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More coverage: Obamacare and You
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As HealthCare.gov Rebounds, New
Glitches Hit Medicaid Enrollments
by Charles Ornstein
ProPublica, Dec. 10, 2013
Before HealthCare.gov [1],
the federal health insurance marketplace, was fixed late last month, supporters
of the Affordable Care Act looked to the law’s expansion of Medicaid for
solace. In October, many more people enrolled in coverage through Medicaid, the
federal-state program for the poor, than chose private plans in the health
insurance marketplace, the New York Times reported earlier this month [2].
But the news involving Medicaid isn’t all good.
Last week, I wrote about a public radio reporter [3] in Missouri
who is too rich for Medicaid in her state, but too poor for a subsidy to buy
private insurance. Missouri is among 25 states that have decided not to expand
their Medicaid programs to cover adults with incomes below 138 percent of the
federal poverty level ($15,856 for one person), as called for in the act. The
Supreme Court gave states the option to refuse the expansion without
consequence, even though the federal government has agreed to pick up the
entire bill for the first three years.
Some other recent news on the Medicaid front:
USA Today [4] reported
Monday that HealthCare.gov “is incorrectly determining that some people are
eligible for Medicaid when they clearly are not, leaving them with little
chance to get the subsidized insurance they are entitled to as the Dec. 23
deadline for enrollment approaches.”
Here’s what happens, per the paper:
When consumers applying for insurance put their income
information into subsidy calculators on HealthCare.gov — the exchange handling
insurance sales for 36 states — it tells them how much financial assistance
they qualify for or that they are eligible for Medicaid. If it’s the latter,
consumers aren’t able to obtain subsidies toward the insurance, although they
could buy full-priced plans.
If a consumer is told he or she is eligible for Medicaid,
and is actually not, valuable time and perhaps money may be wasted.
The USA Today story follows reports by Politico [5] and
The Washington Post [6]
about how the federal government isn’t correctly transferring enrollments from
HealthCare.gov to Medicaid programs.
“Although Medicaid sign-ups through HealthCare.gov have
been considered a rare bright spot in the flawed Obamacare rollout, the federal
portal has been unable to send those Medicaid applications to the states for
final processing,” Politico reported. “If states can’t receive and complete
their work on Medicaid applications by the end of the year, people could go
without Medicaid coverage in early 2014 despite having an eligibility
determination.”
The solution has been to create to circumvent the system
and allow states to “use an incomplete set of data — known as a ‘flat file’ —
to enroll people in Medicaid, even though those files lack critical information
that states normally use to verify eligibility,” Politico wrote.
The National Association of Medicaid Directors reported Monday [7]
that states are seeing an influx of new enrollees and are struggling to keep
up. The association’s update said:
Several states (both expansion and non-expansion)
reported there is growing concern and questions coming in from some consumers
leading up to January 1. Medicaid coverage in all states is retroactive, but
applicants are beginning to express some frustration if they have not received
more information about their eligibility and enrollment. In states that have
opted to expand their Medicaid income eligibility levels, there are many
individual applicants who need to be processed and enrolled in Medicaid. Other
applicants do not qualify for Medicaid and need to be transferred to the state
or federal health insurance marketplace in a timely manner.
Finally, the Commonwealth Fund reported last week [8] that
states that chose not to expand Medicaid will be subsidizing the states that do
expand. A report prepared by Sherry Glied and Stephanie Ma of New York University
found:
By choosing not to participate, Texas, for example, will forgo an estimated
$9.58 billion in federal funding in 2022. Taking into account federal taxes
paid by Texas
residents, the net cost to taxpayers in the state in 2022 will be more than
$9.2 billion. Similarly, Florida’s
decision to not participate will cost its taxpayers more than $5 billion in
2022. In Georgia,
the state will forgo $4.9 billion in federal funding without the expansion of
Medicaid, and in turn, $2.8 billion will flow out of the state in 2022. In
other states, the costs of not participating will be lower. In South Dakota and Wyoming,
for instance, taxpayers will face a net cost of $224 million and $166 million
in 2022, respectively.
Look up what your state is doing here [9].
Editor’s Note: This post is adapted from Ornstein’s
“Healthy buzz [10]” blog. Have you tried signing up for coverage through the new exchanges?
Help us cover the Affordable Care Act by sharing your insurance story [11].
More coverage: Obamacare and You
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For Medicare Drug Plans, the High Cost
of Doing Nothing
by Charles Ornstein
ProPublica, Dec. 2, 2013
There's a steep price for doing nothing when
it comes time for open enrollment for Medicare prescription drug plans.
My
Thanksgiving ritual each year consists of heaps of turkey, corn casserole and
apple pie — as well as quiet time devoted to helping relatives choose Medicare
prescription drug plans for the following year.
Most people
partake in similar gorging, but not enough spend the time to compare health
plans for their relatives. My experience this past weekend is a particularly
instructive example of how costly it can be to do nothing.
With open enrollment for 2014 drawing to a close
this Saturday, there’s little time for delay. (The process of picking a drug
plan in Medicare is totally different from using healthcare.gov, the federal
health insurance exchange for people under age 65 who are not in Medicare.)
Unlike
Medicare’s hospital and doctor benefits, which are managed by the federal
government, seniors and disabled people needing drug coverage must choose a
subsidized, privately run plan under contract with Medicare. The 36 million
enrollees in the program usually have dozens of choices that offer an array of
monthly premiums, deductibles and copayments. The plans have different
preferred drugs and different requirements for prior approval for expensive
generics. Continue reading at ….. http://www.propublica.org/article/for-medicare-drug-plans-the-high-cost-of-doing-nothing?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter
More coverage: Six Questions About HealthCare.gov's
Future
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Rate Hikes Hidden in California's
Glowing Obamacare Reviews
by Charles Ornstein
ProPublica, Nov. 26, 2013
Half
those whose insurance is being canceled will pay more for plans meeting the
Affordable Care Act requirements.
More coverage: Obamacare and You
During a
meeting last week, officials at Covered California, the state’s much-touted
health insurance marketplace, made a pretty stark admission: Half of the approximately
1 million consumers whose health plans are being canceled will pay more under
the Affordable Care Act.
The numbers,
it seems, have been overshadowed by other, more positive headlines. First, the
state signed up more consumers in October thanHealthCare.gov,
the federal marketplace handling enrollments for 36 states. Second, the board
governing Covered California voted last week not to allow insurers to
offer their canceled policies for another year, rejecting President Obama’s
recommendation earlier this month.
But the
figures do call into question the sweeping plaudits California has received —
including from New York Times columnist Paul Krugman in Monday’s newspaper — for
signing up so many people (about 80,000, as of last week).
By way of
background, many of these consumers’ plans are being canceled because they were
“non-grandfathered,” meaning they were purchased after the Act was signed by
President Obama in March 2010 and their benefits do not meet its requirements
(some were pretty skimpy).
Although the
federal law allowed these plans to be renewed for another year, Covered California’s contracts
with health insurers require them to be canceled at the end of this year.
Officials said the idea was to create stability in the new marketplace and
provide consistency for all consumers.
As
cancellation letters went out, supporters of the law contended that the
canceled policies either had inferior coverage or would cost far less in the
exchanges. California’s
numbers show that is only half the story.
“It’s not a
success story,” said Jamie Court, president of Consumer Watchdog, a group that
supports a California
ballot measure to regulate insurance rates. “It’s a success story only if you
consider that the federal website didn’t work and ours did. It’s not a success
story because people are in open revolt about how much they’re paying. The only
people who are happy are people who have subsidized policies. The middle class
is outraged.”
Let’s look
at the numbers: Continue reading at ….. http://www.propublica.org/article/rate-hikes-hidden-in-californias-glowing-obamacare-reviews?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter
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A Cheat Sheet For The Obamacare
Hearings
by Charles Ornstein
ProPublica, Nov. 25, 2013
Over a month, 10 hearings plumb the problems
with HealthCare.gov.
Every few
days, it seems, there’s another hearing into one problem or another with
rolling out the Affordable Care Act. It’s hard to keep track.
Since late
October, by my count, there have been 10 House and Senate hearings. Eight were
by House committees led by Republicans who oppose the law; two were before
Senate panels run by Democrats.
The most
memorable of the hearings was Oct. 30 when Health and Human Services Secretary
Kathleen Sebelius first testified about the HealthCare.gov
debacle. Also buzzworthy was the Nov. 13 hearing of the House Oversight and
Government Reform Committee. The panel subpoenaed Todd Park, the U.S. chief
technology officer, and it was unclear whether he would appear (he did.)
Here’s a
look at highlights from the Hill:
Date: October 24, 2013
Committee: House Energy and Commerce
Title: PPACA Implementation Failures: Didn’t Know or Didn’t
Disclose?
Witnesses:
Cheryl Campbell, senior vice president, CGI Federal; Andrew Slavitt, group
executive vice president, Optum/QSSI; Lynn Spellecy, corporate counsel, Equifax
Workforce Solutions; John Lau, program director, Serco
Length: 4
hours, 24 minutes
Minority
party response and transcript.
Highlight:
“Federal officials did not fully test the online health insurance marketplace
until two weeks before it opened to the public on Oct. 1, contractors told
Congress on Thursday,” the New York Times reported. “While individual
components of the system were tested earlier, they said, the government did not
conduct ‘end-to-end-testing’ of the system until late September.”
Memorable exchange: Continue
reading at ….. http://www.propublica.org/article/a-cheat-sheet-for-the-obamacare-hearings?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter
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Health Policy Canceled? What We Know
and Don't Know
by Charles Ornstein
ProPublica, Oct. 31, 2013
Every day,
we’re seeing reports that consumers across the country will be dropped by their
health insurance companies on Jan. 1 or another date in 2014. But two central
questions remain:
First, just
how many people will be affected?
Second, and
more importantly, is this a good or bad thing?
We don’t yet
know the answer to either question, although the answer to the first question
is surely a big number. Here’s where things stand:
A minimum of
several hundred thousand people with individual health insurance policies
(those not provided by their employers) have received letters notifying them
that their coverage will be terminated on Jan. 1 — or at some date after that —
because their plans don’t meet the requirements of the Affordable Care Act.
The issue
has been percolating for several weeks, initially being overshadowed by the
rocky rollout of the Healthcare.gov federal health insurance
marketplace. But this week, in part because of a prominent NBC News report, the issue has gained traction.
Republican lawmakers and the act’s opponents have given it more attention than the website’s continuing woes.
The story is
full of nuance, and that’s what makes it easy to misunderstand.
What is
definitely true is that many people are receiving notices saying that they will
have to find new insurance coverage on Jan. 1 or a later date. That directly
contradicts what President Obama said repeatedly: that those who liked their
plans could keep them. (The Washington
Post has said Obama’s statements deserve four pinnochios because they were not true.)
How many
people are affected?
According to
the NBC News report:
Four sources
deeply involved in the Affordable Care Act tell NBC News that 50 to 75 percent
of the 14 million consumers who buy their insurance individually can expect to
receive a "cancellation" letter or the equivalent over the next year
because their existing policies don’t meet the standards mandated by the new
health care law. One expert predicts that number could reach as high as 80
percent.
Sarah Kliff
at the Washington Post writes:
It’s hard to
put an exact number on this, given that insurance plans are the ones who decide
whether or not to continue offering an insurance product. Experts have
estimated that somewhere between half and three-quarters of those who currently
buy their own policies will not have the option to renew coverage, which works out
to around 7 to 12 million people.
Continue reading at …. http://www.propublica.org/article/health-policy-canceled-what-we-know-and-dont-know?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter
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Podcast: Why Is Healthcare.gov So
Flawed?
by Minhee Cho
ProPublica, Oct. 29, 2013, 11:35 a.m
Healthcare.gov,
the home of the federal insurance marketplace, has faced nothing but problems since it launched
on Oct. 1. ProPublica’s Charlie Ornstein has chronicled the range of issues
that have plagued the site, including duplicate enrollments and children
reported as parents, as well as a wildly misleading price estimator tool.
How did we
end up in this mess?
Ornstein
joins ProPublica’s Editor-in-Chief Steve Engelberg on the podcast to discuss
the many challenges Healthcare.gov has been up against since the Affordable
Care Act was first passed in 2010; how, if the site’s glitches aren’t fixed
soon, it could face a so-called “death spiral”; and the government’s decision
to move forward with the site launch even though it knew there were problems:
“...the
administration was out there loudly proclaiming, go to Healthcare.gov. It’s
open for business. Sign up for coverage. Lady Gaga tweeted it...but the
infrastructure to get covered wasn’t working,” Ornstein says. “They were
directing millions of people to a website that was completely incapable of
handling the traffic.” Continue reading
at …. http://www.propublica.org/podcast/item/podcast-why-is-healthcare.gov-so-flawed/?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter
You can
listen to this podcast on iTunes and Stitcher.
And for more on Healthcare.gov, read Ornstein’s latest reports:
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Today's Obamacare Hearing: What You
Need To Know
by Charles Ornstein | @charlesornstein ProPublica, Oct. 29, 2013
Last week,
the House Energy and Commerce committee held the
first of what is likely to be many hearings on how the rollout of Healthcare.gov
went so wrong. Today, the House Ways and Means Committee takes its
turn with scheduled testimony from Marilyn
Tavenner, administrator of the Centers for Medicare and Medicaid
Services, which runs Healthcare.gov.
Here’s what
you need to know:
1 Watch the hearing here:
Continue reading at ….. http://www.propublica.org/article/todays-obamacare-hearing-what-you-need-to-know?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter
The Affordable Care Act's Most Important Date: Not What You Think
More coverage: Healthcare.gov's Users Speak Out:
'Clean This Mess Up'
Also read ……
Nov 5, 2013
… A former federal health
official says consumers in the individual health-care market deserved more of a heads-up about what was coming …
6 days ago …
Performance issues continue to dog the federal government's updated health care marketplace. Live chat
helper: “Yes, others are experiencing …
Nov 5, 2013
… How far have we come? Journalists take a hard look at our nation's system of
caring for the mentally ill.
Nov 5, 2013
… While California's
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Obama administration says consumers are …
Oct 31, 2013
… Hundreds of thousands of individual policyholders, at minimum, will have to
find new plans as insurers respond to new coverage requirements …
Nov 7, 2013
… Lack of kids' dental benefits, other coverage gaps help “tank” couple's Kaiser
Permanente insurance plan — but so did contracts with …
Oct 14, 2013
… How many people have enrolled in health
plans using the new federal exchange ? Er, nobody seems to have a clue.
Oct 30, 2013
… Q&A with Sandy Praeger, a Republican insurance commissioner in a state
that's refused to go along with the Affordable Care Act.
Oct 23, 2013
… The metaphor is the Wright Brothers, not the Indianapolis 500,” says Ian
Morrison . “Let's just get this sucker up in the air before we declare
that …
Oct 11, 2013
… It's simple: Make the enrollment software work like Medicare Part D.
Nov 12, 2013
… Just a fraction of the 500000 people expected to enroll in Obamacare via the
new health exchanges have done
so, according to media reports …
Nov 4, 2013
… Charlie Ornstein and Steve Engelberg talk about the hundreds of thousands of
Americans who are about to lose their current health plans …
Nov 8, 2013
… Many state and federal insurance pools covering patients with pre-existing
conditions are set to close Dec. 31, but it's an open question …
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