Five Things You Don’t Know About Health-Care Reform

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Insurance sign-ups are just around the corner for millions of Americans under health-care reform, yet there’s still much people don’t know about this landmark legislation, particularly those changes occurring over the next decade inside hospitals, clinics, and doctors’ offices.

It’s a workforce thing. All the attention is on politics, or who will receive what benefits and where the money will come from. But the most important question is who will deliver the care and how it will be done. Most of the change will be accomplished by the health-care workforce. Transforming health care is a huge management challenge. Many clinicians and staff will have to fundamentally change their professional objectives and standards, daily routines, compensation, patient relationships, and employer relationships. The scope of health-care reform and current market pressures are unparalleled in any other industry; the re-engineering of health-care workforce roles now underway may completely change relationships between patients and clinicians in the next decade.

Biggest long-term problem: clinician shortages.An additional 30 million Americans will receive health-care coverage by the end of the decade, during a time when a further 15 million patients will become eligible for Medicare. Who will take care of all those people? By 2020, a shortage of 91,500 primary care and specialist physicians is predicted. Shortages of nurse practitioners and physician assistants, who could help fill in the gaps in primary care, also are predicted. Without enough clinicians, effective health-care reform could be stifled.

Getting paid to keep you well, rather than cure your illness. Changes in compensation for doctors and nurses will dramatically transform from quantity of work to quality of work. Until very recently, compensation and reimbursement were entirely based on the volume of patients and treatments. Now they’re beginning to reflect value-based benchmarks that will increase every year. Some of these include patient satisfaction, readmission rates, health risk assessments, and patient wellness, among other benchmarks. For hospitals, making sure patients are satisfied will become a pocketbook issue. For clinicians, careful disease management and preventive care to keep patients out of the hospital could directly affect how much they are paid.

Independent doctors’ practices are quickly fading. Physicians who hang a shingle outside a private office are becoming rarer. A recent survey showed that 55 percent of practicing physicians work for someone else, usually a hospital or a practice owned by a hospital or health system. That figure grew 8 percent in one year. Meanwhile, nearly 40 percent of physicians younger than 45 have never worked in private practice. Doctors are moving to employed positions in hospitals and health systems in search of greater stability in the rapidly changing health-care environment.

Your doctor may not be a doctor. One of the most striking changes for consumers may be team-based care, with physicians, nurse practitioners, physician assistants, psychologists, pharmacists, and others working together to improve quality of care and lower costs. If your health-care provider employs a team approach, when you make an appointment with your doctor you may instead see a nurse practitioner or physician assistant, depending on a quick assessment of your health status. In more than a dozen states, nurse practitioners can diagnose, treat, or prescribe with no physician involvement. Laws and regulations on the scope of practice for these clinicians are changing rapidly.

Health-care reform isn’t just about getting coverage for millions of people who don’t have it. It’s also about changing the way health care is delivered to reduce costs and improve patient care. Unless we can accomplish those two goals, increasing coverage will become prohibitively expensive. Transforming health-care delivery requires the active participation of America’s 16-million member health-care workforce.

Salka is President and CEO of AMN Healthcare, one of the nation’s largest health care staffing companies.
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How the health reform law will affect senior care

By KATRINA CAMERON-Staff Writer

POSTED:   08/17/2013 12:19:05 AM PDT

The Affordable Care Act won’t hurt health care for the baby boomer population, and it will strengthen Medicare, the national insurance program for people age 65 and older.Every day across the nation, 10,000 people are turning 65, said Myron Machula, vice president and CFO of Enloe Medical Center. The total number of people age 65 or older in Butte, Glenn and Tehama counties is 55,000.

“That’s a fair amount of the population,” Machula said. “They count on this Medicare program for the health care that they receive.”

“There has been a misconception that the Affordable Care Act is going to take away benefits from people with Medicare, and it isn’t going to,” said Tatiana Fassieux, program manager at Passages.

Instead of cutting basic Medicare benefits, it improves them, she said.

According to the National Council on Aging, prescription drug costs will lessen because the coverage gap — better known as the “donut hole” — for those with Part D plans will be slowly phased out by 2020.

“Ideally, what’s going to happen is on a general basis nationally people won’t have to spend more than 25 percent for their prescriptions, so that was one aspect of the Affordable Care Act,” Fassieux said.

Medicare beneficiaries will also benefit from more preventative care, such as cancer and diabetes screening, according to the National Council on Aging. A free annual wellness visit allows the beneficiary and doctor to develop a prevention plan to keep the patient healthy. Patients can also get free vaccines.

“Preventative care is what saves money,” Fassieux said.

The law also helps ensure Medicare patients return home successfully from hospital stays, according to the National Council on Aging.

Eighty percent of older American have a least one chronic medical condition such as high blood pressure, heart disease or diabetes.

About 65 percent of Enloe Medical Center’s in-patient care is Medicare beneficiaries, Machula said. About 40 percent of outpatients are on Medicare.

The law also makes it easier to receive and pay for long-term care at home, according to the National Council on Aging. Medicare doesn’t currently cover long-term care, but starting in 2014 the law will increase protection for spouses of individuals who receive Medicaid home care services.

Another benefit is the law allows the Department of Justice to go after individuals or hospitals that have committed Medicare fraud, Fassieux said.

Medicare began paying bonuses of 10 percent to primary care doctors to improve access, according to the National Council on Aging.

The difficulty of getting into a primary physician’s office has already been an issue, but the rising number of people who will soon have insurance through the Affordable Care Act may make it more problematic.

“Why is that occurring?” Machula said. “Well, because again the volume of physicians is shy of what the need is, so the idea is to take the mid-level practitioners to help with what will be this increase for those who need care because they have the card.”

A question still unanswered is what an individual is to do if he or she bought an exchange insurance plan and then becomes eligible for Medicare. Fassieux said it’s unknown if someone can have both Medicare and the exchange plan.

Although there are still many unanswered questions regarding the Affordable Care Act, it appears that it will benefit older Americans.

Source Link: http://www.chicoer.com/health/ci_23882967/how-health-reform-law-will-affect-senior-care

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.

Health Insurance Changes Coming Your Way Under the Affordable Care Act

The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act

2014 is coming–are you ready for Obamacare? Join the YouToons as they walk through the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, when major parts of the Affordable Care Act, also known as “Obamacare,” go into effect.

This cartoon was written and produced by the Kaiser Family Foundation. Charlie Gibson, former anchor of ABC’s World News with Charlie Gibson and a member of the Foundation’s Board of Trustees, narrated the video. Creative production and animation was provided by Free Range Studios.

http://youtu.be/JZkk6ueZt-U | #HCR #affordablecareact #uninsured #medicaid #exchange #ACA #healthcarereform

Obamacare pilot project lowers Medicare costs

By: Brett Norman
July 17, 2013 05:00 AM EDT
 

Source Link:  http://dyn.politico.com/printstory.cfm?uuid=81086AEB-BC65-4936-8901-F1E34EB14854

An ambitious program under the health law to change how care is paid for lost nearly a third of its participants after the first year, but not before all were able to boost the quality of care provided to patients in an experiment that some experts say holds promise to bring down health care costs in the long run.

The Centers for Medicare & Medicaid Services announced Tuesday that all 32 health care organizations had hit performance benchmarks for improving care in the Pioneer Accountable Care Organization program, and 13 had done so while substantially lowering Medicare costs. In part, that was by reducing hospitalization and rehospitalizations, CMS reported.

By health care standards, the savings claimed were relatively modest — $87.6 million in 2012. And two participants reported increasing costs by $4 million. Overall, for the 669,000 Medicare enrollees in the program, costs rose by just 0.3 percent compared with 0.8 percent for typical Medicare patients.

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“These results show that successful Pioneer ACOs have reduced costs for Medicare and improved the quality of care for their patients,” CMS Administrator Marilyn Tavenner said in a statement. “The Affordable Care Act has given us a wide range of tools to realign payment incentives in Medicare and Medicaid, and these efforts are already paying off.”

Mark McClellan, former CMS administrator under President George W. Bush and a leading accountable care expert, said the first-year performance is in line with similar undertakings in the private sector. Quality improvements typically precede savings because they can be accomplished more quickly while the savings sometime lag.

“Improving diabetes care now, you see benefits 18 months, 24 months down the road,” said McClellan, now at The Brookings Institution.

“This is a difficult journey,” he said. “It’s a marathon not a sprint, and some organizations are in a better position to do it faster, and others slower.”

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The Pioneer ACO program is among the health care law’s most aggressive experiments in improving care and cutting costs. Networks of doctors coordinate care for patients and share in both the savings they generate and — eventually — the risk of losses.

The Medicare Shared Savings Program is a risk-free version of the accountable care effort, but the share of the savings for the health care organization is also substantially smaller. Seven of the Pioneer ACOs are transitioning to that option this year, and two are opting out of the health law’s ACO programs altogether, although they may adapt their ACO investments for contracts with private insurers, Blair Childs, senior vice president for Premier healthcare alliance, said.

Presbyterian Healthcare Services in New Mexico is one of two Pioneers to drop out of the ACO program completely. The integrated health system, which also has a large health plan, faced two major challenges, according to Todd Sandman, its vice president for strategy and customer engagement. Part of the problem centered on using retrospective data, and part was that New Mexico is a “low-cost, low-reimbursement, low-health care utilization state” — putting it at a disadvantage to perform better than other Medicare providers, Sandman said.

“Frankly, what was hard for us getting out is we really do believe this is the right direction for health care providers,” Sandman said, describing the relationship with CMS as “very collaborative.”

More than 200 health care organizations are participating in the shared-savings program in addition to the Pioneer ACOs, and private insurers are employing the concept as well.

It’s one of several ideas, including bundled payments and medical homes, that are all likely to be part of reorganizing the payment model toward paying for quality, not volume, of care, McClellan said.

CMS should strike “the right balance between incentives and encouragement for change and getting participation in the program,” McClellan said. But the agency shouldn’t back off of rigorous goals — it “should continue to think of [the Pioneer ACO] program as pushing the envelope.”

Some participants had threatened to leave the program this spring over what they said was an overly ambitious set of 33 quality measures. CMS did not make the adjustments they sought. Health systems also have complained that the agency has not been fast enough in providing Medicare claims data that would help them keep track of whether their patients were filling needed prescriptions, for instance, or following up on referrals to specialists.

Jason Millman contributed to this report.

© 2013 POLITICO LLC

Brace for super-stripped-down online health insurance exchange

July 14, 2013 9:07 am by Morgan, David | MedCityNews (Orginally posted on Reuters)

 

WASHINGTON (Reuters) – With time running out, U.S. officials are struggling to cope with the task of launching the new online health insurance exchanges at the heart of President Barack Obama’s signature health reforms by an October 1 deadline.

The White House, and federal agencies including the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), must ensure that working marketplaces open for enrollment in all 50 states in less than 80 days, and are responding to mounting pressure by concentrating on three essential areas that will determine whether the most critical phase of Obamacare succeeds or fails.

“The administration right now is in a triage mode. Seriously, they do not have the resources to implement all of the provisions on time,” Washington and Lee University professor Timothy Jost, a healthcare reform expert and advocate, told an oversight panel in the U.S. House of Representatives last week.

Current and former administration officials, independent experts and business representatives say the three priorities are the creation of an online portal that will make it easy for consumers to compare insurance plans and enroll in coverage; the capacity to effectively process and deliver government subsidies that help consumers pay for the insurance; and retention of the law’s individual mandate, which requires nearly all Americans to have health insurance when Obama’s healthcare reform law comes into full force in 2014.

Measures deemed less essential, such as making larger employers provide health insurance to their full-time workers next year or face fines, and requiring exchanges to verify the health insurance and income status of applicants, have already been postponed or scaled back.

“The closer you get to the actual launch, the more you focus on what is essential versus what could be second-order issues,” said a former administration official. “That concentrates the mind in a different kind of way, and that’s what’s happening here.”

But the risk of failure in the form of major delays is palpable, given the administration’s limited staff and financial resources, as well as the stubborn political opposition of Republicans, who have denied new money for the effort in Congress and prevented dozens of states from cooperating with initiatives that offer subsidized health coverage to millions of lower income uninsured people.

Any further delay could help Republicans make Obamacare’s troubles a focus of their campaign in next year’s congressional midterm elections and in the 2016 presidential race.

HHS denies that its strategy has changed and insists that implementation continues to meet the milestones laid out by planners 18 months ago.

“All of the systems are exactly where we want them to be today. They will be ready to perform fully on October 1,” said Mike Hash, director of the HHS Office of Health Reform.

White House officials acknowledge the approach of the open enrollment deadline has put a greater emphasis on priorities. They describe the strategy as a “smart, adaptive policy” and assert that delayed or scaled-back regulations demonstrate better policy decisions or flexibility with stakeholders, rather than a need to minimize distractions.

NO MARGIN FOR ERROR

Advocates point out that the reform, formally titled the Patient Protection and Affordable Care Act and informally known as Obamacare, constitutes the most sweeping healthcare legislation since the creation of Medicare and Medicaid, large successful government programs for the elderly and the low income that also faced fierce political opposition when they were created in 1965. Both required years of work after their launch to refine implementation.

The administration has already delayed or scaled back at least half a dozen health reform measures since last year. These include regulations involving star quality ratings for insurance company plans, the choice of insurance plans for small-business employees and a requirement that state Medicaid agencies notify individuals of their eligibility for federal assistance.

Other efforts that could still be delayed include deadlines for some health insurers to get their plans certified by HHS as well as requirements for how the insurance exchanges provide customer service.

House Speaker John Boehner and other House Republican leaders, warning of a “train wreck”, have called on Obama to defer an essential task: the individual mandate, which requires people to have insurance coverage in 2014 or face penalties that begin modestly, but rise sharply by 2016.

But experts say it is the other essential tasks – establishing the high-tech capabilities necessary to process government insurance subsidies and create online shopping and enrollment for consumers – that could be most vulnerable with such a compressed timetable.

“The biggest hurdle is to get the systems up and running,” said one health insurance official. “Nothing’s happened so far that prevents you from being up and running on October 1. But there’s virtually no margin for error.”

The administration is working according to an ambitious schedule for testing a technology hub and its ability to transfer consumer data on health coverage, income, tax credits and other topics between federal agencies, insurance companies and states. The hub is already exchanging data between the necessary agencies.

A report from Georgetown University’s Center on Health Insurance Reforms says state-run exchanges are on track for a successful October 1 launch and have exceeded federal minimum requirements in some cases.

Failure to have adequate systems in place by September 4, when HHS is due to give insurers final notice about which health plans are qualified to be sold on 34 state exchanges run by the federal government, could delay open enrollment by days or weeks but still allow the law’s core reform provisions to take effect on January 1, experts said.

Insurers will have several days in August to review plan data as it would be presented to prospective enrollees in side-by-side comparisons online. The administration also needs to test the system with a wider audience than the IT experts working on the exchanges to make sure they are consumer-friendly.

Michael Marchand, spokesman for Washington’s Health Benefit Exchange, said the state’s online marketplace had conducted frequent tests with the federal data hub, which had worked well so far. But any last-minute changes to the government’s requirements to its operations could throw a wrench into the IT system, he said.

“If you start adding or removing lines of code it could bring the whole thing down,” he said. “As you add or take away pieces, you have to re-test from the beginning.”

(Additional reporting by Patrick Temple-West in Washington and Sharon Begley in New York; Editing by Michele Gershberg, Martin Howell)

Copyright (2013) Thomson Reuters.

Article Link: http://medcitynews.com/2013/07/braced-for-super-stripped-down-online-health-insurance-exchanges/

Where each state stands on ACA’s Medicaid expansion

A roundup of what each state’s leadership has said about their Medicaid plans

June 14, 2013 | Posted on The Advisory Board Company, Advisory.com

 

The Supreme Court’s ruling on the Affordable Care Act (ACA) allowed states to opt out of the law’s Medicaid expansion, leaving each state’s decision to participate in the hands of the nation’s governors and state leaders.

Based on lawmakers’ statements, press releases, and media coverage, the Daily Briefing and American Health Line editorial teams have rounded up where each state currently stands on the expansion.

We will continue to update this map and list as more information becomes available. Send us news, tips, and feedback by commenting below or emailing dailybriefing@advisory.com.

Click to expand a quick-to-scan graphic or an interactive graphic. (Note: The interactive graphic may not be optimized for all mobile devices.)

A state-by-state look at governors’ stances

Text last updated on June 14, 2013. States are categorized based on statements from governors or enacted state laws.

* indicates a state’s participation in the multistate lawsuit against ACA

NOT PARTICIPATING (13 states)

  • Alabama*: Gov. Robert Bentley (R) on Nov. 13 announced that Alabama will not participate in the Medicaid expansion because the state “simply cannot afford it” (Gadsden Times, 11/13).
  • Georgia*: Gov. Nathan Deal (R) in an Atlanta Journal-Constitution/Politico/11 Alive interview on Aug. 28 said, “No, I do not have any intentions of expanding Medicaid,” adding, “I think that is something our state cannot afford.” When asked about the insurance exchanges, Deal said “we do have a time frame for making the decision on that I think, especially on the exchanges,” adding that “we have just a few days after the election in order to make a final determination on that” (Wingfield, “Kyle Wingfield,” Atlanta Journal-Constitution, 8/28/12).
  • Idaho*: Gov. C.L. Otter (R) in his 2013 State of the State address delivered on Jan. 7 said that while “there is broad agreement that the existing Medicaid program is broken,” the state “face[s] no immediate federal deadline” to address the situation. He added, “We have time to do this right … [s]o I’m seeking no expansion of” the program. Otter said he’s instructed the state Health and Welfare director to “flesh out a plan” that focuses on potential costs, savings and economic impact, which he plans to introduce in 2014 (Ritter Saunders, Boise State Public Radio, 1/7/13; Young, Huffington Post, 1/7; Petcash, KTVB, 1/7/13).
  • Louisiana*: Gov. Bobby Jindal (R) in an NBC “Meet the Press” interview on July 1 said, “Every governor’s got two critical decisions to make. One is do we set up these exchanges? And, secondly, do we expand Medicaid? And, no, in Louisiana, we’re not doing either one of those things” (Barrow, New Orleans Times-Picayune, 7/2/12).
  • Maine*: Gov. Paul LePage (R) on Nov. 16 said that Maine will not participate in the Medicaid expansion. He called the expansion and the state-based insurance exchanges a “degradation of our nation’s premier health care system” (Mistler, Kennebec Journal, 11/16/12).
  • Mississippi*: Gov. Phil Bryant (R) on Nov. 7 said Mississippi will not participate in the Medicaid expansion, reiterating previous statements that he had made about the ACA provision (Pender/Hall, Jackson Clarion-Ledger, 11/7/12).
  • North Carolina: Gov. Pat McCrory (R) on Feb. 12 announced that his state will not expand Medicaid or establish its own health insurance marketplace under the Affordable Care Act. McCrory said state officials conducted a comprehensive analysis to determine the advantages and disadvantages of expanding Medicaid and the right type of exchange option in the state, and concluded that it is “abundantly clear that North Carolina is not ready to expand the Medicaid system and that we should utilize a federal exchange.” He said the review included discussions with other governors, White House officials, health care providers, and leaders in the state Legislature (Binker/Burns, “@NCCapitol,” WRAL, 2/12/13; Cornatzer, Raleigh News & Observer, 2/12/13).
  • Oklahoma: Gov. Mary Fallin (R) on Nov. 19 said Oklahoma will not participate in the Medicaid expansion. “Oklahoma will not be participating in the Obama Administration’s proposed expansion of Medicaid,” she said in a statement. She noted that the program would cost the state as much as $475 million over the next eight years (Greene, Tulsa World, 11/19/12).
  • Pennsylvania*: Gov. Tom Corbett (R) on Feb. 5 sent a letter to HHS saying he “cannot recommend a dramatic Medicaid expansion” in Pennsylvania because “it would be financially unsustainable for Pennsylvania taxpayers.” He noted that the expansion would necessitate “a large tax increase on Pennsylvania families” (Tolland, Pittsburgh Post-Gazette, 2/5/13).
  • South Carolina*: Gov. Nikki Haley (R) on July 1 announced via Facebook that South Carolina “will NOT expand Medicaid, or participate in any health exchanges.” The state Legislature is expected to make a decision on the Medicaid expansion during the 2013 session (Gov. Haley Facebook page, 7/1/12; Holleman, Columbia State, 11/9/12).
  • South Dakota: Gov. Dennis Daugaard (R) in his annual budget address on Dec. 4 said he does not plan to participate in the Medicaid expansion. “I really think it would be premature to expand this year,” he said, adding that he hoped for more flexibility for the state program (Montgomery, Sioux Falls Argus Leader, 12/4/12).
  • Texas*: Gov. Rick Perry (R) in a statement on July 9 said, “If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under ObamaCare.” Perry also sent a letter to HHS Secretary Kathleen Sebelius on July 9 asserting this position. The Dallas Morning News reported that on Nov. 8, Perry reiterated his opposition to the expansion, saying, “Nothing changes from our perspective” (Office of Gov. Perry release, 7/9/12; Gov. Perry letter, 7/9/12; Garrett, Dallas Morning News, 11/11/12).
  • Wisconsin*: Gov. Scott Walker (R) on Feb. 13 announced his rejection of the Medicaid expansion. He proposed an alternative plan that would expand coverage to low-income state residents through private health care exchanges (Spicuzza, Wisconsin State Journal, 2/13/13).

LEANING TOWARD NOT PARTICIPATING (6 states)

  • Alaska*: Gov. Sean Parnell (R) on Feb. 28 expressed opposition to the Medicaid expansion. He said he will not ask the state Legislature to consider expansion this session, but he will continue to examine the issue (Bohrer, AP/Alaska Journal of Commerce, 3/1/13).
  • Kansas*: Gov. Sam Brownback (R) has punted the decision on Medicaid expansion to Kansas’ Republican-controlled legislature. Lawmakers have not reached consensus on the issue, and a state budget amendment that is expected to pass would prohibit Brownback from expanding the program without the support of the legislature (Celock, Huffington Post, 5/6/13).
  • Nebraska*: Gov. Dave Heineman (R) in a statement on his website on June 28 said, “As I have said repeatedly, if this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased. If some state senators want to increase taxes or cut education funding, I will oppose them.” Heineman on July 11 sent a letter to state lawmakers saying the state could not afford the expansion, but he stopped short of saying that the state will not participate in the expansion, according to Reuters (Office of Gov. Heineman release, 6/28/12; Wisniewski, Reuters, 7/11/12).
  • Utah*: Gov. Gary Herbert (R) has not yet announced a decision on Medicaid expansion. He has asked the state health department to convene a workgroup to examine cost-effective alternatives that would expand coverage for low-income residents (Dobner, Salt Lake Tribune, 4/23/13).
  • Virginia*: Although Gov. Bob McDonnell (R) has not made an official announced on the Medicaid expansion, he has expressed opposition to the ACA provision, according to the Virginian-Pilot. However, the Pilot notes, the future of the state’s Medicaid expansion will likely depend on the outcome of the November gubernatorial election: Democrat Terry McAuliffe support expansion, but Republican Ken Cuccinelli opposes it (Walker, Virginian-Pilot, 4/11/13).
  • Wyoming*: Gov. Matt Mead (R) on Nov. 30 recommended that Wyoming not participate in the Medicaid expansion, but added that his position could change in the future and urged “everyone to keep an open mind on this.” The state legislature will make the final decision on whether to expand the program, the AP/Jackson Hole Daily reports (Brown, Wyoming Tribune Eagle, 12/1/12; Graham, AP/Jackson Hole Daily, 12/1/12).

LEANING TOWARD PARTICIPATING (1 states)

  • New York: Gov. Andrew Cuomo (D) in a statement on his website on June 28 said he was “pleased the Supreme Court upheld the [ACA]” and looks forward “to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers.” On July 26, Danielle Holahan—project director for New York’s health insurance exchange planning—said the state “largely meet[s] the federal required Medicaid levels already.” Although Cuomo’s office has not officially announced a decision, the Associated Press reported on Nov. 13 that New York will expand Medicaid (Office Gov. Cuomo release, 6/28/12; Grant, North Country Public Radio, 7/27/12).

PARTICIPATING (26 states and the District of Columbia)

  • Arizona*: The Arizona Legislature on June 13 approved a fiscal year 2013-2014 budget blueprint that includes a plan to expand the state’s Medicaid program under the Affordable Care Act. Gov. Jan Brewer (R)—who in January announced her support for the expansion, which would extend Medicaid coverage to about 300,000 additional state residents—is expected to the sign the budget measure (Viebeck, “Healthwatch,” The Hill, 6/13; Schwartz, Reuters, 6/13/13; Christie/Silva, AP/Yahoo! News, 6/14/13).
  • California: Gov. Jerry Brown (D) in a statement on June 28 said the Supreme Court’s ruling “removes the last roadblock to fulfilling President Obama’s historic plan to bring health care to millions of uninsured citizens.” California got a head start on expanding its Medicaid program in November 2010 with its “Bridge to Reform” program, which aimed to bring at least two million uninsured Californians into Medicaid (Office of Gov. Brown release, 6/28/12; DeBord, “KPCC News,” KPCC, 6/28/12).
  • Colorado*: Gov. John Hickenlooper (D) on Jan. 3 announced that his state will participate in the expansion. In a news release, his office said the move would extend Medicaid coverage to about 160,000 low-income residents and save Colorado an estimated $280 million over 10 years without affecting the state’s general fund (Stokols, KDVR, 1/3/13; Wyatt, AP/Denver Post, 1/3/13).
  • Connecticut: Gov. Dannel Malloy (D) was among the first governors to sign up for the Medicaid expansion after the ACA was enacted in March 2010. Soon after the Supreme Court ruling on June 28, Malloy said “it’s great … [and a] very important decision for the people of Connecticut. 500,000 people would have lost coverage if Republicans had their way” (Davis, WTNH, 6/28/12).
  • Delaware: Gov. Jack Markell (D) in a statement on June 28 said, “The Supreme Court’s ruling enables Delaware to continue to implement provisions of the Patient Protection and Affordable Care Act to provide access to health care benefits for Delawareans.” He added, “On the Medicaid front, Delaware already voluntarily expanded the state’s Medicaid coverage program in 1996 to cover many Delawareans not previously covered” (Office of Gov. Markell release, 6/28/12).
  • District of Columbia: D.C. Mayor Vincent Gray (D) in a statement on June 28 said, “The District is not at risk of losing any Medicaid funding as a result of this ruling, because District officials have already begun implementation of the ACA’s Medicaid-expansion provisions and will continue to implement the expansion” (Executive Office of the Mayor release, 6/28/12).
  • Florida*: Gov. Rick Scott (R) on Feb. 20 announced that the state will participate in the ACA’s Medicaid expansion, citing HHS’s conditional support for a waiver to shift most of the state’s Medicaid beneficiaries into a managed-care program. However, Scott said that Florida would only participate in the expansion for three years before reevaluating the decision. Supporters of the ACA heralded Florida’s shift as a major reversal; Scott mounted his successful campaign for governor in 2010, in part, by being one of the nation’s foremost critics of President Obama’s planned health reforms (Kennedy/Fineout, Associated Press, 2/20; Office of Gov. Scott release, 2/20/13).
  • Hawaii: Gov. Neil Abercrombie (D) in a statement on June 28 welcomed the Supreme Court’s ruling and said the ACA “is our ally” in the effort to “support a health care system that ensures high quality, safety and sustainable costs.” Pat McManaman, director of the state Department of Human Services, said Hawaii’s Medicaid eligibility requirements in July would fall in line with the law’ guidelines, meaning an additional 24,000 people will be eligible for the program by 2014 (Office of Gov. Abercrombie release, 6/28/12).
  • Illinois: Gov. Pat Quinn (D) on June 28 praised the court’s decision and said he “will continue to work with President Obama to help working families get the healthcare coverage they need,” including expanding Medicaid (Office of the Governor release, 6/28; Thomason, Rock River Times, 7/3/12; Ehley, Fiscal Times, 8/20/12).
  • Kentucky: Gov. Steve Beshear (D) on May 9 announced that Kentucky will participate in the Medicaid expansion. He called the decision “the single-most important decision in our lifetime for improving the health of Kentuckians” (Halladay, Louisville Courier-Journal, 5/9/13).
  • Maryland: Gov. Martin O’Malley (D) in a statement on June 28 said the Supreme Court’s decision “gives considerable momentum to our health care reform efforts here in Maryland,” adding that the state will move forward to implement the overhaul (Office of the Governor release, 6/28/12).
  • Massachusetts: Gov. Deval Patrick (D) in late June said Massachusetts is “an early expansion state as you know and we’re expecting further resources from the federal government to sustain the experiment here in Massachusetts.” Patrick called the ruling “good news for us” (Walker, YNN, 6/28/12).
  • Michigan*: Gov. Rick Snyder (R), in a statement released on Feb. 6, announced that his fiscal year 2014 budget proposal includes a plan to expand the state’s Medicaid program under the Affordable Care Act. The plan would extend Medicaid benefits to about 320,000 eligible residents. Snyder said the plan contains safeguards that will ensure the financial stability of the program and protect against changes in the government’s financial commitment to the expansion (Office of Gov. Snyder release, 2/6/13).
  • Minnesota: Gov. Mark Dayton (D) said in a statement on June 28, 2012, said, “Today’s ruling will be met with relief by the Minnesotans whose lives have already been improved by this law.” On Feb. 19, 2013, Dayton signed a bill authorizing expansion the state (AP/KARE 11, 2/19/13).
  • Missouri: Gov. Jay Nixon (D) on Nov. 29 announced that Missouri will participate in the Medicaid expansion. Nixon said he will include the expansion in the state budget proposal he submits to lawmakers. “We’re not going to let politics get in the way of doing the best thing for our state,” he said (Crisp, “Political Fix,” St. Louis Post-Dispatch, 11/29/12).
  • Montana: Gov. Steve Bullock (D) in January 2013 said he planned to expand Medicaid in Montana. However, the state Legislature defeated all bills that would expand the state health care program in 2013. On the last day of the legislative session, Bullock said, “Let me be clear, we will reform healthcare in Montana. We will do it with or without the Legislature’s help” (Johnson, Billings Gazette, 1/5/13; KXLH, 5/2/13).
  • Nevada*: Gov. Brian Sandoval (R) on Dec. 11 announced that the state will participate in the Medicaid expansion. “Though I have never liked the Affordable Care Act because of the individual mandate it places on citizens, the increased burden on businesses and concerns about access to health care, the law has been upheld by the Supreme Court,” Sandoval said in a statement, adding, “As such, I am forced to accept it as today’s reality and I have decided to expand Nevada’s Medicaid coverage” (Damon, Las Vegas Sun, 12/11/12).
  • New Jersey: Gov. Chris Christie (R) in his Feb. 26 budget address announced that New Jersey will participate in the Medicaid expansion. The ACA provision is expected to extended Medicaid coverage to about 300,000 uninsured New Jersey residents (Cheney, Politico, 2/26/13).
  • New Hampshire: Gov. Maggie Hassan (D) in her Feb. 14 budget address said that New Hampshire will opt into the ACA’s Medicaid expansion because “it’s a good deal…[that will] allow us to save money in existing state programs, while increasing state revenues.” A state report estimates that the expansion will cost New Hampshire about $85 million through 2020, but will bring in $2.5 billion in federal funds and help reduce the number of uninsured residents from roughly 170,000 to 71,000 (Ramer, AP/Seacoastonline.com, 2/14)
  • New Mexico: Gov. Susana Martinez (R) on Jan. 9 announced that her state will participate in the Medicaid expansion, which potentially could extend health coverage to nearly 170,000 additional low-income uninsured residents. Martinez noted that contingency measures will be established if federal funding for the expansion diminishes, which would mean scaling back the expansion by dropping newly covered beneficiaries from the Medicaid rolls (Schirtzinger, Santa Fe Reporter, 1/9/13; Reichbach, New Mexico Telegram, 1/9/13).
  • North Dakota*: Gov. Jack Dalrymple (R) in January said the politics associated with the ACA should not prevent North Dakota from participating in the Medicaid expansion. In April 2013, he signed a legislation that expanded Medicaid in the state (AP/Prairie Business Magazine, 4/16/13).
  • Ohio*: Gov. John Kasich (R) on Feb. 4 announced that the state will be participating in the Medicaid expansion, the Cleveland Plain Dealer reports. He made the announcement in his two-year budget announcement, but warned that Ohio would “reverse this decision” if the federal government does not provide the funds it has pledged to the expansion (Tribble, Cleveland Plain Dealer, 2/4/13).
  • Oregon: Gov. John Kitzhaber (D) said on June 28 that he is confident that the Oregon Legislature will approve a state Medicaid decision. In an interview with the Oregonian just hours after the Supreme Court issued its ruling on the ACA, Kitzhaber said, “We’ll make a decision on whether or not to expand the Medicaid program really based on, I think, the resources we have available in the general fund for that purpose going forward” (Budnick, Oregonian, 6/28/12).
  • Rhode Island: Gov. Lincoln Chaffee (I) in a statement on his website on June 28 said, “I have fully committed to ensuring Rhode Island is a national leader in implementing health reform whatever the Supreme Court decision, and this just reinforces that commitment.” According to Steven Costantino, the state’s secretary of health and human services, “The expansion is easy to do and makes sense.” Moreover, on July 12, USA Today reported that Chaffee planned to participate in the expansion (Chaffee statement, 6/28/12; Wolf, USA Today, 7/12/12; Radnofsky et al., Wall Street Journal, 7/2/12).
  • Vermont: Gov. Peter Shumlin (D) on June 28 said Vermont’s Medicaid program already meets the requirements under the health reform law’s Medicaid expansion (Steimle, WCAX, 7/1/12).
  • Washington*: In an email responding to a query by American Health Line, Karina Shagren—a deputy communications director in Gov. Chris Gregoire’s (D) administration—in early July said “the governor supports the Medicaid expansion—and Washington will move forward.” U.S. Rep. Jay Inslee (D)—who supports the expansion—was elected governor on Nov. 6 (Shagren email, 7/5/12; Washington Secretary of State website, 11/12/12).
  • West Virginia: Gov. Earl Ray Tomblin (D) on May 2 announced that West Virginia will participate in the Medicaid expansion. “At the end of the day, we have weighed the options and believe expanding Medicaid is the best choice for West Virginia,” he said (Boucher, Charleston Daily Mail, 5/2/13).

Participating through an alternative expansion model (4 states)

  • Arkansas: Gov. Mike Beebe (D) in February announced that HHS had approved a plan to expand coverage to expansion-eligible residents through the health information exchanges. As with the Medicaid expansion, the federal government has agreed to cover 100% of the premiums for the first three years and 90% of the premiums after 2020 (Ramsey, “Arkansas Blog,” Arkansas Times, 2/26/13).
  • Indiana*: Gov. Mike Pence (R) has proposed a plan to expand coverage to expansion-eligible residents through Indiana’s Healthy Indian Plan (Sikich, Indianapolis Star, 4/1/13).
  • Iowa*: Gov. Terry Branstad (R) on May 22 said he will support a compromise deal that would extend health insurance coverage to 150,000 low-income state residents through a new state plan or through the state’s insurance exchange. The Senate approved the compromise deal on May 22, and the House approved it on May 23 (Lucey, AP/Modern Healthcare, 5/23/13; Petroski, Des Moines Register, 5/24/13).
  • Tennessee: Gov. Bill Haslam (R) on March 27 announced in an address to a joint session of the General Assembly that the state will not participate in the Medicaid expansion. Instead, he said he favors an alternative option, under which the state would use federal funds to shift Medicaid-eligible residents into private health plans (Humphrey, Knoxville News Sentinel, 3/27/2013; Goodnough, New York Times, 3/27/13).

Article Link: http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap

Five Things You Might Not Know About the Affordable Care Act

Published on Modern Medicine (http://www.modernmedicine.com)

Publish Date: JUN 21,2013

A big change in America’s health care system is coming at the beginning of next year.

The Affordable Care Act, also known as Obamacare, will go into full effect in 2014, giving millions of uninsured Americans access to health care.

However, there are still misconceptions about the law.

In today’s Just Explain It, we’ll tell you five things you might not know about Obamacare.

Number one… Contrary to what 42 percent of Americans think, Obamacare really is happening. In fact, people can start signing up for state-run health insurance on October 1st. That’s when states and the federal government will open marketplaces, called exchanges, to offer subsidized benefits to the nation’s 50 million uninsured.

Number two… Another survey found that a majority of Americans think the law cuts Medicare benefits and covers undocumented immigrants. It doesn’t.

Actually, the government expects the average Medicare recipient to save approximately $35,000 over the next ten years.

Number three… Tax credits. Next year, health insurance for eligible individuals or families will be subsidized.

For example, someone making just under $23,000 a year wouldn’t have to spend more than 6.3 percent of their annual income on health insurance. Based on a $3,030 plan, their contribution would be $1,450. Under Obamacare, they’d receive a tax credit of $1,580 to put towards their coverage.

Number four… The 80/20 rule. Insurers are now required to spend at least 80 percent of premium dollars on providing healthcare. The other 20 percent can be used on overhead expenses like excessive administrative costs and profits. In 2012, this provision saved Americans over two billion dollars.

If insurers don’t comply, they’re required to provide customers with a rebate. In 2011, over 13 million consumers received $1.1 billion in rebates – that’s around $150 per customer.

And finally… taxes. No matter what you’ve heard, your health benefits under Obamacare will not be taxed. The law does require that employers report the value of your annual coverage on your W-2, but the government says that’s just for workers’ information.

In the end, the Affordable Care Act is incredibly complex piece of legislation. It enacts sweeping reforms that involve every state and millions of Americans. Do you think it will work for you?

Let us know what you think. Do you have a topic you’d like explained? Give us your feedback in the comments below or on Twitter using #JustExplainIt.

Source URL: http://www.modernmedicine.com/modern-medicine/news/five-things-you-might-not-know-about-affordable-care-act

Kentucky Introduces New Health Insurance Exchange

Reported by: Aaron Adelson

Email: aadelson@wtvq.com

 

Published: 5/15 3:48 pm

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Updated: 5/15 7:20 pm

Twitter: https://twitter.com/AAdelsonABC36

As part of the Affordable Care Act, Governor Beshear announces Kentucky’s new health insurance exchange program. It’s called Kynect.

Governor Beshear says Kentucky ranks at, or near the bottom in most health statistics.  He says too many people are using the emergency room instead of seeing a primary care physician.

“This lack of early care is one reason Kentucky’s heath picture is so horrendous,” said Governor Beshear.

He says a big part of the problem is a lack of health insurance.  The Governor says about 650,000 Kentuckians are uninsured.  He says this hurts the state in a number of ways.

“A kid is not going to do better in school if they’re sick, if they don’t feel good, if they’ve got bad teeth,” said Beshear.

Last week, the Governor announced half of the uninsured will now be eligible for Medicaid.  The other half will be able to purchase health insurance through Kynect.

“There’s always that fear of the unknown.  I would refer you to Massachusetts in 2006, when then Governor Mitt Romney instituted a program very similar,” said Beshear.

You’ll be hearing a lot about Kynect.

“There will be a full scale advertising campaign,” said Beshear.

The state says 5 insurance companies plan to participate in the exchange.  The state hopes to know how much the plans will cost at the end of the month.

To learn more about Kynect, you can go to: http://kynect.ky.gov/

 

Link: http://www.wtvq.com/content/localnews/story/Kentucky-Introduces-New-Health-Insurance-Exchange/mTHSrKv4MU-YDvuA9XgGWQ.cspx

Who benefits in Louisville? Impact of the Medicaid decision

Written by
Laura Ungar

Bernice Glenn, 55, Shively

Bernice Glenn, shown with her husband, Nelson Glenn Jr., says of Medicaid expansion, ‘I won’t have to worry about how I have to pay’ her bills for medical treatment. / Photos by Kylene White/The Courier-Journal

Family: Husband, Nelson Glenn Jr., 58; three grown children.

Job, income, insurance: Bernice Glenn is unemployed, and her husband has been out of work since being injured in an accident more than a decade ago. He supports the couple with his Social Security disability payments of $1,623 a month. Bernice is uninsured.

Health issues: High blood pressure, diabetes, a nerve condition in her face, arthritis and a bad knee. She uses a cane.

Consequences of being uninsured: Although she sees a primary care doctor at Family Health Centers, she skips some preventive care. For example, she hasn’t gotten a colonoscopy to check for colon cancer, which is recommended for people when they turn 50. She also has medical bills she can’t pay.

Thoughts on expansion: “I won’t have to worry about how I have to pay these bills and how they’re going to come after me about these bills.”

Rosemary Elan, 56, South Louisville

Family: Widow.

Job, income, insurance: Elan does seasonal work for H&R Block, helping people with their taxes, but has no other income and no health insurance. She lives with her 26-year-old daughter, who works at a convenience store, earning $7.35 an hour, and also has no health insurance.

Health issues: Diabetes, high blood pressure, five cardiac stents.

Consequences of being uninsured: She has delayed getting needed care. When her heart bothered her in 2011, “I would just rub it to keep it from acting up.” She eventually needed a fifth stent and incurred $21,000 in medical bills. She said she has no way to pay: “You can’t get blood from a stone.”

Thoughts on expansion: She said she doesn’t like the health care overhaul in general, especially the penalty people would have to pay if they choose not to get health insurance. But she supports Medicaid expansion. “It would help a whole lot,” she said. “It would be a lot less strain on a lot of people.”

Job, income, insurance: She is unemployed because of illness, existing on Supplemental Security Income disability benefits for her children of about $2,000 a month. Her children have Medicaid, but she has no health insurance. She said she’s tried to buy an individual insurance policy but has been turned down because of her health.

Health issues: Jones has severe high blood pressure and a severe form of anemia, both of which have repeatedly put her in the hospital.

Consequences of being uninsured: She has medical bills exceeding $200,000 for hospital stays to treat her blood problems. She gets low-cost primary care at Family Health Centers-Portland, but stopped going to the James Graham Brown Cancer Center when she realized she couldn’t pay the bills. “After a while you get tired of it and throw your hands up,” she said.

Thoughts on expansion: “There’s a lot of people who want to go to work and just can’t because they have conditions like mine. I just think it’ll be better for people who can’t afford (care), and people who actually need it.”

Angela Kildoo, 28, western Louisville

Family: Single with three children, who are in her parents’ custody. She stays at a friend’s house.

Job, income, insurance: A former medical assistant and a temporary warehouse worker who is unemployed, with no income or health insurance.

Health issues: Thyroid problems; high blood pressure; pseudotumor cerebri, which occurs when pressure inside the skull builds up for no obvious reason.

Consequences of being uninsured: Unpaid medical bills, including a $2,000 bill for surgical removal of two teeth and other bills from blood work. She gets low-cost care at Family Health Centers-Portland, but sometimes skips care because of the cost. “I may just stay at home and just suffer with the pain and everything,” she said.

Thoughts on expansion: “I think it would help a lot of people.”

Link to article:  http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013305090048