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


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.

Branding Obamacare: ‘New York State of Health’

WebMD News from Kaiser Health News

By Phil Galewitz


Some folks like to get away, Take a holiday from the neighborhood. Hop a flight to Miami Beach or to Hollywood. But I’m takin’ a Greyhound on the Hudson River line. I’m in a New York state of mind

… er … make that “New York State of Health.”  Playing off the title of Billy Joel’s iconic 1976 song, the officials running New York’s health insurance exchange announced Tuesday that they have chosen New York State of Health as the brand name of their new onlinemarketplace.

“We wanted a name that was distinctive and unique to New York and is emotional and not just functional description,” said Leo Mamorsky, executive group account director with DDB New York  which is handling advertising  for the exchange.

In their first YouTube ad, there are scenes of Manhattan, Niagara Falls and people in rural and suburban settings. Joel’s song, though, is not on the video. Joel grew up in Hicksville, N.Y., and lives in the Hamptons.

New York is the latest state attempting to brand the new marketplaces. The marketplaces, one of the key ways the health care law extends coverage to the uninsured, open for enrollment Oct. 1, selling policies that will take effect Jan. 1. New York exchange officials announced last month that average premiums sold on the exchange would be about half the price they are today for individuals who buy their own insurance.

“In creating a name, we wanted it to be meaningful, memorable and capture the essence of what it is to be a New Yorker – that unique ‘can do’ attitude and state of mind,” said Donna Frescatore, New York  State of Health’s executive director. “We’re confident the ‘NY State of Health’ name and campaign will inspire New Yorkers who are uninsured or underinsured to explore the options and choose the plan that fits their needs.”

Despite being a fan favorite for decades, “New York State of Mind” was never a hit song and was never released as a single. Joel famously played the song at The Concert For New York City, the October 2001 benefit for the New York City Fire and Police Departments and the loved ones of first responders killed during the terrorist attack on Sept 11. He reprised that theme, playing it during his Dec. 12, 2012 concert at Madison Square Garden to raise money for victims of Hurricane Sandy, where he changed the lyrics to include places like “Breezy Point.”

New York officials said Joel was not consulted about their marketing effort. They said they had no plans to use Joel or his song in their ads.

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.

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Incoming Med School Students to be Well-Versed in Affordable Care Act

By Jeff Saperstone

|  Tuesday, Aug 20, 2013  |  Updated 7:28 PM EDT

You could call them the Affordable Care Act class. Incoming medical students at Quinnipiac University’s new medical school will graduate when the new law is fully in effect.

While they are beginning their studies they’re also very aware about the changes coming to the nation’s health care system.

“It’s opportunities as well as challenges,” said Benjamin Cramer, a Quinnipiac University medical student.

Cramer said a lot of questions remain about how ACA will impact patient care. He wants to open a clinic in a rural community, a region he sees as the most in need.

“Financially I’m not extremely concerned about how it will affect me personally but I am concerned about how it will affect my patients,” Cramer said.

He is concerned about patients who will still have a hard time accessing affordable insurance.

Students believe there are a lot of unknowns when it comes to the new law but some say it’s good thing to expand coverage.

“It’s very complex,” Daniell Vottalico said. “I think that some sort of change is needed and we have to start somewhere.”

Over the years, medical students nationwide have opted to enter into higher paying specialties, which has created a shortage of primary care doctors.

One of the missions at the new medical school at Quinnipiac University is to graduate more primary care doctors.

That happens to be the same goal of the Affordable Care Act. Supporters of the law believe that if there are more primary care physicians that could mean more patients will be able to get preventative care rather than expensive trips to the emergency room.

“The hope is for those of us who go that route is that there will be more support in general for primary care through the Affordable Care Act,” William Berger said.

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Low prices seen luring young adults to Obamacare: study

By Sharon Begley

NEW YORK | Wed Aug 21, 2013 12:03am EDT

(Reuters) – If uninsured young Americans shun the new health plans offered under President Barack Obama’s healthcare reform law, it will be because the insurance costs too much and not because they don’t expect to need much medical care, according to a study released on Wednesday.

What uninsured young adults do when state exchanges created under “Obamacare” open on October 1 will be one of the most important factors in determining the success of the president’s signature domestic policy achievement. If too few young people, who tend to be relatively healthy, sign up for coverage, then premiums might not cover the medical costs of sicker people who do enroll.

“Contrary to commonly held beliefs, young adults do want affordable health coverage,” said Dr. David Blumenthal, president of the nonpartisan Commonwealth Fund. The group’s study dispels the notion that young adults don’t think they need coverage because they feel invincible, said lead author Sara Collins.

Up to 82 percent of nearly 16 million uninsured young U.S. adults would qualify for federal subsidies or Medicaid under Obamacare, meaning that affordability is less likely to impede enrollment in health insurance via state exchanges, the study concludes. Those ages 19 to 29 will eventually enroll in large numbers, it predicts, without specifying how many years it could take.

That optimistic conclusion comes from what young adults do when offered an opportunity to buy health insurance through their jobs. In such cases, 67 percent took the coverage.

For those who declined, the chief reasons were that they were covered by a family member (54 percent) or couldn’t afford the premiums (22 percent). Only 5 percent turned down coverage because they felt they were unlikely to need much medical care.

That price, not feeling they will never get sick, is the main barrier to young adults buying health insurance, said Aaron Smith, co-founder of Young Invincibles, a non-profit that runs education campaigns and conducts research on issues important to 18-to-34-year olds. “Price is the biggest hurdle.”

The group was not involved in the Commonwealth study but has received government funding to help people enroll in Obamacare insurance.


The Commonwealth study also pointed to what happened when Massachusetts institutedhealthcare reform in 2007, requiring -like Obamacare – that everyone have insurance or pay a penalty. In the first year, the uninsured rate for 19-to-26-year olds fell from 21 percent to 8 percent.

“Based on Massachusetts, there is reason to believe young adults will come to the (state insurance) marketplaces and sign up,” said the Commonwealth’s Blumenthal.

A greater barrier than affordability may be that very few young adults are aware that the new coverage will be an option in less than six weeks.

Confirming other surveys, a Commonwealth poll found that only 27 percent of the 19-to-29-year olds were aware of the state health insurance marketplaces. Awareness was lowest among the uninsured (19 percent knew about the marketplaces) and people with low to moderate incomes (18 percent).

Those groups are most likely to benefit from the federal subsidies available to help people with incomes less than four times the poverty level ($45,960 for an individual) buy policies on the exchanges.

The survey, with 1,885 respondents, was done in March, and young adults’ awareness may be higher now since several states as well as the federal government have begun advertising andmarketing campaigns to tell the uninsured about the exchanges. The survey has a margin of sampling error of 3.2 percentage points.

The report also found that 15 million adults ages 19 to 25 (half of this age group) were on a parent’s health insurance policy in the prior 12 months, up from 13.7 million in 2011. Of the 15 million, an estimated 7.8 million got that coverage through the 2010 Patient Protection and Affordable Care Act, which requires insurers allow children up to age 26 to stay on a parent’s policy.

Partly as a result, the number of uninsured young adults dropped from 18.1 million in 2011 to 15.7 million in 2013.

(Reporting by Sharon Begley; Editing by Michele Gershberg and Lisa Shumaker)

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Sebelius talks up health care reform in Houston

By Lora Hines | August 19, 2013

It was the buzz on news websites. U.S. Health and Human Services Secretary Kathleen Sebelius was going to make a “major announcement” in Houston regarding the health care law.

But Sebelius didn’t unveil a plan to extend Medicaid coverage to uninsured Texans – something Gov. Rick Perryopposes. Nor did she announce a breakthrough to establish a Texas solution for health care reform.

Instead, Sebelius met with Houston officials, plus health care, business and community leaders, continuing what Perry has described as an “Obamacare” promotion tour.

The “major announcement” that the secretary’s handlers promised afterward – was the kickoff of a nationwide video contest to inform young adults about their need to buy health coverage.

Library meeting

Monday’s meeting with about two dozen people at the downtown Julia Ideson Library included U.S. Rep. Sheila Jackson Lee, D-Houston, and Dr. Robert Robbins, CEO of the Texas Medical Center. Sebelius said her office would work with advocacy groups and community health centers to ensure enrollment of uninsured residents into health coverage would operate as smoothly as possible.

Earlier this month, Sebelius, held similar meetings in Austin and San Antonio to discuss implementation of the 2010 federal health care law.

After Monday’s meeting, the secretary held a brief news conference, saying she has traveled the state to meet officials, including Houston Mayor Annise Parker and Harris County Judge Ed Emmett, who “are eager to fully implement the Affordable Care Act.”

Sebelius reiterated much of what she has said about the law and again acknowledged that she knows Perry and other state leaders don’t want to participate in it. Perry will not expand Medicaid to include about 1.5 million uninsured Texans. Nor is he willing to establish a state insurance marketplace, forcing federal officials to create one for Texas.

No longer a debate

“This is the law,” Sebelius repeated. “It’s really not a political debate anymore.”

The insurance marketplaces open on Oct. 1. Navigators will help the uninsured understand the health insurance marketplaces and enroll in coverage.

Despite Texas’ current stance, Sebelius said the state’s opportunity to expand Medicaid remains open.

She then traveled to Legacy Community Health Services‘ Montrose clinic, where she announced the launch of a video contest to educate young people about the health care law. Contestants have until Sept. 23 to submit videos to raise awareness about the law and encourage young people to enroll for coverage. The grand prize is $6,500.

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AFLAC Incorporated : Aflac Launches Enhanced Health Care Reform Website for Employers

08/16/2013 | 10:25am US/Eastern

COLUMBUS, Ga., Aug. 16, 2013 /PRNewswire/ — Health care reform is a puzzle to many U.S. employers and their employees. To help them better understand how to assemble the pieces, Aflac, the No. 1 provider of voluntary and guaranteed renewable insurance in the U.S.(1), has enhanced its health care reform website with materials that explain the legislation in clear, easy-to-understand language.

“Business leaders are confused about health care reform and for good reason – it is complex and as the law is implemented, it can be increasingly difficult for them to understand their options and the specific actions they need to take,” said Michael Zuna, Aflac executive vice president and chief marketing officer. “By using the tools on our site and speaking to our nationwide network of agents, employers can not only stay up to date and understand key decision points, but also obtain information that will help them make the best benefits decisions for their organizations and employees.”

Site visitors will find a variety of tools and resources designed to help employers understand health care reform and how the law affects both businesses and workers. Materials include:

    --  Health Care Reform Communications Toolkit: Provides employers with the
        resources they need to meet the October 1 deadline for informing
        employees about the Health Insurance Marketplace.The kit features:
        --  A PowerPoint presentation with a high-level reform overview of the
        --  Two sets of email and letter templates - one for employers who will
            offer health insurance and one for those who won't.
        --  FAQs that address changes to employee benefits plans.
        --  Videos highlighting Health Insurance Marketplace basics and levels
            of coverage.
    --  Employer's Guide: Explains health care reform and its effect on U.S.
    --  HCR Essentials: A quick guide to HCR information for employers.
    --  Consumer-Driven Health Care Insights: Features tips for helping
        employees understand reform.

Answering Questions, Outlining Solutions

Aflac put additional efforts into developing even more robust health care reform materials after the 2013 Aflac WorkForces Report revealed that employers and workers are having continued trouble understanding the legislation.(2)

Fully 55 percent of employees who took part in the Aflac WorkForces Report said they’d done nothing to prepare for reform-driven changes to their benefits plans, and 76 percent agreed health care reform is too complicated to understand. Employers find reform puzzling too: Just 27 percent said they understand the legislation very or extremely well.

“Aflac is dedicated to helping employers and employees comprehend the changing benefits and health insurance landscape by providing regular updates and new tools throughout the implementation of the ACA,” Zuna said. “Employers can look to Aflac as a partner in demystifying the law, helping educate employees on the resulting changes and providing much-needed voluntary benefits that can help offset rising health care costs.”

Employers who want straight forward and easy-to-understand advice about health care reform should visit

About Aflac
When a policyholder gets sick or hurt, Aflac pays cash benefits fast. For nearly six decades, Aflac insurance policies have given policyholders the opportunity to focus on recovery, not financial stress. In the United States, Aflac is the number one provider of guaranteed-renewable insurance. In Japan, Aflac is the number one life insurance company in terms of individual policies in force. Aflac individual and group insurance products provide protection to more than 50 million people worldwide. For seven consecutive years, Aflac has been recognized by Ethisphere magazine as one of the World’s Most Ethical Companies. In 2013, FORTUNE magazine recognized Aflac as one of the 100 Best Companies to Work for in America for the 15th consecutive year. Also, in 2013, FORTUNE magazine included Aflac on its list of Most Admired Companies for the 12th time, ranking the company number one in the life and health insurance category. Aflac Incorporated is a Fortune 500 company listed on the New York Stock Exchange under the symbol AFL. To find out more about Aflac, visit or

This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit (which may also be contacted at 1-800-318-2596) for additional information.

(1 )The NU 200 Industry Leaders,” National Underwriter, September 19, 2011
(2) The 2013 Aflac WorkForces Report was conducted by Research Now on behalf of Aflac, – accessed July 19, 2013

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Grants will help pay for Affordable Care Act ‘navigators’

Lena H. Sun of The Washington Post


WASHINGTON — Federal health officials awarded $67 million in grants Thursday to more than 100 organizations around the country to help uninsured consumers sign up for health coverage in new insurance marketplaces this fall.

The long anticipated grants — $13 million more than expected — will be used to hire special guides, or “navigators,” who can give individuals face-to-face assistance in shopping for health plans under the federal health-care law known as the Affordable Care Act and derided by critics as Obamacare.

Consumer outreach and assistance are considered keys to the success of the Affordable Care Act. Many uninsured Americans don’t know about the marketplaces or have little idea how they would work, polls show.

Complicating the enrollment process are the huge gaps in resources and readiness between the 17 states and the District of Columbia that are running their own marketplaces and the 34 states that resisted and are being run or partly run by the federal government. The health-care law set aside much more money for states operating their own marketplaces.

Administration officials touted the grants as progress toward implementing the health law, which has run into several delays in recent months.

In February, the administration said it was giving some insurers and employers until 2015 to cap the amount consumers can be charged through deductibles, co-payments and co-insurance.

In July, the administration postponed until 2015 a mandate that all employers with more than 50 employees provide coverage to their workers.

In announcing the grants, Health and Human Services Secretary Kathleen Sebelius said the marketplaces and consumer assistance were on track for enrollment beginning Oct. 1 for coverage effective in January.

“We know we have a lot of work to do, but we’ll be ready for whatever comes up,” she said in a conference call with reporters.

Under the health law, all states must set up websites where people can compare and shop for health insurance coverage. People will also be able to find out whether they qualify for subsidies to reduce their costs or whether they are eligible for Medicaid, the state-federal program for the poor.

Republicans have raised privacy concerns about the access that navigators would have to personal information from people seeking to buy insurance.

Thirteen Republican state attorneys general sent a letter to Sebelius on Wednesday questioning whether there will be enough protection of consumer data in the navigator program.

Sebelius said that navigators will be required to adhere to strict security and privacy standards, including how to safeguard a consumer’s personal information. They will be required to complete 20 to 30 hours of training to be certified and take additional training throughout the year. Training will begin this month.

The exact number of navigators to be hired will be made by the individual organizations receiving grants. They include universities, health departments and health systems, including Ascencion Health, the country’s largest Catholic and nonprofit health system. Planned Parenthood affiliates in Iowa, Montana and New Hampshire also received grants totalling $655,000.

The extra $13 million comes from funds previously set aside for outreach and does not represent new money, officials said.

Federal health officials made the awards based on the numbers of uninsured in each state. States with the largest numbers of uninsured received significantly more funding than earlier projections.

Florida received $7.8 million in grants, more than $2 million more than earlier forecasts. Texas group are receiving nearly $11 million, $2.7 million more than previous estimates.

Other states that received larger grants were Georgia, Illinois, Michigan, Ohio and Pennsylvania. Two states received a smaller total than previous estimates: Maine and South Carolina.

Virginia, the only jurisdiction in the metro Washington region that is defaulting to the federal government to run its marketplace, is receiving about $1.7 million, about $350,000 more than an earlier estimate. One of the recipients is the Virginia Poverty Law Center, which is receiving nearly $1.3 million to hire about 16 navigators across the state.

By contrast, Maryland, which has roughly the same number of uninsured residents, has $24 million to hire 175 navigators and an additional 150 helpers.

The District of Columbia is awarding $6.4 million to 35 community organizations to hire guides to provide in-person help.

The federal government is also enlisting businesses and organizations such as the American Medical Association , the NAACP and the League of United Latin American Citizens to help with outreach.

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How the health reform law will affect senior care


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.

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Health Insurance Navigator Groups Announced

By Amanda Robinson

Reviewed by Lisa Zamosky

WebMD Health News

Aug. 16, 2013 — The Department of Health and Human Services (HHS) has awarded $67 million in grants to 105 organizations that will help people buy health insurance and understand their options in the new health insurance Marketplaces. The grants will go to health care providers, nonprofit organizations, and business groups in 34 states to train insurance “navigators” as part of the Affordable Care Act. The grants are for states where the federal government will run the Marketplace and for states that are partnering with the feds. States that run their own Marketplaces have separate navigator programs.Navigators are supposed to be fair and unbiased helpers who may not accept money from insurance companies. They must complete 20 to 30 hours of training and be certified by the state.

In July, the HHS also awarded $150 million to more than 1,000 community health centers and clinics to help people buy insurance in the Marketplaces, also called Exchanges. Insurance brokers also can assist people with their insurance questions and help them sign up for a health plan through their state’s Marketplace.

Here is the full list of organizations and their expected grants:


  • Alaska Native Tribal Health Consortium, $300,000
  • United Way of Anchorage, $299,918


  • Ascension Health*, $202,706
  • AIDS Alabama, Inc., $501,380
  • Samford University, $326,794
  • Catholic Social Services (Archdiocese of Mobile), $20,750
  • Tombigbee Healthcare Authority, $392,356


  • Southern United Neighborhoods*, $270,193
  • University of Arkansas (The Arkansas Navigator Coalition), $774,745


  • Arizona Association of Community Health Centers, $1,344,096
  • Arizona Board of Regents, University of Arizona (Center for Rural Health at the University of Arizona), $190,268
  • Greater Phoenix Urban League, Inc., $523,773
  • Campesinos Sin Fronteras, Inc., $71,386


  • Chatman, LLC, $510,577


  • University of South Florida (Florida Covering Kids & Families), $4,213,696
  • Epilepsy Foundation of Florida, $637,686
  • Advanced Patient Advocacy, LLC*, $413,152.20
  • Legal Aid Society of Palm Beach County, Inc., $446,783
  • Pinellas County Board of County Commissioners, $600,000
  • National Hispanic Council on Aging*, $646,825.50
  • Cardon Healthcare Network, LLC DBA Cardon Outreach*, $238,000
  • Mental Health America*, $683,691


  • Structured Employment Economic Development Corporation, $2,159,360
  • University of Georgia (College of Family and Consumer Sciences and Cooperative Extension Service), $1,657,378


  • Genesis Health System*, $128,430
  • Visiting Nurse Services of Iowa, $257,142
  • Planned Parenthood of the Heartland*, $214,427


  • Genesis Health System*, $137,283
  • Sinai Health System, $157,271
  • DuPage County Health Department, $182,543
  • Southern Illinois Healthcare Foundation, $240,113
  • A Safe Haven Foundation, $324,736
  • Mercy Hospital and Medical Center, $452,590
  • The Puerto Rican Cultural Center, Inc., $600,000
  • Illinois College of Optometry, $504,016
  • VNA Health Care, $132,737
  • The East Los Angeles Community Union, $294,182
  • National Council of Urban Indian Health*, $35,000


  • Affiliated Service Providers of Indiana, Inc., $897,150
  • Plus One Enterprise, LTD, LLC, $130,875
  • Health and Hospital Corporation of Marion County, $590,985
  • United Way Worldwide, $424,586


  • Advanced Patient Advocacy, LLC*, $195,556
  • Ascension Health*, $165,683
  • Kansas Association for the Medically Underserved, $524,846


  • Southern United Neighborhoods*, $486,123
  • Martin Luther King Health Center, Inc., $81,066
  • Southwest Louisiana Area Health Education Center, $1,099,985.80
  • Capital Area Agency on Aging, District II, Inc., $100,000


  • Western Maine Community Action, $475,000
  • Fishing Partnership Health Plan, $66,846


  • Community Bridges Management Inc., $896,366
  • Arab Community Center for Economic & Social Services, $276,593
  • American Indian Health & Family Services of SE Michigan, Inc., $49,583.50
  • Michigan Consumers for Healthcare, $1,319,345


  • Primaris Healthcare Business Solutions, $1,045,624
  • Missouri Alliance of Area Agencies on Aging, $750,000


  • Oak Hill Missionary Baptist Church Ministries, $317,742
  • University of Mississippi Medical Center, $831,986


  • Intermountain Planned Parenthood, Inc., $295,604
  • Montana Primary Care Association, Inc., $299,382
  • Rural Health Development DBA Montana Health Network, $143,076

North Carolina

  • Randolph Hospital, Inc., $352,320
  • Mountain Projects, Inc., $359,750
  • North Carolina Community Care Networks, $1,988,428
  • Alcohol/Drug Council of North Carolina, $324,798

North Dakota

  • Great Plains Tribal Chairmen’s Health Board*, $186,000
  • Minot State University, North Dakota Center for Persons with Disabilities, $414,000


  • Community Action of Nebraska, Inc., $562,457
  • Ponca Tribe of Nebraska, $37,543

New Hampshire

  • Bi-State Primary Care Association, $434,839
  • Planned Parenthood of Northern New England, $145,161

New Jersey

  • Center for Family Services, Inc., $677,797
  • Wendy Sykes – Orange ACA Navigator Project, $239,810
  • The Urban League of Hudson County, $565,000
  • Public Health Solutions, $400,583
  • FoodBank of Monmouth and Ocean Counties, Inc., $137,217


  • Ohio Association of Foodbanks, $1,958,961
  • Children’s Hospital Medical Center, $124,419
  • Clermont Recovery Center, Inc., $44,938
  • Helping Hands Community Outreach Center, $230,920
  • Neighborhood Health Association, $684,630


  • Cardon Healthcare Network, LLC DBA Cardon Outreach*, $178,500
  • Oklahoma Community Health Centers, Inc., $860,866
  • Little Dixie Community Action Agency, Inc., $580,733


  • Resources for Human Development, Inc., $953,176
  • Pennsylvania Association of Community Health Centers, $694,380
  • Pennsylvania Mental Health Consumers’ Association, $380,000
  • Cardon Healthcare Network, LLC DBA Cardon Outreach*, $178,500
  • Mental Health America*, $503,129

South Carolina

  • DECO Recovery Management LLC, $1,211,203
  • The Cooperative Ministry, $508,313
  • Beaufort County Black Chamber of Commerce, $234,099.21

South Dakota

  • South Dakota Community Action Partnership, $336,000
  • Great Plains Tribal Chairmen’s Health Board*, $264,000


  • Structured Employment Economic Development Corporation*, $1,216,013
  • Tennessee Primary Care Association, $781,265


  • United Way of Metropolitan Tarrant County, $5,889,181
  • Migrant Health Promotion, Inc., $589,750
  • National Hispanic Council on Aging*, $646,825
  • Change Happens, $785,000
  • United Way of El Paso County, $642,121
  • Southern United Neighborhoods*, $600,678
  • East Texas Behavioral Healthcare Network, $1,337,520
  • National Urban League, 376,800


  • Utah Healthy Policy Project, $406,788
  • Utah AIDS Foundation, $126,258
  • Cardon Healthcare Network, LLC DBA Cardon Outreach, $238,000
  • National Council of Urban Indian Health*, $35,000


  • Virginia Poverty Law Center, Inc., $1,278,592
  • Advanced Patient Advocacy, LLC*, $483,433


  • Partners for Community Development, Inc., $315,720
  • Northwest Wisconsin Concentrated Employment Program, Inc., $285,035
  • Legal Action of Wisconsin, Inc./SeniorLAW, $70,000
  • National Council of Urban Indian Health*, $35,000
  • National Healthy Start Association, $191,667
  • R&B Receivables Management Corporation DBA R&B Solutions, $104,520

West Virginia

  • Advanced Patient Advocacy, LLC*, $276,617
  • West Virginia Parent Training and Information, Inc., $365,758


  • Memorial Hospital of Laramie County DBA Cheyenne Regional, $401,281
  • Wyoming Senior Citizens, Inc., $198,719

(*) Organization is operating in more than one state

6 Surprises From Health Insurance Reform

By Jay MacDonald

Published August 16, 2013

Mere months before major elements of the historic Affordable Care Act take effect, polls show that many Americans still don’t understand the basics of health insurance reform or the impact it will have on their lives.

As plans take shape for the opening of the first-ever public health insurance exchanges this October, the picture is slowly becoming clearer as to how President Barack Obama’s ambitious, intricately layered health care overhaul will affect the nation. Some of the impacts have seemed a bit surprising, even unfortunate.

“No single law can solve all problems,” says Linda Blumberg, a health economist and senior fellow at the Urban Institute, a Washington, D.C., think tank. “We have to take things one step at a time and know that this is going to be a continuing process of trying to reform a system that has flaws, with markets that aren’t now and never have been competitive, and evolve to (a) more efficient provision of high-quality care.”

With the full effect of health care reform just months away, here are six Obamacare consequences that are coming to light — some unforeseen, others that only seem that way.

You could lose your existing health plan

In 2009, Obama reassured Americans, “If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”

So why are some insurers notifying policyholders that their health plan is being discontinued?

The short answer: Insurers are phasing out some plans and are replacing them with others designed to meet the new federal minimum value and affordability standards for individual and small-business plans under health insurance reform.

Technically, you can still hold onto your policy, thanks to language in the law that allowed existing health plans to be “grandfathered” in, thus exempting them from the new requirements. But experts say once you’re offered better coverage for less, why wouldn’t you make a move?

“You can keep that policy, but you may very well not want to,” says Blumberg. “A lot of people are going to be making the proactive decision to leave them, so they’ll diminish pretty significantly over time.”

Big employers may offer bare-bones coverage

Large companies with many low-income and currently uninsured workers, such as restaurant chains and retailers, are flirting with offering a barely qualifying version of barely there “mini-med” health coverage to sidestep Obamacare’s $2,000-$3,000 per-employee penalty for failing to offer qualifying coverage.

That “employer mandate” was to take effect Jan. 1 but has been delayed until 2015.

Incorporating so-called skinny coverage that may not take care of X-rays, surgery or maternity care is just one of several cost-cutting options that large employers are exploring to offset the additional expenses of health reform.

Tracy Watts, national health care reform leader at Mercer, a global research and consulting firm, says the goal for these employers is to design a bare-bones plan that costs them less than the penalty for not offering coverage and doesn’t appear too enticing to those who currently opt out of coverage or insure through their spouse.

“The question is, how many people would have to enroll before you would spend as much as you would on the $2,000 penalty, and do you think that many people would enroll?” she says.

Hospital mergers may thwart reform goals

The recent trend toward hospital consolidation would seem to work at cross purposes with health insurance reform’s central mission of seeding the private health care market with incentives that will blossom into better care at a lower cost. After all, studies have shown that when hospitals merge, just the opposite happens: Prices go up, and quality can falter.

According to the American Hospital Association, more than 550 hospitals have been acquired since 2007. A similar spike in mergers and acquisitions followed the rise of health maintenance organizations, or HMOs, in the mid-1990s.

“If you have more and more consolidation of providers (hospitals), it makes it more difficult for insurers to be tough price negotiators,” says Blumberg.

“Even if an insurer has 80% of a market, if they’re dealing with a single must-have provider system in a particular area, that provider could say, ‘You can tell me what you’re going to pay me all you want, but here’s what I’m going to accept.'”

Short of regulating prices, which is currently a political nonstarter, Blumberg says hospital consolidation “is an issue we’re going to continue to struggle with.”

Young people may benefit most from Obamacare

Despite dire predictions of “rate shock” for millennials, most of today’s young adults are best positioned to benefit from health care reform, thanks to federal subsidies that should make quality health insurance affordable for this largely unmarried, lower-earning population beginning in 2014.

Jen Mishory, deputy director of Young Invincibles, a young adult advocacy group based in Washington, D.C., says there are an estimated 21 million young Americans who are uninsured, and the overwhelming majority of them have incomes in the low-to-moderate range. Most will be eligible to purchase affordable coverage with federal assistance through the new state exchanges, beginning with early enrollment in October.

Many millennials who do have health coverage are insured through a parent’s plan until they turn 26 — another perk of health care reform.

“Young people are going to disproportionately be the largest beneficiaries of the Affordable Care Act,” predicts Ron Pollack, executive director of the health care consumer group Families USA.

Tax on ‘Cadillac’ plans hits middle class

Millions of Americans anticipate buying health insurance for the first time through new public exchanges to avoid penalties for not having insurance under health care reform’s “individual mandate” that takes effect in January. At the same time, some employers are already scaling back their group health plans to avoid a 40% excise tax on high-cost, or “Cadillac,” plans that doesn’t take effect until 2018.

The tax will hit individual plans costing more than $10,200 and family coverage costing more than $27,500 annually. A Washington, D.C.-based think tank, the Economic Policy Institute, has criticized the tax as “not well-targeted” because it’s likely to impact many unsuspecting workers with rather ordinary health plans that happen to cost a lot because of company size, job location and other factors.

The institute says the tax creates a strong incentive for employers to move toward cheaper and less-generous coverage that shifts more costs onto workers.

Watts says “about a third” of companies are making corrections now to keep their “Cadillac” plans out of the ditch, with most moving toward “consumer-driven” platforms in which employees are given a fixed sum and allowed to shop for their best health and benefits fit.

Obamacare could be good for entrepreneurs

“Job lock” aptly describes the economic force that keeps employees tied to a job for the health care coverage.

The Affordable Care Act may provide “job unlock.” A new study by the Robert Wood Johnson Foundation, the Urban Institute and the Center on Health Insurance Reforms at Georgetown University finds that health insurance reform will likely unleash 1.5 million Americans to pursue their entrepreneurial dreams.

“In the vast majority of states right now, the nongroup insurance market is very dysfunctional for a lot of people,” says Blumberg, the lead author of the study. “What the Affordable Care Act does — by creating a stable, affordable and adequate nongroup market — is it frees lots of people to make different types of work decisions than they are able to make today.”

Mishory says that’s great news for young people.

“Young people switch jobs so much as they’re building careers that the ability to do that without worrying about health insurance is huge,” she says. “They’ll be able to carve a career path that works for them and has potential positive economic impact as well.”

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