence got financial aid from a nonprofit to help him cover his out-of-pocket costs. Every morning at 10 a.m., he stood over his bathroom sink and swallowed two capsules.\u003c/p>\n\u003cp>“I’d go to take my pills and I’d go, there’s one thousand,” he says. “And there’s another thousand.”\u003c/p>\n\u003cp>Health advocates hear scenarios like this all the time from patients with a range of chronic conditions, including Hepatitis C, HIV, multiple sclerosis and rheumatoid arthritis.\u003c/p>\n\u003cp>“We’ve heard stories of people who’ve emptied their retirement savings to cover their drug needs,” said Betsy Imholz, special projects director at Consumers Union, an advocacy group. “It’s a really frightening, Wild West situation for people who need these specialty drugs.”\u003c/p>\n\u003cp>She and other advocates took their concerns to Covered California, the agency that implements the Affordable Care Act in the state. Advocates argued there should be a limit on how much consumers have to pay for these drugs.\u003c/p>\n\u003cp>The agency agreed, and today the board will vote on a proposal that would cap the monthly out-of-pocket costs for specialty drugs. Under most plans, people would have to pay only $250 per prescription, per month. Some silver plans would have $150-caps, while bronze plans would have caps of $500.\u003c/p>\n\u003cp>\u003cem>UPDATE: Covered California's board approved these caps at Thursday's meeting. Health plans must now incorporate them into their benefits for 2016. \u003c/em>\u003c/p>\n\u003cp>\u003cem>\"We are putting California consumers first,\" said Peter Lee, Covered California's executive director. \"These new policies strike a balance between ensuring Covered California consumers can afford the medication they need to treat chronic and life-threatening conditions while keeping premiums affordable for all.”\u003c/em>\u003c/p>\n\u003cp>This policy will apply only to the 2.2 million people who buy coverage on the individual market. \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/asm/ab_0501-0550/ab_533_bill_20150223_introduced.pdf\" target=\"_blank\">A bill\u003c/a> currently being considered in the state's Legislature would extend that protection to many people with employer-based plans as well.\u003c/p>\n\u003cp>Several other states are also considering similar caps, some as low as $100.\u003c/p>\n\u003cp>“We’re better than most,\" Imholz says, \"but not the absolute top of the heap as we usually are.\"\u003c/p>\n\u003cp>Health insurance companies involved in Covered California meetings tried to negotiate for higher caps, closer to $500 for all plans, Imholz says. Still, she added, insurers did support the overall idea of caps.\u003c/p>\n\u003cp>Nicole Kasabian Evans of the California Association of Health Plans says insurers see a correlation between the cost of a drug and adherence - patients who can't afford what they're prescribed will sometimes split pills, or not take them at all.\u003c/p>\n\u003cp>“If you ultimately have to go back and take a second round, because you didn't take it right the first time, or you never took it and you develop a more serious health condition, it's not good for the consumer, and it costs the health care system more money,” she says.\u003c/p>\n\u003cp>Kasabian Evans says the real root of the problem lies with the pharmaceutical companies that set the drug prices. Last year, more than half a million patients in the U.S. had medication costs that exceeded $50,000, according to a recent \u003ca href=\"http://lab.express-scripts.com/insights/drug-options/super-spending-US-trends-in-high-cost-medication-use\" target=\"_blank\">report\u003c/a> from Express Scripts, a company that manages prescription benefits\u003c/p>\n\u003cp>“This is unsustainable,” she says, “and it’s going to have a major impact on the price of health care.”\u003c/p>\n\u003cp>Even if insurers lower the co-pays for patients who take specialty drugs, the price the insurers pay stays the same. Eventually, they say the only way to balance the books will be to raise monthly premiums for everyone else.\u003c/p>\n\u003cp>“So if we really want to make sure consumers can afford prescription drug coverage, then we need to deal with the root price of the drug,” Kasabian Evans says.\u003c/p>\n\u003cp>Drug companies routinely defend their drug prices, citing the lengthy and expensive process of developing new drugs, and the many failed attempts that often precede successes.\u003c/p>\n\u003cp>The debates aren’t helping Mikkel Lawrence right now. His battle over Hepatitis C drugs continues. Turns out that $140,000 regimen he took last year didn’t work. He fell into the 5 percent of patients who don’t respond. But now he’s caught wind of a new drug that’s coming down the pipeline. And he’s already drafting a series of emails and letters to get it approved and to find the money to pay for it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“As soon as they’re out, I’m taking them,” he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sometimes Mikkel Lawrence gets up in the morning, eats breakfast, and then heads straight back to bed for a nap.\u003c/p>\n\u003cp>“I get really bad tired spells. It’s like you \u003cem>have\u003c/em> to go to sleep,” he says.\u003c/p>\n\u003cp>This is one of the symptoms of Hepatitis C, a virus that damages the liver. Most people who have it don’t have any symptoms, sometimes for decades. But for some people like Lawrence, waves of intense fatigue hit several times a day.\u003c/p>\n\u003cp>“It takes away probably three or four hours of my waking day,” he says.\u003c/p>\n\u003cp>There’s also an increased risk of liver cancer or liver failure. So when Lawrence heard last year that there was a new drug regimen that could cure his disease, he went straight to his insurance company.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The first thing they did, of course, was deny it,” he says.\u003c/p>\n\u003cp>But the real problem, once he did get approval, was the price tag. Each pill costs $1,000.\u003c/p>\n\u003cp>“The first quote I got was $140,000, and I would be responsible for $14,000 of it,” he remembers.\u003c/p>\n\u003cp>Lawrence is a retired middle school teacher. He lives on Social Security. There was just no way he could come up with $14,000 on his own.\u003c/p>\n\u003cp>“I went to everybody I knew of,” he says, “and fussed and fumed and all that stuff.”\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/206549879&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/206549879'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Eventually, Lawrence got financial aid from a nonprofit to help him cover his out-of-pocket costs. Every morning at 10 a.m., he stood over his bathroom sink and swallowed two capsules.\u003c/p>\n\u003cp>“I’d go to take my pills and I’d go, there’s one thousand,” he says. “And there’s another thousand.”\u003c/p>\n\u003cp>Health advocates hear scenarios like this all the time from patients with a range of chronic conditions, including Hepatitis C, HIV, multiple sclerosis and rheumatoid arthritis.\u003c/p>\n\u003cp>“We’ve heard stories of people who’ve emptied their retirement savings to cover their drug needs,” said Betsy Imholz, special projects director at Consumers Union, an advocacy group. “It’s a really frightening, Wild West situation for people who need these specialty drugs.”\u003c/p>\n\u003cp>She and other advocates took their concerns to Covered California, the agency that implements the Affordable Care Act in the state. Advocates argued there should be a limit on how much consumers have to pay for these drugs.\u003c/p>\n\u003cp>The agency agreed, and today the board will vote on a proposal that would cap the monthly out-of-pocket costs for specialty drugs. Under most plans, people would have to pay only $250 per prescription, per month. Some silver plans would have $150-caps, while bronze plans would have caps of $500.\u003c/p>\n\u003cp>\u003cem>UPDATE: Covered California's board approved these caps at Thursday's meeting. Health plans must now incorporate them into their benefits for 2016. \u003c/em>\u003c/p>\n\u003cp>\u003cem>\"We are putting California consumers first,\" said Peter Lee, Covered California's executive director. \"These new policies strike a balance between ensuring Covered California consumers can afford the medication they need to treat chronic and life-threatening conditions while keeping premiums affordable for all.”\u003c/em>\u003c/p>\n\u003cp>This policy will apply only to the 2.2 million people who buy coverage on the individual market. \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/asm/ab_0501-0550/ab_533_bill_20150223_introduced.pdf\" target=\"_blank\">A bill\u003c/a> currently being considered in the state's Legislature would extend that protection to many people with employer-based plans as well.\u003c/p>\n\u003cp>Several other states are also considering similar caps, some as low as $100.\u003c/p>\n\u003cp>“We’re better than most,\" Imholz says, \"but not the absolute top of the heap as we usually are.\"\u003c/p>\n\u003cp>Health insurance companies involved in Covered California meetings tried to negotiate for higher caps, closer to $500 for all plans, Imholz says. Still, she added, insurers did support the overall idea of caps.\u003c/p>\n\u003cp>Nicole Kasabian Evans of the California Association of Health Plans says insurers see a correlation between the cost of a drug and adherence - patients who can't afford what they're prescribed will sometimes split pills, or not take them at all.\u003c/p>\n\u003cp>“If you ultimately have to go back and take a second round, because you didn't take it right the first time, or you never took it and you develop a more serious health condition, it's not good for the consumer, and it costs the health care system more money,” she says.\u003c/p>\n\u003cp>Kasabian Evans says the real root of the problem lies with the pharmaceutical companies that set the drug prices. Last year, more than half a million patients in the U.S. had medication costs that exceeded $50,000, according to a recent \u003ca href=\"http://lab.express-scripts.com/insights/drug-options/super-spending-US-trends-in-high-cost-medication-use\" target=\"_blank\">report\u003c/a> from Express Scripts, a company that manages prescription benefits\u003c/p>\n\u003cp>“This is unsustainable,” she says, “and it’s going to have a major impact on the price of health care.”\u003c/p>\n\u003cp>Even if insurers lower the co-pays for patients who take specialty drugs, the price the insurers pay stays the same. Eventually, they say the only way to balance the books will be to raise monthly premiums for everyone else.\u003c/p>\n\u003cp>“So if we really want to make sure consumers can afford prescription drug coverage, then we need to deal with the root price of the drug,” Kasabian Evans says.\u003c/p>\n\u003cp>Drug companies routinely defend their drug prices, citing the lengthy and expensive process of developing new drugs, and the many failed attempts that often precede successes.\u003c/p>\n\u003cp>The debates aren’t helping Mikkel Lawrence right now. His battle over Hepatitis C drugs continues. Turns out that $140,000 regimen he took last year didn’t work. He fell into the 5 percent of patients who don’t respond. But now he’s caught wind of a new drug that’s coming down the pipeline. And he’s already drafting a series of emails and letters to get it approved and to find the money to pay for it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“As soon as they’re out, I’m taking them,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Study: Covered California 'Narrow Networks' Do Not Affect Quality, Access",
"title": "Study: Covered California 'Narrow Networks' Do Not Affect Quality, Access",
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"content": "\u003cp>Health plans offered through Covered California have narrower hospital networks than commercial insurance plans but they don’t appear to have lower-quality providers or differences in geographic access,\u003ca href=\"http://content.healthaffairs.org/content/34/5/741.abstract\" target=\"_blank\"> according to a study\u003c/a> published in the May issue of \u003cem>Health Affairs\u003c/em>.\u003c/p>\n\u003cp>Health plans with narrow networks restrict the number and scope of contracting physicians and hospitals to keep premiums low. Narrow networks are not new, but they have proliferated under the Affordable Care Act as health plans participating in both state marketplaces and the federal healthcare.gov balance cost with access.\u003c/p>\n\u003cp>The \u003cem>Health Affairs\u003c/em> study analyzed hospital networks available to Californians through private commercial coverage and through Covered California during the initial enrollment period of 2013 to 2014. For comparison, the researchers chose four insurers in each region of the state that offered plans in both the commercial market and through Covered California. These were: Anthem, Blue Shield of California, Kaiser Permanente and Health Net.\u003c/p>\n\u003cp>The study included 338 hospitals in 19 regions of the state.\u003c/p>\n\u003cp>Overall, Covered California enrollees had about 83 percent of the number of hospitals in-network compared to those with privately purchased insurance, according to the study.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>However, geographic access was about equal between plans. About 92 percent of Covered California consumers were within at least one hospital network, compared to 93 percent for private plans.\u003c/p>\n\u003cp>Quality of hospital services also did not suffer in the Covered California plans, said David Weimer, a professor of public affairs at the University of Wisconsin–Madison and co-author of the study.\u003c/p>\n\u003cp>“Two of the analyses show no substantive difference in the average quality of the networks, but a third measure indicates that the average quality in the exchange networks is actually higher than that in the commercial networks,” Weimer said.\u003c/p>\n\u003cp>“Insurers may be deliberately excluding some hospitals that have not been designated as top performers.”\u003c/p>\n\u003cp>A state bill that aims to provide more transparency around which physicians and hospitals contract with what health plans was moved to the suspense file on Monday in the state Senate Appropriations Committee for consideration later this month.\u003c/p>\n\u003cp>\u003ca title=\"SB 137\" href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137&search_keywords=\" target=\"_blank\">SB 137\u003c/a>, by Sen. Ed Hernandez (D-West Covina), would require health insurers to update their directories on contracting providers on a weekly basis, and meet or exceed a 97 percent accuracy rate.\u003c/p>\n\u003cp>California has taken other steps to improve transparency of provider networks. Under \u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB964\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB964\" target=\"_blank\">a bill \u003c/a>signed by Gov. Jerry Brown last October, the California Department of Managed Health Care must review insurers’ contracts annually between insurers and providers to ensure timeliness of care. Previously, the department was required to review these reports every three years.\u003c/p>\n\u003cp>In February, \u003ca title=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2015/upload/nr012-NetworkAdequacyApproval.pdf\" href=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2015/upload/nr012-NetworkAdequacyApproval.pdf\" target=\"_blank\">emergency regulations\u003c/a> requiring health insurers to have sufficient medical providers in networks went into effect. California Insurance Commissioner Dave Jones issued the regulations after receiving numerous consumer complaints about skimpy networks and unexpected bills from out-of-network providers even when an in-network provider isn’t available.\u003c/p>\n\u003cp>Among the rules, health plans must provide accurate directories of in-network providers and make them available to the public.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Insurers are also no longer allowed to bill patients at out-of-network rates when in-network providers are unavailable.\u003c/p>\n\n",
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"headline": "Study: Covered California 'Narrow Networks' Do Not Affect Quality, Access",
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"nprByline": " Rebecca Vesely, California Healthline",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health plans offered through Covered California have narrower hospital networks than commercial insurance plans but they don’t appear to have lower-quality providers or differences in geographic access,\u003ca href=\"http://content.healthaffairs.org/content/34/5/741.abstract\" target=\"_blank\"> according to a study\u003c/a> published in the May issue of \u003cem>Health Affairs\u003c/em>.\u003c/p>\n\u003cp>Health plans with narrow networks restrict the number and scope of contracting physicians and hospitals to keep premiums low. Narrow networks are not new, but they have proliferated under the Affordable Care Act as health plans participating in both state marketplaces and the federal healthcare.gov balance cost with access.\u003c/p>\n\u003cp>The \u003cem>Health Affairs\u003c/em> study analyzed hospital networks available to Californians through private commercial coverage and through Covered California during the initial enrollment period of 2013 to 2014. For comparison, the researchers chose four insurers in each region of the state that offered plans in both the commercial market and through Covered California. These were: Anthem, Blue Shield of California, Kaiser Permanente and Health Net.\u003c/p>\n\u003cp>The study included 338 hospitals in 19 regions of the state.\u003c/p>\n\u003cp>Overall, Covered California enrollees had about 83 percent of the number of hospitals in-network compared to those with privately purchased insurance, according to the study.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>However, geographic access was about equal between plans. About 92 percent of Covered California consumers were within at least one hospital network, compared to 93 percent for private plans.\u003c/p>\n\u003cp>Quality of hospital services also did not suffer in the Covered California plans, said David Weimer, a professor of public affairs at the University of Wisconsin–Madison and co-author of the study.\u003c/p>\n\u003cp>“Two of the analyses show no substantive difference in the average quality of the networks, but a third measure indicates that the average quality in the exchange networks is actually higher than that in the commercial networks,” Weimer said.\u003c/p>\n\u003cp>“Insurers may be deliberately excluding some hospitals that have not been designated as top performers.”\u003c/p>\n\u003cp>A state bill that aims to provide more transparency around which physicians and hospitals contract with what health plans was moved to the suspense file on Monday in the state Senate Appropriations Committee for consideration later this month.\u003c/p>\n\u003cp>\u003ca title=\"SB 137\" href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137&search_keywords=\" target=\"_blank\">SB 137\u003c/a>, by Sen. Ed Hernandez (D-West Covina), would require health insurers to update their directories on contracting providers on a weekly basis, and meet or exceed a 97 percent accuracy rate.\u003c/p>\n\u003cp>California has taken other steps to improve transparency of provider networks. Under \u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB964\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB964\" target=\"_blank\">a bill \u003c/a>signed by Gov. Jerry Brown last October, the California Department of Managed Health Care must review insurers’ contracts annually between insurers and providers to ensure timeliness of care. Previously, the department was required to review these reports every three years.\u003c/p>\n\u003cp>In February, \u003ca title=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2015/upload/nr012-NetworkAdequacyApproval.pdf\" href=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2015/upload/nr012-NetworkAdequacyApproval.pdf\" target=\"_blank\">emergency regulations\u003c/a> requiring health insurers to have sufficient medical providers in networks went into effect. California Insurance Commissioner Dave Jones issued the regulations after receiving numerous consumer complaints about skimpy networks and unexpected bills from out-of-network providers even when an in-network provider isn’t available.\u003c/p>\n\u003cp>Among the rules, health plans must provide accurate directories of in-network providers and make them available to the public.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Insurers are also no longer allowed to bill patients at out-of-network rates when in-network providers are unavailable.\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",
"info": "Sold Out: Rethinking Housing in America",
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