Medicare Pay to Shrink 2% as Sequester Looms on Friday

By: Robert Lowes

Feb 27, 2013



Unless a Congressional miracle occurs, Medicare reimbursement for physicians will decrease by 2% as $85 billion worth of automatic, across-the-board budget cuts called sequestration take effect on March 1 for the current fiscal year.

Organized medicine is complaining not only about reduced pay, which could push struggling medical practices further into a hole, but also about the deleterious effect of even larger budget cuts in store for federal agencies such as the Centers for Disease Control and Prevention, the US Food and Drug Administration, and the National Institutes of Health.

“Many physicians are worried about what will happen to the fundamental infrastructure of healthcare,” American College of Physicians (ACP) President David Bronson, MD, told Medscape Medical News. “And they’re concerned about a dysfunctional Congressional system that’s not getting people’s problems solved.”

President Barack Obama has invited Congressional leaders to meet with him on Friday to negotiate a deal to retroactively replace sequestration with a more discriminating deficit reduction deal that does not halt cancer research, furlough air traffic controllers, reduce fighter jet maintenance, and force children out of Head Start. The medical profession witnessed such postdeadline remedies in 2010 in the form of legislation that erased massive Medicare pay cuts required by the program’s notorious sustainable growth rate (SGR) formula.

The scheduled 2% reduction in Medicare reimbursement to physicians and other providers presumably would apply to all services rendered, beginning Friday. A spokesperson for the Centers for Medicare and Medicaid Services (CMS) told Medscape Medical News yesterday that the agency had no comment at this time on how the pay cut would be implemented.

When SGR-triggered pay cuts have loomed on the horizon in the past, CMS has informed physicians that Medicare administrative contractors (MACs) cannot pay electronic, error-free claims any sooner than 14 working days. This time lag allows MACs to sit on claims temporarily instead of processing them at a new, reduced rate. Likewise, lawmakers have 14 working days to nullify a Medicare pay cut so that MACs can process suspended claims at the old rate.

In the sequester crisis set to erupt on March 1, MACs would be forced to pay post–March 1 claims at the new reduced rate if Congress does not undo sequestration within the first 14 working days of March. If lawmakers forge an agreement afterward, MACs would reprocess the claims at the old rate.

A retroactive solution to sequestration could, in fact, come late this month, when a so-called continuing appropriations resolution expires March 27 and forces lawmakers to pass a new resolution to continue funding government operations. That legislation conceivably could apply a cure to the sequester.


2% Cut Comes on Top of Rising Medical Practice Costs

The sequester is all but certain to happen because Congressional Democrats and Republicans are just as stalemated on how to shrink the budget deficit in 2013 as they were in 2011, when the current sequester was born.

That year, Congress passed the Budget Control Act, which charged a bipartisan committee to propose at least $1.2 trillion in deficit reduction over the course of 10 years for lawmakers to approve. Under the act, failure to achieve this goal would trigger an equal level of sequestration beginning January 1, 2013, that would apply to defense as well as domestic spending. Medicare benefits, Social Security, and Medicaid are off-limits.

The idea behind sequestration was that the prospect of blind cuts to the armed services and social service programs such as Head Start would pressure conservative and liberal lawmakers alike to reduce the budget deficit in a more thoughtful, less painful way.

The pressure did not work. The bipartisan committee could not reach a deal, in part because Democrats and Republicans deadlocked on the issue of tax increases. Congress partly came around last December in its fiscal-cliff legislation, when it agreed to preserve the Bush-era tax cuts for everyone except the ultra-affluent. That legislation, the American Taxpayer Relief Act, also delayed a 26.5% Medicare pay cut until January 1, 2014, and sequestration was delayed until March 1 of this year.

Glenn Stream, MD, who chairs the board of directors of the American Academy of Family Physicians (AAFP), told Medscape Medical News that the 2% reduction in Medicare reimbursement required by sequestration poses more of a threat to medical practices than one might imagine.

“This is not about reducing a physician’s income, but revenue to the practice,” said Dr. Stream. “For practices with a high percentage of Medicare patients that are already struggling financially, even a 2% cut could make the difference between being a viable business or not.”

Similar to others, the ACP’s Dr. Bronson notes that the cut will occur even as medical practice expenses are expected to increase 3%. “So it’s a functional 5% cut,” said Dr. Bronson.

Sequestration will take an even bigger toll elsewhere in the federal government, reducing outlays during the remaining 7 months in fiscal 2013 by roughly 9% for domestic programs and roughly 13% for the military, according to the Obama administration.

The administration has ticked off a number of blows that sequestration would deliver to the nation’s health:

  • The National Institutes of Health would be forced to postpone or stop scientific projects and decrease the number of new research grants by the hundreds.
  • New drug approvals would slow down in a budget-whacked US Food and Drug Administration.
  • Cuts at the Centers for Disease Control and Prevention could result in 400,000 fewer HIV tests.

The AAFP’s Dr. Stream also worries about the effect of sequestration on federal programs that fund family medicine education.

“Everyone recognizes that the status quo can’t go forward, that we must carefully balance revenue and spending,” said Dr. Stream. “But sequestration is such a blunt instrument to implement that. We need to be strategic and prioritize our spending.”


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95% of Health Care Pros Plan to Join a Health Insurance Exchange

2014 could be one of the largest open enrollments in history.

Insurance Networking News, February 27, 2013

Chris McMahon


More than 95 percent of senior health care professionals plan to participate in at least one health insurance exchange (HIX), according to “HIX Insights from the 

2013 Healthcare Mandate Summit,” a study from Edifecs Inc. And 80 percent plan to join one in 2014. The Congressional Budget Office projected that as many as 12 million Americans would buy health insurance through a HIX in 2014.

“The message we heard from Summit attendees is that while compliance with mandates such as Health Insurance Exchanges is no easy feat, there are considerable benefits to be gained, including increased member enrollment,” said Jamie Gier, VP of corporate marketing for Edifecs. “The value of the Healthcare Mandate Summit was in helping healthcare organizations confirm whether they are on the right path toward compliance and where they can improve. And as the results of the survey demonstrate, many health insurers are embracing the opportunities that exchanges can provide.”

The survey also found skepticism that state and federal exchanges will be ready by the mandated Oct. 1, 2013 deadline. Respondents also are concerned about potential disruptions to current IT infrastructures, the difficulties of reconciling premiums, enrollments and payment records from the HIXs.

HIXs are essential to the effectiveness of the Affordable Care Act (ACA), healthcare industry experts said, because they offer an online marketplace where consumers can shop for, compare and purchase health insurance.

According to Edifecs, the upside potential for health insurers participating in a HIX is significant. The anticipated 12 million people who would buy insurance through a HIX in 2014 would pay a total of $60 billion in premiums, according to a PwC Health Research Institute dated November 2011, which could grow to 28 million consumers paying $200 billion in premiums by 2019.

Report highlights:

• 80 percent plan to participate on an exchange in 2014, which is expected to be one of the largest open enrollments in history.

• 70 percent are “very confident” or “somewhat confident” their organization would be ready

• 69 percent rated the quality of information sharing and collaboration among health insurers and the HIXs they plan to join as “poor” or “very poor”

• 93 percent expressed a strong desire for exchanges to solicit input from them on how to define and operate their enrollment processes

• 31 percent said they plan to participate on three to five exchanges

• 15 percent plan to participate on more than eight

Health insurers are more concerned about the challenges of operating on an exchange than the process of actually joining one, Edifecs said. States have considerable leeway in how they will run exchanges, meaning health insurers operating on multiple state exchanges must support multiple exchange formats, adding levels of complexity.

The Edifecs report includes responses from more than 125 senior healthcare professionals who attended the 2013 Healthcare Mandate Summit, which that took place in early February.

For more information on related topics, visit the following channels:

Insurance Network


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Health insurance plans in Kentucky move forward

Written by: Logan Bayan

Written on: February 23, 2013


Kentucky establishes new agency to manage health insurance exchange

While many states throughout the U.S. have decided to abandon their efforts concerning a health insurance exchange, Kentucky is one of the few that has decided to build and operate its own. State officials chose for the state to run its own exchange in the hopes that it will better address some of the health insurance concerns that are specific to Kentucky residents. State officials have now formed the Office of the Kentucky Health Benefits Exchange, a new agency that will oversee the operation of the state’s health insurance exchange program.


Agency boasts of $40 million annual budget

This agency will boast of 30 employees, but several hundred contract workers and insurance agents throughout the state. This agency is notably different from others in the state, largely because of its annual budget, which comes in at nearly $40 million. These funds cover the operational costs of the state’s health insurance exchange and the administrative costs of the agency itself, with surplus to account for any catastrophic issues that the exchange may experience in the future.


Health insurance to be accessible to 600,000 people

State officials expect that the exchange system will help more than 600,000 residents throughout the state gain access to health insurance coverage. Many of these people do not have insurance currently, and Kentucky officials believe that this is primarily due to the high costs of coverage for some individuals and families. Kentucky officials aim to address these issues through the exchange. Much of the initial funding that is required for the exchange to take form is being provided by the federal government.


Health insurance exchange to help boost state revenue

The state will impose a 1% fee on all health insurance policies sold through the exchange. This will account for some $50 million in annual revenue for the state. The federal government plans to impose a 3% fee on insurance policies it sells through exchanges it operates throughout the country. State officials have noted that another reason the state has chosen to operate its own health insurance exchange is to avoid potentially paying to help cover the costs of federal exchanges that are being built elsewhere in the U.S.


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Health Insurance Exchanges Bring Concerns of IT Disruptions: Survey

By Brian T. Horowitz  | Posted 2/25/2013


Insurers want to implement federally mandated health insurance exchanges, but they worry about IT infrastructure headaches, an Edifecs survey revealed.

Health insurers are embracing the move toward health insurance exchanges, yet they’re concerned about IT infrastructure changes, according to a Feb. 20 report by Edifecs, a health care IT software company.

The Obama administration’s Affordable Care Act calls for states to implement the exchanges, referred to as HIXes, by October 2013 or have the federal government implement them on their behalf. The Web-based exchanges allow small businesses or uninsured individuals to purchase health insurance.

Edifecs—which based its study on interviews with 125 senior health care professionals at the 2013 Healthcare Mandate Summit Feb. 4 to 6 in Austin, Texas—found that 95 percent of respondents plan to participate in an HIX, and 80 percent will join in 2014.

However, 88 percent of respondents are concerned about disruptions to their current IT enrollment infrastructure and processes when they join an exchange. Insurers will have to create new business processes and integration points rather than simply add new data from individuals and small businesses, according to Jamie Gier, vice president of corporate marketing at Edifecs.

“It goes beyond simple data feeds,” Gier told eWEEK in an email. “Beyond integrating their systems with federal and/or state exchanges, insurers will need to reconcile their detailed member records with those maintained by the exchange on at least a monthly basis.”

Insurers must manage and reconcile their membership records between their own insurer systems and HIXes, said Gier. This cross-checking of data will confirm eligibility and credit premiums, as well as ensure correct payments, said Gier.

In the survey, insurers also voiced concerns about a lack of time for sufficient testing of the exchange systems, said Gier.

“We are now less than eight months from the Oct. 1, 2013, deadline for exchanges to start offering enrollment,” Gier noted. “Many systems have yet to be set up, and all must be tested across multiple scenarios.”

A lack of comprehensive testing of IT systems could lead to major disruptions for the carriers and the exchanges. In fact, HIX health plans go into effect Jan. 1, 2014, and qualified health plans, benefit tiers and payment contracts must be entered and integrated with insurers’ IT systems by then, said Gier.

Many states will also have to overhaul their existing IT systems to comply with the Affordable Care Act, the survey revealed.

Ninety-three percent of respondents said they wanted more input in how the exchanges will be built. In addition, 69 percent said the information received from exchanges to date was either “poor” or “very poor.”

A lack of common data interoperability could be a problem as insurers transmit and receive information in the exchanges, Gier suggested.

Of respondents, 39.7 percent were “somewhat concerned” and 35.3 percent were “very concerned” about being able to support multiple formats from different exchanges. In addition, 96 percent of respondents were concerned about data formats changing over time.

“These formats will likely change as each exchange fixes issues and improves business processes,” said Gier. “Insurers will need flexible IT systems to accommodate the changes.”

Insurers participating in more than one exchange face additional data-transfer challenges. More than 30 percent of survey respondents intend to participate in three to five exchanges, according to Gier.

Meanwhile, doctors could face payment delays if insurance exchange data doesn’t match up.

“In the HIX model, that goal is more difficult to achieve because insurers have to work with the exchange and the federal government to reconcile and verify information,” Gier noted.

Still, the Web-based exchanges will bring fewer unpaid bills for doctors, said Gier.

She noted that low or unpredictable data quality will also be a challenge in HIXes.

“Health plans will need to carefully examine membership/enrollment updates coming from state exchanges,” said Gier. “Each state is at varying stages of HIX adoption and will have their own transaction formats, member identifiers and process flows.”

Brian T. Horowitz is a freelance technology and health writer as well as a copy editor. Brian has worked on the tech beat since 1996 and covered health care IT and rugged mobile computing for eWEEK since 2010. He has contributed to more than 20 publications, including Computer Shopper, Fast Company,, More, NYSE Magazine, Parents,, USA Weekend and, as well as other consumer and trade publications. Brian holds a B.A. from Hofstra University in New York.

Follow him on Twitter: @bthorowitz

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U.S. sets final rule for insurance exchange coverage


Posted on

2:47 PM CST, February 20, 2013


The Obama administration on Wednesday issued its long-awaited final rule on essential health benefits that insurers must offer consumers in the individual and small-group market beginning in 2014 under health care reform.

A cornerstone of President Barack Obama’s plan to enhance the breadth of health care coverage in the United States, the mandate allows the 50 U.S. states a role in identifying benefit requirements and grants insurers a phased-in accreditation process for plans sold on federal health care exchanges.

Wednesday’s rule included few changes from previous administration proposals, which could help states and insurers as they prepare for new online state health insurance marketplaces, known as healthcare exchanges, scheduled to begin enrolling beneficiaries for federally subsidized coverage on Oct. 1.

“The administration has been consistent in its approach to essential health benefits for more than a year, and that continued today. It’s good news for states and insurers because it means they don’t have to make any changes,” said Ian Spatz, a senior health care adviser at the consulting firm Manatt Health Solutions.

The exchanges are expected to cover as many as 26 million people within 10 years and seem likely to dominate individual and small group insurance markets. Another 12 million people are expected to receive health care coverage through an expansion of the Medicaid program for the poor, according to the nonpartisan Congressional Budget Office.

Obama’s Patient Protection and Affordable Care Act sets out 10 benefit categories that must be covered by most plans at the same level as a typical employer plan. The categories range from hospitalization, prescription drugs and maternity and newborn care.

Insurers including UnitedHealth Group Inc., Aetna Inc. and Cigna Corp. will use the government’s final word on these required benefits as they design plans and set premiums before the exchange launches. They have each said they will sell plans on some of the exchanges, but have not yet committed to which ones.

UnitedHealth, the largest insurer, said it is still reviewing the new rule. The company said the exchange insurance plans will essentially be a new type of coverage.

“In the long term, we are expecting and preparing for an ‘exchange’ category of coverage to become established as a new benefit category between Medicaid and the traditional commercial benefits markets,” spokesman Daryl Richard said.

The Department of Health and Human said the rule would mean greater access to mental health and substance abuse services by requiring parity with other health care benefits. HHS estimated that 62 million Americans would gain mental health coverage, an issue that has risen in importance after a string of mass shooting including last year’s elementary school massacre in Newtown, Conn.

The final rule preserved the state role in determining how the requirements are met by selecting their own benchmarks from plans sold within their respective borders. Most states opted for their home market’s largest small-group plan.

HHS kept to the benchmark rule despite objections from consumer groups who claimed that some of the selected plans were not comprehensive enough and argued for a single, uniform federal package.

But HHS officials found that maintaining states as primary regulators of state insurance markets would keep benefit offerings more in line with services typically offered through employer-sponsored plans in each state.

“The states continue to maintain their traditional role in defining the scope of insurance benefits and may exercise that authority by selecting a plan that reflects the benefit priorities of that state,” HHS said in the rule.

The administration also gave insurers the chance to phase-in requirements for plans sold on federally facilitated exchanges and denied requests from groups that wanted to exempt low-cost community health plans and Medicaid managed-care plans from the accreditation process.


Copyright © 2013, Reuters


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What does the Affordable Care Act mean for you?

February 20, 2013 12:00 am  •  Christine Bryant Times Correspondent

These next two years are important years in health care, with several provisions of the Patient Protection and Affordable Care Act taking effect.

Although several features have already been implemented, including prohibiting insurance companies from denying coverage to children based on pre-existing conditions and eliminating lifetime limits on insurance coverage, there’s a lot still to watch for in 2013.


Medicaid expansion

In a little less than a year, on Jan. 1, 2014, Americans younger than 65 whose family income is less than 133 percent of the poverty level will be eligible to enroll in Medicaid as part of a new initiative.

States will receive 100 percent federal funding for the first three years to support the expanded coverage, followed by 90 percent federal funding after the first three years.

The catch – states can choose whether they want to participate and accept the additional funding.

Several states have said yes so far, including Illinois. Indiana, however, remains undecided.

About half of the uninsured who want medical coverage under the Affordable Care Act will do so under Medicaid, and several Democrat lawmakers have called for Indiana to expand Medicaid under the act.

Gov. Mike Pence, who opposed the Affordable Care Act as a congressman, has not yet included money for the Medicaid expansion in his budget, saying it would cost too much money.

Dr. Alex Stemer, president of Franciscan Medical Specialists, says opting in would open Medicaid to thousands of families who couldn’t otherwise afford health coverage.

“I think it would be a misfortune for Indiana to decline it because it would bring a lot of healthcare dollars primarily to indigent neighborhoods, like Gary, East Chicago and Hammond,” he said.

Watch this year for Indiana to decide whether to participate in the Medicaid expansion.


Medicare payments

In the meantime, as of Jan. 1 this year, the Affordable Care Act requires states to pay primary care physicians Medicare payment rates for Medicaid patients. In other words, Medicaid payments to physicians will look more like Medicare payments.

The increase is fully funded by the federal government, and allows Medicaid patients to have more choices in which doctors they see because more doctors will now be willing to accept Medicaid.

While this may be beneficial to Medicaid patients, patients with private insurance may have more difficulty getting in to see their primary care physician in a timely manner, Stemer said.

This initiative is meant to keep more Medicaid patients from having to go the emergency room for medical help, but if a patient cannot get in to see his primary care physician, he may have to turn to the emergency room regardless, he said.


Health insurance exchanges

Beginning in 2014, if your employer doesn’t offer insurance and you aren’t on Medicaid, you must buy insurance in what is called the Health Insurance Marketplace – a health insurance exchange that is tightly regulated and offers citizens various plans from which to choose based on their needs.

No one can be turned down, and people who make between 133 and 400 percent of the federal poverty line will receive subsidies in the form of tax credits to help defer the cost.

States have the option on whether to form local exchanges, and if they choose not to, the federal government will.

Gov. Pence has said in the past he has opted to allow the federal government to run the state’s exchange.

If someone who can afford basic health insurance but chooses not to get it, he must pay a fee to help offset the costs of caring for uninsured Americans. If someone cannot afford it, he will be eligible for an exemption.


The cost

In 2012, employees paid a 1.45-percent tax for Medicare, but this year, if you earn more than $200,000, that tax goes up by 0.9 percent.

The Affordable Care Act also creates a new, 3.8-percent tax on investment income.

Some might also see an increase in their premiums, Stemer warns, because more people of various conditions will be covered.

“I don’t think health insurance is going to be cheaper, and a policy may cost more than last year,” he said. “There is a shift in covering those without preexisting conditions to those with preexisting conditions.”

Stemer also said the cost of medications will not decrease because that health care cost is not part of the Affordable Care Act.

“The U.S. government cannot negotiate those prices, so if the companies choose to raise those prices, the cost of health care for families will go up,” he said.

However, the increase in availability of generic drugs has helped alleviate many of those concerns, he said.

Stemer said there are still many uncertainties of how this act exactly will affect families – and it may differ for each individual family.

Many will benefit from this act, he said, but those who are healthy and rarely seek medical care may not benefit.

“We have a program with a lot of unknowns because it’s never been done before here,” he said.


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Big tobacco and anti-cancer activists agree: Health provision goes too far

Posted by Sarah Kliff on February 18, 2013 at 7:27 pm


For all the political division over the nation’s health-care law, one provision has managed to put two longtime rivals on the same side.

Big tobacco companies and anti-cancer activists are standing in opposition to a part of the Affordable Care Act that allows insurance companies to charge smokers 50 percent more than patients who do not use tobacco.

Cigarette makers such as Altria say the policy amounts to discrimination against smokers.

The American Cancer Society, meanwhile, worries that the high surcharges could make health insurance unaffordable to cigarette smokers, who are disproportionately low income.

“We’re anti-smoking, not anti-smoker,” said David Woodmansee, the cancer society’s associate director for state and local campaigns.

Unlike other groups that have failed to get a divided Congress to kill parts of President Obama’s signature legislative accomplishment, these unusual partners could have a shot at success: They can take the battle to individual states, which have the authority to bar health insurers from considering tobacco use in setting subscriber premiums.

Health insurance plans have typically set premiums higher for patients who they expect to have higher health costs. They tend to charge women more, for example, because pregnancies can be costly. Older patients, too, usually face higher premiums, because they use the health-care system more.

Starting in 2014, the Affordable Care Act will curtail this practice. Health insurance plans are barred from charging women higher premiums than men. They can charge older patients only three times as much as the youngest members. Smokers, meanwhile, could face a 50 percent surcharge on their premiums.

Although low- and middle-income tobacco users will get premium subsidies meant to make health insurance more affordable, that government assistance would not apply to the tobacco surcharge, leaving the smoker to foot the bill.

One analysis, prepared by the nonpartisan Institute for Health Policy Solutions, estimated that the tobacco surcharge could cause a low-income individual’s annual premiums to jump from $708 to $3,308.

“Our concern is that a tobacco use surcharge carries a risk of rendering health insurance unaffordable for many people,” Campaign for Tobacco-Free Kids president Matthew Myers said.

Health insurance companies tend to support the provision, which they argue allows them to adequately charge tobacco users for the additional health-care costs they incur.

“If issuers are not allowed to adjust rates for tobacco use for these individuals, they will have to increase standard rates for all individuals,” the Blue Cross Blue Shield 

Association wrote in comments to the Department of Health and Human Services last month.

The American Cancer Society opposed the tobacco rating provision during the congressional debate about the health-care law. It is now looking at a state-by-state approach to work on rolling back the provision.

Members of the group’s policy team are working on a template for testimony they could provide at the legislative hearings that they expect to occur.

“It is the law of the land, but we will be supportive of states that try to restrict the surtax,” policy director Steve Finan said. “We are engaging on the state level.”

Altria, which owns cigarette company Philip Morris, is monitoring the states for similar developments. The group spent more than $10 million on federal lobbying in 2012, according to the Center for Responsive Politics, but has not yet engaged on the issue at the state level.

“It is something that we’ll be monitoring as state legislatures come into session,” spokesman David Sutton said. “It’s something that we’re monitoring and looking at what’s being discussed, what might move at the state level.”

Five states already barred insurance companies from charging tobacco users more prior to the Affordable Care Act. Now, others are weighing the issue and are coming to disparate conclusions on the best path forward.

California is weighing legislation that would bar health-insurance companies from charging tobacco users more than non-smokers. It already has implemented such restrictions within its health exchange, the new marketplace that will launch in 2014, but has no such restrictions for carriers who sell in the outside market.

“We know that people who are smokers tend to be lower-income,” California Assemblyman Richard Pan, who sponsored the legislation, said. “The fact that the subsidies won’t cover the increase is problematic for this group of people. They are going to be unlikely to get insured.”

New Hampshire may take a different approach: A bill introduced there by the state insurance department would codify the Affordable Care Act provision allowing health insurance companies to charge the tobacco surcharge.

If states do not alter the health law’s rule, there is at least one industry that sees promise in this provision: manufacturers of electronic cigarettes. Since these products use nicotine, but not tobacco, their users could dodge the tobacco rating requirements.

“We definitely see there will be a potential for this law to drive current tobacco smokers to an alternative, and the most likely product is electronic cigarettes,” White Cloud 

Electronic Cigarettes co-founder Matthew Steingraber said.

His company plans to launch a direct mail campaign targeting demographics with high rates of smoking sometime this spring.


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Health Insurance Exchanges: Which Option Did Each State Choose?

Written by Jim McLaughlin | February 18, 2013

Becker’s Hospital Review


Friday was the deadline for states to apply to run part of their own health insurance exchange or cede all control and oversight on the online marketplaces to the federal government by default.

States opting to build and operate their own exchange had until Dec. 14, 2012, to submit their proposed plan to HHS. With a few exceptions, most Republican governors have balked at implementing the online marketplaces, which are key elements of the Patient Protection and Affordable Care Act, and have punted that task onto the feds.

Federal regulators will run all or part of the exchanges for more than half the states. Here is the status of each state’s health insurance exchange, as of last week’s deadline. Note: Data is based on data from consulting firm Avalere Health.

— Federally operated exchange
Gov. Robert Bentley, MD (R)    

Alaska — Federally operated exchange    
Gov. Sean Parnell (R)

Arizona — Federally operated exchange
Gov. Jan Brewer (R)

Arkansas — Federal-state partnership
Gov. Mike Beebe (D)

California — State-run exchange
Gov. Jerry Brown (D)

Colorado —     State-run exchange
Gov. John Hickenlooper (D)

Connecticut — State-run exchange
Gov. Dan Malloy (D)

Delaware — Federal-state partnership
Gov. Jack Markell (D)

District of Columbia — District-run exchange
Mayor Vincent Gray (D)

Florida — Federally operated exchange
Gov. Rick Scott (R)

Georgia — Federally operated exchange
Gov. Nathan Deal (R)

Hawaii — State-run exchange
Gov. Neil Abercrombie (D)

Idaho — State-run exchange
Gov. Butch Otter (R)

Illinois — Federal-state partnership    
Gov. Pat Quinn (D)

Indiana — Federally operated exchange
Gov. Mike Pence (R) (Mitch Daniels previously)

Iowa — Federal-state partnership    
Gov. Terry Branstad (R)

Kansas — Federally operated exchange
Gov. Sam Brownback (R)

Kentucky — State-run exchange
Gov. Steve Beshear (D)

Louisiana — Federally operated exchange    
Gov. Bobby Jindal (R)

Maine — Federally operated exchange    
Gov. Paul LePage (R)

Maryland — State-run exchange
Gov. Martin O’Malley (D)

Massachusetts — State-run exchange
Gov. Deval Patrick (D)

Michigan — Federal-state partnership
Gov. Rick Snyder (R)

Minnesota — State-run exchange
Gov. Mark Dayton (D)

Mississippi — Federally operated exchange
Gov. Phil Bryant (R)

Missouri — Federally operated exchange
Gov. Jay Nixon (D)

Montana — Federally operated exchange
Gov. Steve Bullock (D) (Brian Schweitzer previously)

Nebraska — Federally operated exchange
Gov. Dave Heineman (R)

Nevada — State-run exchange
Gov. Brian Sandoval (R)

New Hampshire — Federal-state partnership
Gov. Maggie Hassan (D) (John Lynch previously)

New Jersey — Federally operated exchange
Gov. Chris Christie (R)

New Mexico — State-run exchange
Gov. Susana Martinez (R)

New York — State-run exchange
Gov. Andrew Cuomo (D)

North Carolina — Federally run exchange
Gov. Pat McCrory (R) (Bev Purdue previously)

North Dakota — Federally operated exchange
Gov. Jack Dalrymple (R)

Ohio — Federal-state partnership *   
Gov. John Kasich (R)

Oklahoma — Federally operated exchange
Gov. Mary Fallin (R)

Oregon — State-run exchange
Gov. John Kitzhaber, MD (D)

Pennsylvania — Federally operated exchange
Gov. Tom Corbett (R)

Rhode Island — State-run exchange
Gov. Lincoln Chafee (I)

South Carolina — Federally operated exchange
Gov. Nikki Haley (R)

South Dakota — Federal-state partnership    
Gov. Dennis Daugaard (R)

Tennessee — Federally operated exchange    
Gov. Bill Haslam (R)

Texas — Federally operated exchange
Gov. Rick Perry (R)

Utah — State-run exchange **
Gov. Gary Herbert (R)

Vermont — State-run exchange
Gov. Peter Shumlin (D)

Virginia — Federal-state partnership *
Gov. Bob McDonnell (R)

Washington — State-run exchange
Gov. Jay Inslee (D) (Christine Gregoire previously)

West Virginia — Federal-state partnership *
Gov. Earl Ray Tomblin (D)

Wisconsin — Federally operated exchange
Gov. Scott Walker (R)

Wyoming — Federally operated exchange
Gov. Matt Mead (R)

*Pending HHS approval

**Utah has requested HHS approve its existing health insurance exchange for small businesses called Avenue H. HHS has stated they will work to assist the state to come into full compliance with the health law, but have not yet fully approved Utah’s proposal.

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How to Market a Health Insurance Exchange

Posted By Dylan Scott | February 13, 2013


Scribbled in purple marker on a poster board at the front of the room were these words: “Message: Affordable Health Care.” That’s the message that officials at the Washington, D.C., Health Benefits Exchange want to deliver to the public. Now they just have to figure out how to send it.

Government officials, health-care providers, advocacy groups and all sorts of stakeholders convened at Mt. Vernon United Methodist Church Tuesday for a communication summit, hoping to create a strategy for getting the word out. It’s a tall task: many Americans still don’t know what a health insurance exchange—or marketplace, if you like—is. But more than 20 million are expected to be purchasing health coverage through them in the next decade, choosing an insurance plan in an online experience much like Expedia’s, the online travel booking service.

Even in Washington, where the Affordable Care Act (ACA) that created the exchanges was born, officials face a significant challenge.

 “They say: ‘If you build it, they will come.’ I don’t believe that,” Mohammad Akhter, chairman of the D.C. health exchange’s board of directors, told the attendees at Tuesday’s meeting. “It’s only when everyone gets involved, that is the only way to turn the tide and get everyone insured. That’s why we need your help.”

D.C. is one of 19 state-level exchanges to be approved by the U.S. Department of Health and Human Services (HHS) to open on Oct. 1, 2013. Creating the marketplace, which amounts to launching a huge interactive website, is an immense undertaking. (To get a sense of the scope, check out Governing’s series on Rhode Island’s health exchange implementation.)

But once the website is up and running, you have to get people signed up for it, and nobody is quite sure how to do that. People aren’t used to buying health insurance on their own, and ‘exchange’ is probably one of the wonkiest terms in health policy. So states are getting creative, floating ideas like working exchanges into primetime TV storylines or advertising on Pandora radio. But that just underlines how daunting the problem is.

“Beyond the Beltway, nobody knows anything about the [ACA],” Kim Holland, executive director of state affairs for the BlueCross/BlueShield Association, told Governing last month. “We cannot underestimate the amount of effort it will take to get people to the system.”

In the District of Columbia, everyone from church clergy to city accountants to doctors, got together to sketch a strategy for doing that. The emphasis was on collaboration: if people can get information about the exchange from almost any source, whether it’s their doctor’s office or their church or the health department, they’re more likely to get the message. With as many as 63,000 District residents going without insurance at some point during the year, you need to cast as wide of a net as possible.

It’s also about keeping thing simple. Like simple message on the board at the front of the room said, remember the mantra: affordable health care. Who can get it? Any eligible U.S. citizen. Where do they get it? The website or a toll-free phone number. See? That’s not so complicated. Of course, then you need to explain how costs will be shared, what services will be covered and how consumers can redeem the federal tax subsidies that are supposed to make insurance cheaper. That’s why customers will need a knowledgeable presence to help them out.

The bland conference room where the meeting was held felt like a gospel revival tent at times as the exchange officials and attendees tried to galvanize excitement about their task. Whoops, applause and hearty laughter abounded.

To cultivate that communal feel, each of the 150-plus participants was asked at the beginning of the meeting to introduce themselves and describe their personality with an adjective that shared the first letter of their first name. One speaker began his presentation by asking the audience if they knew someone who was uninsured, and every hand went up. With a healthy showing from the faith community, and a sense of urgency clearly present, there was no hesitation in invoking the Almighty.

“This is a very important endeavor we’re embarking on. We need your help,” said Linda Wharton-Boyd, who runs the exchange’s communications office. “We need your support. We need your prayers.”

But they also had some very specific ideas about how to accomplish their mission. The exchange has already convened workgroups, which almost anyone can join, and they are already providing official policy recommendations to the exchange board. Officials are currently in the midst of developing a ‘brand’ for the marketplace, thus doing away with the wonky ‘exchange’ moniker. Market research is underway to identify who will use the exchange. An advertising campaign will launch sometime in September for the Oct. 1 opening.

Official service centers will be set up across the District, complete with kiosks where users can access the exchange. Those will be placed in other public places, too, like libraries. The city will also secure federal grants to pay for training of ‘navigators’ and ‘assisters’, many of whom will be volunteers at community organizations, who will learn all the details of the ACA and develop their own strategies to get that information to their distinct constituents.

Danielle Davis, the communications director at neighboring Maryland’s health exchange, came to share how her state is handling some of the same issues. They include: drafting template materials for navigators in English and Spanish, crafting a social media outreach plan and coordinating launch events across the state closer to the exchange’s opening. One attendee also offered the idea of ‘peer educators’, normal people who live alongside Washington’s uninsured and volunteer to distribute information to their friends and neighbors.

That was the most prevalent theme as the summit wore on. Fair or not, the uninsured are more likely to be low-income and less educated. They might not be web savvy or might have concerns about online privacy. So they’re going to need a helping hand in finding the exchange and understanding it once they’re get there. Those people are probably going to trust their neighbor or their doctor or their church brethren more than a government official or an impersonal advertisement on the television or radio. Just one example: Hispanic Washingtonians are more likely to digest information about the exchange if it comes from one of the many cultural groups or associations that they already know.

Doctors should be asking their patients if they need insurance. Clergy should be asking their parishioners the same thing. Help thy neighbor. That’s the principle that will be driving the District’s communications strategy going forward.

“We can’t depend on them to come to us. We’ve got to go to them,” said Richard Sorian, a former HHS official who assisting the exchange with its outreach. “We need trusted voices, people who work in their community and live alongside them.


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Affordable Care Act expands, equalizes care to women, proponents say

February 13, 2013 1:20 am by Kersey, Lori | Med City News

CHARLESTON, W.Va. – The Affordable Care Act will expand and equalize health care for women, proponents of the law said Tuesday.

Under health-care reform, about 17 million women in the United States will get coverage.

Dozens of people attended a town hall meeting about the ACA’s impact on women’s health hosted by the West Virginians for Affordable Health Care and other local agencies.

The meeting was held Tuesday evening at the Schoenbaum Family Enrichment Center on Charleston’s West Side.

 Under the Affordable Care Act, preventative care services must be covered without co-pay or deductible, said Renate Pore, health care policy director for WVAHC.

Those services include mammography, cervical cancer screenings, domestic violence screening and counseling, well-woman visits, all FDA-approved contraceptive methods and more.

Women may need to instruct their physicians that these services are preventative and not diagnostic, or patients could be billed for co-pays and deductibles, a representative from the West Virginia Offices of the Insurance Commissioner said.

Medicare will cover preventative services, too, Pore said.

“The federal government wants seniors to be healthy and getting preventive care,” she said.

The ACA also provides reproductive health care for women, Pore said. However, the law doesn’t change the rules about abortion services. Federal funds are limited for abortion to the cases of rape, incest or to protect the life of the pregnant woman, she said.

While many of the measures under the Affordable Care Act are in place, Gov. Earl Ray Tomblin has yet to decide whether to expand Medicaid to those who earn up to 138 percent of the federal poverty line, or $26,300 for a family of three.

If Tomblin were to expand Medicaid, it would mean Medicaid coverage for 125,000 West Virginians, including 63,000 women, Pore said.

The federal government would pay for all of the expansion during the first three years. After that, the federal match would gradually decline to 90 percent.

Pore encouraged those attending the meeting to tell the governor to expand Medicaid.

“I think it’s time now to start pressuring the governor to get with the program,” she said.

Results from an actuary study about the cost of Medicaid expansion are expected in March.


Reach Lori Kersey at or 304-348-1240. ___

(c)2013 The Charleston Gazette (Charleston, W.Va.)

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