$67M doled out to those aiding others navigate health care

Kelly Kennedy, USA TODAY8:25 a.m. EDT August 16, 2013

TAMPA — The Department of Health and Human Services on Thursday awarded $67 million in grants to 105 navigators, or groups of people who will help uninsured Americans sign up for health insurance beginning in October.

HHS Secretary Kathleen Sebelius made the announcement at the University of South Florida, which received a $4 million grant. Eight groups in Florida will receive a total of $7.8 million.

Florida is one of the three states where federal officials hope to add millions of young, uninsured and healthy adults to the pool of people who will buy health insurance through the state exchanges created by the 2010 health care law. California and Texas are the other two states.

“We know that a lot of people prefer in-person help,” Sebelius said of the navigators, adding that the helpers will receive an initial 20 hours of training, as well as additional training throughout the year.

“We know there’s a lot of work to be done, but we’ll be ready for whatever comes up,” she said.

The grants come as the law’s supporters and opponents argue about its merits and potential impact. Organizing for Action, the non-profit political group backing President Obama, released a third advertisement to explain the law’s benefits, while Crossroads GPS, a political group created by Republican strategist Karl Rove, continues its media campaign criticizing the law.

Some Republican officials, including Sen. Ted Cruz of Texas, are calling for a government shutdown at the end of September to stop funding for the law, a move that other Republican officials are calling counterproductive and suicidal for the party’s chances.

HHS looks for groups who already have networks in place, who already have connections” to be navigators, Sebelius said. “We had lots more people apply than we could fund,” she said.

Sebelius also recognized Thursday the more than 100 volunteer organizations educating people about the exchanges. The exchanges are online marketplaces where people may buy health insurance from private companies. At healthcare.gov, consumers can compare benefits and costs of several plans. They will also be able to see whether they qualify for a subsidy to help pay for insurance.

HHS officials have tried to keep the process of buying insurance but acknowledge that many Americans will still need help. A recent survey found that just 14% of Americans understood basic insurance terms, such as “premium” and “deductible.”

Often, people have been shut out of the insurance system because of pre-existing medical conditions, poverty or simply not being able to quickly choose a plan because information was not available.

Across the nation, the states have also taken a role in advertising the law. In the District of Columbia, exchange spokesman Richard Sorian said, about 35 organizations have received training to help people enroll, and a call center will be open 24 hours a day and seven days a week to answer questions, because some people who may be eligible for subsidies may work two or three jobs.

District officials have also asked for help from community leaders, such as churches, African-American groups, African-immigrant organizations and LGBT groups, as well as the Chamber of Commerce and the restaurant association.

“We see the population that is uninsured as fairly hard to reach,” Sorian said. “So we’re taking a systematic approach.”

In Hawaii, the state will start running television advertisements and they are making presentations to community organizations that will also promote the exchanges, said Brian Fitzgerald, spokesman for the Hawaii Health Connector.

“I think people are just now realizing the law takes effect Jan. 1, and they’re saying, ‘What do I need to do?'” he said. “There’s a lot of excitement.”

Illinois has just started training its navigators, and 44 community organizations will help enroll people in insurance, state health care spokesman Mike Claffey said.

In Maryland, officials are training 325 navigators and 5,000 aides known as “assistors,” said Danielle Davis, spokeswoman for the Maryland Health Connection, beginning the last week in August.

In Arkansas, the Health Connector website launched July 1 and has had 91,000 individual hits.

“We’ve had robust outreach in every county,” said Deputy Insurance Commissioner Cindy Crone. “We’ve had a lot of positive response.”

They have a state “guide” program to help the federal navigator program, but state legislators decided all of those who assist people must have licenses.

The federal government has also launched a 24-hour-a-day call center, and 1,200 community health centers are also working to educate people.

Navigators must follow strict security and privacy standards to protect personal information, such as Social Security numbers and income, Sebelius said.

On Thursday, she recognized organizations, such as the American Medical Association, NAACP, League of United Latin American Citizens and the National Baptist Convention, that are working to inform people about the exchanges.

Follow @KellySKennedy on Twitter

Source Link:  http://www.usatoday.com/story/news/politics/2013/08/15/navigators-affordable-care-act/2658753/

Health care reform: What do I need to know now?

Published: August 15, 2013

This is the first in an educational series about Health Care Reform from Blue Cross of Northeastern Pennsylvania.

The Affordable Care Act, or ACA, which is commonly referred to as Health Care Reform, was signed into law by President Obama in March 2010. And on June 28, 2012, the U.S. Supreme Court issued its landmark decision upholding the ACA provision that requires the purchase of health insurance, thus allowing all provisions of Health Care Reform to move forward as scheduled.

But if you’re still uncertain about what Health Care Reform means for you, you are not alone. A recent poll by the Kaiser Family Foundation found that much of the public remains confused about Reform, with 4 in 10 Americans unaware that the ACA is the law of the land.

What’s important for you to know right now? Let’s start with the basics.

The Affordable Care Act was intended to help more people access and afford health care coverage regardless of their health status. The law creates fundamental changes in the way health insurance options are developed, priced and offered to consumers.

While many parts of the law won’t take effect until the start of 2014, the following provisions are already in place:

1. Health care coverage for children with pre-existing conditions.

If you have a child under 19 with an illness or disability, often called a “pre-existing condition,” he or she cannot be denied coverage. Before the law was put into place, health plans could in some situations refuse to offer coverage or could limit benefits because of a pre-existing condition.

2.  If you have children under age 26, they can stay on your insurance plan.

Parents can add or keep children on their plans until they reach age 26. Your child can stay on your plan even if they are not living with you, and even if they are eligible to enroll in their own employer’s plan, unless your plan is grandfathered.

3.  Insurance coverage cannot be cancelled if you get sick and have previously made an unintentional mistake on your application.

Health plans cannot rescind, or cancel retroactively, your insurance coverage if you or your employer made an honest mistake on your application. Coverage can only be rescinded in cases of fraud or intentional misrepresentation.

4.  No lifetime limits on coverage and restricted annual limits.

The law prohibits lifetime dollar limits on coverage and also restricts and phases out the annual dollar limits a health plan can place on most of your benefits, eliminating these limits entirely in 2014.

5.  Direct access to OB/GYN services.

All health plans must provide women with direct access to participating obstetric and gynecologic care providers without the need for prior authorization or referral.

6.  No cost sharing for preventive services.

Preventive care services are covered at 100 percent. This means that covered individuals are not charged a copayment or coinsurance for these services as long as they are received from a provider within your health plan’s network.

7.  The right to an internal and external appeal of health plan decisions.

Consumers have the right to appeal decisions made by their health plans, including the denial of a payment for a service or treatment. If your plan denies payment after considering your appeal, the law gives you the right to have an independent organization conduct a medical review of that decision.

As you can see, many of the law’s provisions have already been put into action, but the most transformational aspects of Health Care Reform will take effect in 2014. In the meantime, it’s important that you learn all you can to get the most out of your health plan for you and your family. Visit www .healthcare.gov for the latest information from the U.S. Department of Health & Human Services

Blue Cross of Northeastern Pennsylvania is committed to sharing critical information about Health Care Reform. Now that we’ve looked at what’s already taken effect, watch for the next installment of this series in July to learn more about what’s changing next, and when. And visit http://www.bcnepa.com/reform anytime for more resources that can help you understand what Health Care Reform means for you.

A. Paul Holdren is senior vice president and chief sales & marketing officer for Blue Cross of Northeastern Pennsylvania.

Source Link:  http://standardspeaker.com/health-care-reform-what-do-i-need-to-know-now-1.1536330

Expert: Exchanges Could Boost Quality Reporting, Delivery Reform

Tuesday, August 13, 2013

Health insurance exchanges under the Affordable Care Act could be a mechanism for delivery reform and quality reporting, an insurance exchange expert said at an Alliance for Health Reform briefing on Friday, MedPage Today reports (Pittman, MedPage Today, 8/12).


Under the ACA, states by January 2014 must create online health insurance exchanges to provide coverage options for individuals and small businesses.

Most insurance exchanges will rely on a solid IT foundation to connect with advanced eligibility systems for Medicaid and other state-administered health programs (iHealthBeat, 6/27).

Details of Comments

Sarah Dash of Georgetown University’s Center on Health Insurance Reform said that insurance exchanges will be required to report quality measures on participating plans beginning in 2016 but that some marketplaces could ask insurers to record more data on specific items.

After the briefing, Dash said that states “might want to come up with new quality metrics that they think are important.”

According to Dash, several states will require plans sold through the exchange to report quality measures in the first year to provide consumers with more information when selecting coverage.

Dash said, “Whether consumers are going to be actively following that … I think that remains to be seen” (MedPage Today, 8/12).

Source Link: http://www.ihealthbeat.org/articles/2013/8/13/expert-exchanges-could-boost-quality-reporting-delivery-reform

Five Ways the Affordable Care Act Helps America’s Small Businesses

Ari Matusiak

August 14, 2013
05:05 PM EDT
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Small businesses are the backbone of our economy, and for the 28 million small employers across the country, healthcare is a major concern. The Affordable Care Act provides benefits and opportunities to small businesses that will help increase access to affordable coverage options.

Here are five key ways the Affordable Care Act can benefit small employers and their workers:

  1. SHOP Marketplaces: Currently, small businesses face premiums that are on average 18% higher than large businesses. On October 1, 2013, the new Small Business Health Insurance Options Program (SHOP) Marketplaces will be open for businesses, and small employers in every state will be able to shop for health coverage on a competitive marketplace, that brings unprecedented transparency to the market and gives small businesses the same purchasing clout as big businesses.
  2. Reducing Administrative Complexity: SHOP Marketplaces include web portals that provide standardized, easy-to-understand information that will make comparing and purchasing coverage easier, and will simplify the administrative challenges that businesses often face when offering plans. Visit www.HealthCare.gov to learn more about the SHOP Marketplace and to get ready for open enrollment.
  3. New Tax Credits: The small business tax credit helps small businesses afford the cost of healthcare coverage for their employees, and is already helping qualifying small businesses offset the cost of insurance by up to 35%. In 2014, this tax credit goes up to 50% and is available to qualified small businesses who obtain coverage through the SHOP Marketplace.
  4. Improved Risk Pooling: The new SHOP Marketplaces will allow small groups to pool risks and reduce administrative complexity, thereby increasing their purchasing power and reducing costs for small businesses that want to provide coverage to their workers. Business can enroll starting on October 1, 2013, through their brokers, or directly through the SHOP Marketplace. Stay connected to the latest information on the Marketplaces by going to www.HealthCare.gov.
  5. Workplace Wellness:  The Affordable Care Act creates new incentives to promote workplace wellness programs and encourages employers to take more opportunities to support healthier workplaces. Effective for plan years after January 1, 2014, final rules allow the maximum reward to employers using a health-contingent wellness program to increase from 20 percent to 30 percent of the cost of health coverage, and the maximum reward for programs designed to prevent or reduce tobacco use will be as much as 50 percent.

To help provide small business owners with the resources and information they need, the Obama Administration recently launched Businesss.USA.gov/healthcare, a one-shop where employers of all sizes can go for customizable information about how the law impacts them, based on the size, location and future plans for offering coverage. And, the Department of Health and Human Services launched a call center specifically to serve the needs of small businesses interested in the SHOP Marketplace. This call center (1-800-706-7893) is a new resource to help business owners get information to make the right decision for their bottom line and their employees. It’s open Monday-Friday from 9 AM- 5 PM, with representatives available to help in English and Spanish.

The Small Business Administration has also teamed up with Small Business Majority to offer a weekly webinar series designed to educate small business owners about what the healthcare law means for them. To sign up for a weekly Thursday Webinar before open enrollment starts on October 1, 2013, visit: www.sba.gov/community/blogs/community-blogs/health-care-business-pulse-/affordable-care-act-101-weekly-webinar-se.

Related Topics: JobsSmall BusinessEconomyHealth Care

The Challenge of Helping the Uninsured Find Coverage

Source Link:  http://www.nytimes.com/2013/08/15/us/politics/the-challenge-of-helping-the-uninsured-find-coverage.html?partner=rss&emc=rss&_r=0


Published: August 14, 2013

OAKTON, Va. — Cyndy Dailey held a job fair at her nonprofit agency here last weekend, with a major caveat: she did not yet know if she could hire.

Like many organizations across the country, Ms. Daily’s agency, Northern Virginia Family Service, is hoping to win a federal grant to help uninsured people in the state sign up for coverage under President Obama’shealth care law. With the money, she hopes to hire at least a handful of “navigators” — a new category of worker created under the law to educate consumers about new health insurance options and, starting in October, to walk them through the enrollment process.

Navigators are seen as crucial to the success of the law. As the Jan. 1 deadline approaches when most Americans will be required to have health coverage or pay a fine,  navigators are supposed to explain away confusion and fear among the legions of uninsured, helping them understand how new health insurance markets will work and whether they will qualify for subsidies to help with the cost of coverage.

But as the navigator effort gets under way across the country, it is clear that their impact will vary from state to state, with wide discrepancies in how much will be spent to hire and train navigators and how many people they will be able to reach. Many will be operating on shoestring budgets, with extremely tight time frames and hostile political climates.

“There’s definitely going to be a tremendous difference, not only in navigators but also in marketing funds,” said Andy Hyman, senior program officer at the Robert Wood Johnson Foundation. “So what we’re going to have to see in states with fewer funds is a lot more ingenuity.”

Maryland is spending $24 million on a program that will soon dispatch 325 navigators and assisters around the state. Colorado is investing $17 million on 400 “coverage guides,” and New York is spending $27 million on a similar effort.

But in states like Virginia, which declined to build their own insurance markets under the law and ceded the task to the federal government, navigators will not have much money to get the word out. The Obama administration has promised up to $54 million for navigators in the 34 states where the federal government is setting up all or part of the markets. The grants are to be awarded Thursday.

In Virginia, up to $1.4 million will be distributed to navigator groups, which may include nonprofit community organizations, trade groups, chambers of commerce, unions and other public and private entities.

“It is what it is,” Ms. Dailey said about the comparatively tiny budget for navigators in her state. “All we can do is make our best effort.”

Her agency has asked for $495,000, about a third of the total navigator funds allocated for Virginia. That would cover the equivalent of seven and a half full-time navigators (some may end up working part-time), computers and other equipment for them to do their jobs, informational materials, marketing, and continuing outreach events in five counties.

The federal government did not anticipate having to cover the cost of running the insurance markets in 34 states, which is why it has only $54 million — transferred from a fund for public health prevention programs — for navigators in those states. The health care law set aside much more money for states that built their own markets, assuming that most would do so.

To fill in the gaps, other organizations will also be working to get the word out and helping people sign up for health plans through the new markets. About 1,200 community health centers around the country, which provide medical care for the uninsured, have received a total of $150 million in federal money to help with outreach and enrollment. Virginia’s health centers received $2.5 million.

In addition, many groups that did not apply for navigator funds will nonetheless help educate the uninsured about their options, connect them with navigators or point them toward the new insurance markets.

Insurance agents or brokers may also help people sign up for coverage through the markets; insurance companies selling plans through the markets will also play a role. Northern Virginia Family Service plans to enlist a network of partner organizations, many of whom already work with the uninsured, to help with outreach and enrollment or provide space and other resources.

“Other local groups may have funding or be in a position to get volunteers to do some of this work,” said Christine Barber, a senior policy analyst at Community Catalyst, a consumer advocacy group. “Everyone is anxious to know who the navigators are so that other groups can partner with them, know who to refer people to, know how to flesh out their coalitions and their outreach.”

Navigators, who will also help small businesses and their employees learn about and enroll in health plans offered through the new markets, cannot recommend any particular health plan or receive compensation from an insurance company. They will get at least 20 hours of training and take a certification test.

Opponents of the health care law have nonetheless questioned whether navigators will know enough to help consumers understand the complexities of insurance coverage, and whether they can be trusted with the personal data that consumers will include in applications for coverage.

Ms. Dailey said her agency planned to run background checks on navigators and have them sign off on ethics policies, adding, “We will do a good job because we have all these protocols in place.”

Once the federal grants are awarded, recipients will have to move quickly to hire and train navigators and set their outreach plans in motion. Judy Robinson, whose small nonprofit group in Charlottesville, Va., hopes to win a grant to hire three navigators who would team up with at least a dozen volunteers, said she was excited about the possibility despite the pressure.

Ms. Robinson said her group, the Jefferson Area Board for Aging, was already getting calls from uninsured residents seeking information about the new insurance market.

“I’m a planner, I like to anticipate things, so it is a little hard for me,” she said. “But I’m just going to try to let go, go with the flow of it and not be upset not to have it all in place.”

Ms. Dailey said her “contingent-upon-award” job fair for navigators last weekend drew about 20 people, including retirees, recent college graduates and people with compelling personal stories about health care and insurance.

“My hope would certainly be that we could do fast-track interviews,” she said. “I think I have a good pool of folks.”

A version of this article appeared in print on August 15, 2013, on page A12 of the New York edition with the headline: The Challenge Of Helping The Uninsured Find Coverage.

Language barriers could deter minorities from benefiting from healthcare reform

  • At a panel discussion, state Assemblyman Phil Ting, D-San Francisco, promoted Assembly Bill 1263.

With California at the forefront of the most comprehensive nationwide health care reform effort in half a century, it isn’t affordability but language barriers that providers and legislators fear will prevent minorities from taking advantage of greater access to coverage.

The Affordable Care Act, which begins open enrollment in October and becomes effective Jan. 1, will make health insurance more accessible and affordable to millions of Americans who now lack insurance. But in California, where nearly 16 million people, or 43 percent, speak a language other than English — it’s 45 percent in San Francisco — implementing the act presents a challenge.

At a panel discussion about this topic Wednesday, state Assemblyman Phil Ting, D-San Francisco, promoted Assembly Bill 1263, under which California would invest $200,000 to gain $270 million in federal funds authorized by the act to fund interpreter services for state Medicaid enrollees.

Interpreters are very often “our lifeline,” Ting said, noting that many immigrant families are accustomed to having their children translate when they receive medical treatment.

The U.S. Department of Health and Human Services does not recommend using children as interpreters, especially because they often lack medical vocabulary, said panelist Annis Arthur, deputy regional manager for the department’s Office for Civil Rights.

Legislation like AB 1263 would help break down language as the barrier to health care access, Ting said.

“We can’t expect our children to be there,” Ting said. “What kind of system will they be able to access? I don’t want to hyperbolize, but in these situations it’s a case of life or death.”

Members of the Asian and Latino community helped put a human face on this issue at Wednesday’s panel.

San Francisco resident Juan Situ shared how she waited hours for an interpreter to help her fill out forms for her sister’s hospitalization, only for the situation to get no better after her procedure.

“After the surgery, the interpreter was gone and we wanted to ask the doctor why my sister was in so much pain,” Situ said in Cantonese. “Finally, the doctor came to us but there was no interpreter, so we could not communicate.”

Although California and the U.S. have great language access laws, lapses exist, said forum panelist Cary Sanders, director of policy analysis at the California Pan-Ethnic Health Network.

“Part of it is they are not aware they have the right to request language access,” she said. “That is a huge issue. We heard a couple stories today but think of all the stories we are not hearing. The system fails and we don’t know about it.”

Affordable care act Study: Half who buy own plans would get aid

Published: Wed, August 14, 2013 @ 12:00 a.m.

Associated Press


About half the people who now buy their own health insurance— and potentially would face higher premiums next year under President Barack Obama’s health care law— would qualify for federal tax credits to offset rate shock, according to a new private study.

Many other people, however, earn too much money to be eligible for help, and could end up paying more.

The estimate, being released today by the nonpartisan Kaiser Family Foundation, tries to answer one of the biggest remaining questions about the impact of Obama’s law on American families: Will consumers wince — or even balk — when they see the premiums for the new plans?

The study found that 48 percent of families currently buying their own coverage would be eligible for tax credits next year, averaging $5,548 per family, or 66 percent of the average cost of a benchmark “silver” policy offered through new state insurance markets.

“About half of the people won’t be paying the sticker price,” said Gary Claxton, director of the health care marketplace project at Kaiser, an information clearinghouse on the health care system. “The people who get help will get quite a lot of help.”

“Many, but certainly not all, of the people who don’t get tax credits will pay more,” he said. “How much more will be a function of a lot of different things.”

For example, some people who don’t qualify for tax credits may get jobs that offer coverage, added Claxton, a co-author of the study. And the bottom line on premiums may not be clear until sometime this fall, after the Health and Human Services Department releases rates for more than 30 states where the federal government is taking the lead setting up new insurance markets for individuals and small businesses.

People can enroll starting Oct. 1, and coverage becomes effective Jan. 1. Most people currently covered by employer plans are not affected.

The law is likely to increase the sticker price for individually purchased coverage next year for several reasons:

Insurers will have to cover people with pre- existing medical conditions, whose needs are costlier to provide for.

Policies must provide certain standard benefits, including prescription drugs, mental health and substance abuse treatment and rehabilitative services.

Policyholders’ annual out-of-pocket costs will be capped.

Article Link: http://www.vindy.com/news/2013/aug/14/affordable-care-act-study-half-who-buy-o/


Obamacare Presents Complex Choices For People With Disabilities

Source Link:  http://www.webmd.com/health-insurance/20130809/obamacare-presents-complex-choices-for-people-with-disabilities?src=RSS_PUBLIC

WebMD News from Kaiser Health News

By Eric Whitney, CPR
The Affordable Care Act has set new standards — called essential health benefits — outlining what health insurance companies must now cover. But there’s a catch: Insurance firms can still pick and choose to some degree which specific therapies they’ll cover within some categories of benefit. And the way insurers interpret the rules could turn out to be a big deal for people with disabilities who need ongoing therapy to improve their day-to-day lives.

Bryce Vernon is a 20-year-old film student who lives in Los Angeles and has cerebral palsy. He speaks only with the aid of a special computer mounted to his wheelchair that tracks his eye movements. Using his eyes, Vernon can indicate on a screen what letters and words he wants the computer’s voice to say.

It’s amazing technology, and Vernon gets a lot more out of it with help from speech-language pathologist Jill Tullman.

“Now Bryce, I’m want to show you this super cool random button I think you’re going to love,” Tullman tells him during a therapy session at a special camp for young people who use the technology. Vernon’s parents paid out-of-pocket for him to attend the camp.

Tullman helps him pre-load several different ways of saying goodbye.

“Bye, later dude, later, bye, I’m out of here, see ya later,” Vernon says, testing it out.

In the parlance of health policy, the work Tullman is doing with Vernon is called “habilitative services.” It’s different from the more familiar sort of rehab people often get after an injury or surgery. Habilitative services are for people who can benefit from one-on-one time with a therapist to improve daily living skills. But such services can be expensive, and not all insurance plans have covered them.

The Affordable Care Act is changing that, says health economist Lisa Clemans-Cope with the Urban Institute.

“You’re much more likely to find these benefits in a plan in the individual market [starting in 2014] than you would be today. Far more likely,” says Clemans-Cope.

This is because “habilitative services” are included within the 10 categories of essential health benefits the ACA will require in those new plans. Still, while some categories are straightforward — such as maternity care and preventive care — the category including habilitative services leaves more room for interpretation.

For instance, insurers could choose to cover physical therapy for someone with a broken bone, but not cover long-term support services for chronic conditions, such as speech therapy for kids with developmental delays.

Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want to have specific therapies covered are going have to slog through some fine print to figure out if they’ll actually benefit from a particular policy. (The new policies will start to go on sale this fall and go into effect beginning Jan. 1, 2014.)

“This is a big improvement, but we should emphasize that it’s not totally fixed,” Clemans-Cope says. “And people are really going to have to get help to decide which plans cover the benefits they need. ”

Whether a person will be able to get the new therapy benefits also depends on where they live. The level of benefits insurers have to provide in each category is based on a model policy in each state, and some of those model policies are a lot more generous than others.

Jill Tappert, an activist in Colorado for people with disabilities, says a lot of details still need to be sorted out before she’ll be able to say whether the health care law has improved things much.

“I certainly hope the way the Affordable Care Act is implemented is a game changer for people in the disabilities community. It can be,” says Tappert, who spent years fighting for habilitative service coverage for her daughter who has autism. “The opportunity is there for policy makers to vastly improve lives.”

Barbara Vernon, Bryce’s mother, says Bryce is now covered by Medi-Cal, California’s Medicaid program. His primary insurance had been her employer-sponsored plan until she was laid off in 2009. She searched for private coverage for Bryce, but says, “Private was so unbelievably expensive, it was unaffordable.”

Barbara says her family’s insurance is “a patchwork,” with Bryce likely to stay on Medi-Cal even after his 21st birthday. She and her other son have an individual plan they have purchased, and her husband has an employer-sponsored plan — but it covers only the employee, not the family.

For his part, Bryce Vernon says his life is a lot better since getting the kind of help that many others may be able to get from the health law, starting in 2014. He works hard to get the most out of the technology and the therapy that lets him speak. His advice to others: “Never, ever give up.”

The new rules for what health insurance companies have to cover may still change. Federal regulators plan to review them as the health law rolls out and could make changes in 2016.

This piece is part of a reporting partnership among NPR, Colorado Public Radio and Kaiser Health News.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Long Term Care Insurance Not Covered by Obamacare Reports Association Director

August 14th, 2013 – 0 comments – Filed Under – by 

Los Angeles, CA, August 14, 2013 –(PR.com)– Long term care insurance is not included under provisions passed by Congress as part of the Affordable Care Act also known as Obamacare according to the director of the American Association for Long Term Care Insurance.

“We are getting an increasing number of calls from consumers wanting to know how to apply for long term care insurance once insurers must accept pre-existing health conditions,” explains Jesse Slome, executive director of the long term care insurance industry trade group. “Unfortunately I have to tell them long term care insurance is not included under Obamacare and is only available to those who can meet health requirements.”

Consumers are expected to start investigating insurance plans available under Obamacare next month and open enrollment starts October 1st.

“The Department of Health and Human Services abandoned any plans to implement the provision calling for a voluntary long term care insurance program which would have allowed those with existing health insurance to apply,” Slome notes. “They found the monthly premiums they’d have to charge would have been far too expensive for people to afford so they walked away and allowed Congress to repeal the CLASS Act.”

“There are about a dozen insurance companies currently offering private long term care insurance,” says Slome. About eight million Americans have some form of protection against the significant risk of needing long term care. “If you have some existing health conditions, we can advise whether pursuing a long term care insurance policy will even be possible.”

The American Association for Long-Term Care Insurance advocates for the importance of long term care planning and supports insurance professionals who market the complete range of planning products.

Consumers interested in learning more about long term care insurance protection can read four consumer guides providing helpful information on planning and reducing long term care insurance costs. They can be accessed on the Association’s website at http://www.aaltci.org/guides and no information is required to access these guides. To connect with a designated long term care insurance professional, a member of the Association, for information and no-obligation cost comparisons call the

Contact Information:
American Association for Long-Term Care Insurance
Jesse Slome
Contact via Email

Read the full story here: http://www.pr.com/press-release/509590

Press Release Distributed by PR.com

U.S. schools face tough decisions on Obamacare benefits

By Yasmeen Abutaleb

WASHINGTON | Wed Aug 14, 2013 7:39am EDT

(Reuters) – Hit by years of budget cuts, some U.S. public school boards are looking to avoid providing health benefits to substitute teachers and supporting staff under President Barack Obama’s reform law, education officials say.

According to the law, employers will have to offer health coverage to all full-time employees, defined as those who work an average of 30 or more hours per week each month, or else pay a fine starting in 2015.

School boards, already struggling to manage after years of state budget cuts, are trying to get ahead of the potential costs of Obamacare for the current academic year, education and labor officials say. The need to find creative solutions, or risk cutting back staff hours further, will increase as they finalize their budgets, they say.

In Pennsylvania’s Penn Manor School District, Superintendent Mike Leichliter said there is no room in its constrained budget to provide additional employee insurance. Instead of cutting hours, the district used a substitute-teacher contracting service to pay part of the salaries for 95 employees. Money for such a service does not count against the school’s budget.

“When we looked at our costs, (healthcare) was one area that really had the potential to skyrocket,” Leichliter said. “This is absolutely the worst time for school districts to be faced with mandated increases.”

The National School Board Association said many states and school districts have at least explored reducing hours, according to Linda Embrey, a communications officer. Several school officials contacted by Reuters said they could not find a way around cuts.

In Indiana’s Fort Wayne Community Schools district, one of the state’s largest, administrators reduced hours for 610 of its 4,050 employees, including substitute teachers and support staff, who were working 30 or more hours a week. Providing them with health insurance would have cost $10 million annually, said Krista Stockman, public information officer for Fort Wayne.

“You get to a point where there’s a danger that you’re cutting too much and that the quality of education you’re providing isn’t as great,” Stockman said. “We’re just going to have to do the same amount or more with less.”

Most of the employees affected are substitute teachers, classroom aides, cafeteria workers, bus drivers or similar support staff, according to school officials and labor representatives. They had not been receiving healthcare coverage from their employers in the past. Now, instead of getting such employer-sponsored benefits under the reform law, they may be eligible for government-subsidized coverage that will be offered by new state insurance exchanges starting on October 1.


During the 2012-2013 school year, 26 states provided less money to local school districts than the prior year, and 35 states provided less funding than in 2008 (a better year), according to the Center on Budget and Policy Priorities.

This year they are also grappling with across-the-board “sequester” spending cuts introduced after Congress deadlocked over how to fix the deficit. An Obama administration official said those cuts plus the states’, and not healthcare reform, are the main reasons for staff losing work-time at schools.

“We are seeing no systematic evidence that the Affordable Care Act is leading to a shift to part-time work,” the official said. “There are a variety of factors impacting schools, including sequestration, which is cutting budgets and is a completely separate issue.”

The National Education Association is working with union leaders across the country to figure out how to encourage employers to avoid cutting hours as a result of healthcare reform, said Joel Solomon, NEA senior policy analyst. The effort has included a training session for dozens of labor representatives in June, and more sessions are planned for this year.

Solomon said one popular solution offered by the NEA is to help schools get a more precise accounting of employee hours to see whether staff are truly working an average of 30 hours a week each month when holidays and other time off are included. That has helped some schools make less drastic cuts in employee hours, he said.

Many school employees are expected to qualify for Obamacare’s tax subsidies, which are available starting in January to people who make within 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013).

Even if they don’t, the new plans are preferable to what they currently have to buy on the individual market because insurers cannot deny coverage based on prior illness.

In Nebraska, the Plattsmouth Community School District is limiting the hours of permanent substitute teachers, who typically work every day, said Marlene Wehrbein, a labor union official who advocates for employees in the state’s public school districts.

“It creates a lot of inconsistency in staffing, and I can’t see how that would be good for students,” Wehrbein said. “How could you have a teacher teaching English four days a week and then on the fifth day you have someone else?”

(Reporting by Yasmeen Abutaleb; Editing by Michele Gershberg and Prudence Crowther)