Category Archives: Medical

How to add your baby to your health plan

Congratulations on your new baby! While you are figuring out the whole parenting thing, it is also very important to make sure that your little one has proper health coverage. adding baby

Welcoming a child qualifies you for a Special Enrollment Period, a short window of time to sign up for health insurance. However, the clock starts ticking the minute you give birth: You only have 60 days to add a new baby to a plan purchased through a health exchange.

Here are four simple steps for adding a new baby to your health insurance plan:

  1. Review your budget. Make sure you can afford the increase in insurance premiums from the addition of a new baby to the health insurance plan during your Special Enrollment Period. Contact your state’s department of health to learn more about options for low cost coverage.
  1. Notify your health insurance carrier. If you do not notify your insurance provider of the addition of a new baby within the allotted time period, you will be financially responsible for all medical costs.
  1. Submit all required paperwork. Be sure to turn in all paperwork in a prompt and timely manner to add a new baby to your coverage.
  1. Take advantage of the maternity and newborn care covered under the 10 Essential Health Benefits.

We’re here to help you find a plan that meets your growing family’s health and budgeting needs during your Special Enrollment Period.  To speak with a GoHealth licensed insurance agent, call us at 888-322-7557, or start comparing your health plan options here.

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Go Health Insurance Blog

Are Pediatricians Prepared To Help Patients Who Want IUDs?

The ParaGuard IUD, which releases copper into the uterine cavity, can last up to 10 years. In clinical studies, the pregnancy rate among women using the device was less than 1 pregnancy per 100 women annually.

The ParaGuard IUD, which releases copper into the uterine cavity, can last up to 10 years. In clinical studies, the pregnancy rate among women using the device was less than 1 pregnancy per 100 women annually. Mark Harmel/Science Source hide caption

itoggle caption Mark Harmel/Science Source

When Wendy Sue Swanson started out as a pediatrician eight years ago, it never crossed her mind to bring up the option of intrauterine devices — an insertable form of long-acting contraception — when she had her regular birth-control discussions with teenage patients who were sexually active.

“The patch had been the thing,” she said, referring to a small, Band-Aid-like plastic patch that transmits hormones through the skin to prevent unwanted pregnancies.

But Swanson’s approach changed after a casual conversation with her sister-in-law. This relative wasn’t a doctor, but she worked at the Adolescent Pregnancy Prevention Campaign of North Carolina, and she told Swanson that the devices could be used as a first choice of contraception for teenagers. Now Swanson regularly discusses IUDs, which are more than 99 percent effective, in her Seattle practice.

“I thought, ‘I can’t believe I don’t know this, and no one else in my office knew’ ” that IUDs could be a good choice for some patients, she said.

Yet some pediatricians and other doctors worry they aren’t properly prepared to make this form of birth control available, because their training didn’t cover insertion of the devices.

Serious medical problems reported with the use of the Dalkon Shield in the 1970s frightened many women away from IUDs, and the extra cost associated with their insertion often stopped women from using them. But the devices have become increasingly popular. IUDs, which use copper or hormones to block sperm from fertilizing eggs, are considered safe in part because they do not use the problematic strings that were part of the Dalkon Shield, and a number of physician groups recommend them. And under the 2010 health law, women with insurance are eligible for IUDs without paying out-of-pocket costs.

Almost 12 percent of women who used birth control between 2011 and 2013 chose long-acting contraception such as IUDs or hormonal implants, a rate surpassed only by contraceptive pills and condoms, according to a recent analysis by the Guttmacher Institute.

Last fall, the American Academy of Pediatrics for the first time recommended IUDs as a first-line form of contraception for adolescents who have sex, though condoms and the pill are also accepted options. This recommendation builds on support from the American College of Obstetricians and Gynecologists, which in 2011 termed it the most effective form of birth control and noted that it posed minimal risks. A year later, the group recommended it specifically for teens. Rare problems reported include disruption of menstrual cycles and, in rarer instances, perforation of the uterus. The IUD also can occasionally be expelled by a woman’s body, meaning it no longer prevents pregnancy.

Once inserted, IUDs don’t require daily attention. They last for years before they need to be removed or replaced. This makes them easier to manage than options such as condoms or daily birth control pills, which teenagers must remember to use or, in the pill’s case, take on a daily basis.

Unlike condoms but like the pill, the IUD doesn’t prevent sexually transmitted diseases. Though the patch is about as effective as an IUD, it requires weekly maintenance and has attracted scrutiny in recent years for potential side effects such as strokes and blood clots.

“So many kids never pick up the pills, or pick up the pills and don’t take them right,” said Melanie Gold, medical director of Columbia University’s School-Based Health Centers. “Clearly, an IUD is a better choice.”

But even with this relatively recent buzz, a December editorial in the journal JAMA Pediatrics asserted that pediatricians often aren’t trained in the procedure — making it, experts said, harder for teenage girls to access this form of birth control, unlike adult women, who are more likely to see a gynecologist.

Pediatric residents typically spend only a month studying “adolescent medicine,” which includes contraception.

Julia Potter, a doctor based in New York-Presbyterian Hospital’s pediatric department and a co-author of the editorial, said the instructors who teach adolescent medicine often aren’t themselves trained in IUD insertion procedure. Medical residents then may not pick up the skills they would need to provide this birth control option once they start practicing.

If residents are exposed to the procedure — something that depends heavily on the patients they happen to see during that monthlong rotation — that time frame is “certainly not enough time to learn how to put in an IUD,” said Jane McGrath, chief of adolescent medicine at the University of New Mexico.

Doctors offered different thoughts on how many times would be enough to become competent in inserting IUDs, but Gold suggested it might take 10 insertions before a physician would feel comfortable doing it.

Pediatricians also may be less comfortable offering IUDs to patients than are other doctors, suggests a 2013 survey published in the Journal of Adolescent Health. The study found that 26 percent of doctors practicing pediatrics or internal medicine provided IUDs or other long-acting contraception — compared with 88 percent of those identified as OB-GYNs or family medicine providers.

Those who do bring it up often refer patients interested in IUDs to other providers, such as gynecologists, said Annie Hoopes, a pediatrician and adolescent medicine fellow at Seattle’s Children’s Hospital. But for teens, such referrals can get complicated.

Privacy can be an issue, said Swanson, who doesn’t do the insertion procedure in her office. A teenager may not want her parents to know she’s receiving the birth control, but “if she goes in and sees a gynecologist and the visit is billed,” it’s impossible for the pediatrician to guarantee that won’t appear on an insurance statement.

In those situations, Swanson said, she will send patients to Planned Parenthood or a similar provider, where the visit doesn’t get billed to a parent’s insurance plan.

Teens also don’t always act on the referral, said Marissa Raymond-Flesch, an adolescent and young adult medicine fellow at the University of California, San Francisco.

“They may have limited control over their time — particularly if they’re trying to come to receive services confidentially,” she said. That fear of attrition, she added, is a reason her practice has moved to offer IUD insertions in-house. Otherwise, “adolescents could be lost to follow-up.”

And in places where a provider is harder to reach, geography could pose another barrier to teens who don’t get the IUD from their regular doctor.

Meanwhile, conversations with patients and their parents have changed “dramatically” since she began discussing IUDs, Swanson said. Initially, parents would be nervous about IUDs, suggesting, for instance, that they might cause infertility for their daughters. Now, by contrast, both teens and parents seem “very open to” long-acting contraception, she said, and teenage girls are more likely to ask about IUDs without prompting.

Swanson added that, though parents sometimes bring up birth control issues, she waits to raise the subject until the one-on-one portion of a teenager’s visit, when parents are required to leave the room.

It’s still unclear whether and how residency curricula might change to incorporate IUDs and similar forms of contraception. If they become more popular, residents — especially those with an emphasis on adolescent medicine — might come to demand such training in medical school.

But it’s hard to know when or how this might happen, said Mandy Coles, another co-author of the JAMA Pediatrics editorial and an adolescent medicine physician and assistant professor of pediatrics at Boston University School of Medicine.

“The bottom line is this is going to take more time and advocacy and research to improve training,” she said.

Recommended article: Chomsky: We Are All – Fill in the Blank.
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Health Care

Bending the Curve on Patient Safety?

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The Commonwealth Fund: Blog

The Latest Health Wonk Review Is Up

Peggy Salvatore at the Health System Ed blog hosts the latest version that’s been aptly titled the Valentine Edition of the Health Wonk Review: For Health Policy Lovers Everywhere. The aw shucks PHB is there with other blogging luminaries who are embracing topics that run from the cells of women to health-worker strikes.

Recommended article: Chomsky: We Are All – Fill in the Blank.
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The Population Health Blog

Texas Insurance Brokers Play Bigger Role In 2015’s Obamacare

4 min 2 sec


Dallas insurance agent Jo Ann Charron has worked with clients to help clear confusion over subsidies offered by plans on the federal health insurance exchange. This sort of free guidance can save insurance shoppers time and money, agents say.

Dallas insurance agent Jo Ann Charron has worked with clients to help clear confusion over subsidies offered by plans on the federal health insurance exchange. This sort of free guidance can save insurance shoppers time and money, agents say. LM Otero/AP hide caption

itoggle caption LM Otero/AP

As Obamacare’s second open enrollment season barrels to a close on Sunday, nearly a million Texans have purchased or applied for health insurance. Instead of going it alone, many applicants this time have turned to insurance brokers, who are aggressively marketing their services as savvy guides to Obamacare. It’s a big change for the brokers, who have long had an uneasy relationship with the federal health law.

Bart Franco in the chapel next to his home in Houston.

Bart Franco in the chapel next to his home in Houston. Carrie Feibel/Houston Public Media hide caption

itoggle caption Carrie Feibel/Houston Public Media

Bart Franco is one customer who sought help from a licensed broker this round. He is the pastor of a community church that he founded in a garage behind his house near downtown Houston.

At age 65, Franco is retired and covered by Medicare, but needed to buy insurance for his wife and son. When he tried to enroll them in an Affordable Care Act health plan last year, he got nowhere.

“First, I called the 1-800 number,” he recalls. “And I was on hold for 40 minutes and just hung up — gave up. I’m not going to put up with that.”

Franco missed the 2014 deadline to get insurance on He later called an insurance company directly — Blue Cross Blue Shield of Texas — and succeeded in purchasing a short-term catastrophic health plan for his family. But he felt the process was rushed.

“They just give you … insurance,” Franco says, and tell you ” ‘It costs this much, and you only pay $ 146 (a month).’ That sounds good, doesn’t it? OK, fine. You’re hooked, and you don’t even know what you have.”

Franco didn’t like the plan’s high deductible, which was more than he made in a year.

So this year, when enrollment began again for 2015 plans, he turned to Jo Middleton, a licensed insurance broker who had advertised in the local paper.

“She connected us on the computer,” Franco says. “She showed us everything; showed us a deduction, why we didn’t want this and why we didn’t want that. So she explained everything.”

Franco’s rough experience last year was common, says Middleton, who is also president of the Houston Association of Health Underwriters. People struggled to pick plans on their own in 2014, using the website. Many only learned later that they couldn’t afford the deductible. Others discovered that their favorite doctor or hospital wasn’t accepting a particular plan.

“Buying an insurance policy is not like going online and buying a vacation,” Middleton says. “It’s much more complicated. There are a lot more nuances.”

Some shoppers turned to government-funded navigators for help — but there are fewer than 500 of them in Texas, compared to more than 190,000 health insurance agents.

Many brokers say the federal health law sidelined them from its inception, with marketing that focused on the navigators and the federal website.

Last year, Houston brokers worked individually to help consumers. But now they’re uniting to assert their expertise and market themselves. Middleton has organized two enrollment events featuring brokers from the Houston Association of Health Underwriters.

A brochure by insurance brokers in Texas offering to help sign up people for insurance under the Affordable Care Act.

A brochure by insurance brokers in Texas offering to help sign up people for insurance under the Affordable Care Act. Courtesy of Houston Association of Health Underwriters hide caption

itoggle caption Courtesy of Houston Association of Health Underwriters

Brokers across Texas are trying multiple strategies: holding events with hospitals and community groups, putting up fliers and even buying TV ads.

The agents say the health law’s impact on them has been mixed.

On the one hand, the law created a whole new market of potential customers for insurance agents, who get paid a commission every time they sign up one of those people for a new health policy.

But the brokers also say their commissions have been cut. That’s because the law puts a cap on insurance companies’ profits; some companies have avoided that squeeze on their own profit by reducing the agents’ commissions as well.

Marcy Buckner is with the National Association of Health Underwriters in D.C.

“This has just kind of devastated the agent community, and has been in place for several years,” Buckner says.

Her association is backing a bill in the new Congress that would help insurance agents and brokers with those reduced commissions.

In the meantime, Buckner says, brokers have had to adjust.

“We’ve seen some agents who have been able to really work the new opportunities that they’ve had in the marketplace,” she says. They’ve “continued to grow their business, and have succeeded very well, while the others have still been struggling under this cut in commissions.”

And some brokers have to switch their focus to Medicare policies or to health plans for small businesses.

It’s too early for any exact numbers on how many brokers stayed in the game, or how many people they signed up. What is clear, a few days before the deadline, is that more than 9 million people have signed up or re-enrolled this year. And about 1 in 10 of those people is from Texas.

This story is part of NPR’s reporting partnership with Houston Public Media and Kaiser Health News.

Recommended article: Chomsky: We Are All – Fill in the Blank.
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Health Care

The End of Power Health Care?

Corporate titans enjoying

the good old days.

While Moses Naim’s The End of Power devotes only a few pages to medicine, it’s still provocative and worthwhile reading for anyone involved in the delivery of health care.

As the Population Health Blog understands it, the book’s central thesis is that traditional “power” is being disrupted by the three modern trends of “more,” “mobility” and “mentality.”

We live in an unprecedented era of more (relative) widespread wealth, have an astonishing ability to move goods, services, information and ourselves around the globe (mobility) and are far less likely to adopt the cultural and intellectual assumptions and norms of established society (mentality).

Despite the depressing narrative of the “elite 1%,” the irony is that governments and corporations have far less ability to command and control the 99%. This has big implications for world affairs, democracy and U.S. power.


Big themes like this naturally prompt the excitable Population Health Blog to speculate about the implications of Naim’s more-mobility-mentality for health reform in the United States.

It should be no wonder that policymakers, politicians, academics and regulators are promoting a large and concentrated i.e. powerful version of healthcare delivery.  These cognoscenti argue that huge integrated delivery systems, accountable care organizations and regional providers can “rationalize” health care with standardized protocols, less variation, efficient service lines, alignmment of incentives, optimum capital deployment and assumption of insurance risk.

Mr. Naim cautions that the power-play may not succeed. The PHB extrapolates:

1. While pundits can argue whether the Affordable Care Act’s insurance options are as good as they should be, we’re devoting a lot of wealth toward health care. More individuals have higher levels of resources to put into their care than they’ve ever had before. And they know it.

2. While that wealth is being tempered by out-of-pocket expenses, network exclusions, service limitations and other trade-offs, consumers still have relatively abundant choices on not only when, but where to see that doctor, have that surgery or take that pill.  By the way, information is not only cheaper (thanks to the internet) but no longer monopolized by the health professions. 

3. Whether it’s a one-on-one recommendation to have a procedure or a proposal to build a new hospital wing, gone are the days when a professional expert’s opinion was automatically accepted. Stakeholders are demanding evidence, seeking justification, asking for alternatives and are relishing the “gotcha” moments.

Where do these healthcare versions of more-mobility-mentality take us? Greater access to resources means higher expectations. Mobility means consumers will use exercise choice to cross country, state or even national borders to access care when they choose to do so.  And mentality translates into higher levels of individual consumerism.

Instead of protocols with less variation, patients will want the care to be personalized. Service lines will be judged less on efficiency standard than local notions of value. Provider incentives based on “outcomes” and “upside risk” will have zero value proposition for their wealthy, mobile and skeptical customers.  Capital won’t necessarily flow toward non-performing assets and year-end savings won’t materialize just because policymakers wish it so.

Accountable care organizations and integrated delivery systems will still have huge competitive advantages. That being said, their chances competing successly against smaller competitors and access to capital will be increased if

1) their protocols are flexible,

2) variation is not only welcome but warranted,

3) patients have a good reason to choose their service lines,

4) incentives are broadened, and

5) this new and different level of complicated risk is realistically priced.

And that’s assuming that the health provider policymakers, politicians, academics, regulators and CEOs realize that they’re not quite in charge anymore.

Recommended article: Chomsky: We Are All – Fill in the Blank.
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The Population Health Blog

What is the Fine for Going Uninsured?

This Sunday, February 15 is your last chance to get health insurance to avoid the tax penalty, a costly government fine almost all Americans will face for going uninsured. The examples in this infographic could end up being you or your family members, so don’t wait – get coverage today!

Tax Penalty Example Final 2

Recommended article: Chomsky: We Are All – Fill in the Blank.
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Go Health Insurance Blog

Health Law Co-Ops Seek Flexibility On Financing

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Health Law Co-Ops Seek Flexibility On Financing

The long-term prospects and sustainability of these plans has been under scrutiny since December when CoOportunity Health — which offered plans in Iowa and Nebraska — was liquidated. Other health law headlines include reports about the added layer of difficulty the health law introduces into this year’s tax season and Texas’ high stakes in King v. Burwell.

Politico Pro: Co-Ops Seek Flexibility On Loans, Financing

Obamacare health insurance cooperatives are pushing federal officials to make it easier for the nascent plans to get significant private funding to stay solvent. A major obstacle is determining how and when those loans would be paid back and if government loans would be repaid after any private loans or investments. Representatives from the nonprofit insurers were in Washington this week to meet with federal officials, including CEO Kevin Counihan. (Pradhan, 2/10)

Minneapolis Star-Tribune: Health Care Law Adds New Wrinkle To Tax Season

This tax season offers a new wrinkle as individual filers must report to the IRS whether they had health insurance during 2014. The requirement brings a new task for MNsure, too, since the state’s health insurance exchange must send more than 30,000 tax forms to people who bought private coverage last year. (Snowbeck, 2/10)

The Texas Tribune: Texas Has High Stakes In Lawsuit Over Health Law

Nearly 1 million Texans have now signed up for health insurance on the federal marketplace, known as But Texas, and 33 other states that did not create their own exchanges, will be the most vulnerable if the U.S. Supreme Court rules against the Obama administration in the latest lawsuit challenging the Affordable Care Act, health policy experts say. (Walters, 2/10)

And from Capitol Hill -

The New York Times’ First Draft: No ‘Manly Firmness’ In Denying Health Care, McCaskill Says

Is repealing the Affordable Care Act an issue of manhood? A state representative in Missouri suggested as much in a resolution asking members of the state’s congressional delegation to undo the law. The bill, introduced by State Representative Mike Moon, a Republican, insists that “each member of the Missouri congressional delegation endeavor with ‘manly firmness’ and resolve to totally and completely repeal the Affordable Care Act, settling for no less than a full repeal.” The macho language raised the eyebrows of Senator Claire McCaskill, a Missouri Democrat who has been a defender of the law. (Rappeport, 2/10)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Recommended article: Chomsky: We Are All – Fill in the Blank.
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Kaiser Health News » Insurance

State Highlights: Criticism Of Gov.’s Push To Change MassHealth; Atlanta Health Care Merger; Iowa Supreme Court Abortion Case

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State Highlights: Criticism Of Gov.’s Push To Change MassHealth; Atlanta Health Care Merger; Iowa Supreme Court Abortion Case

A selection of health policy stories from Massachusetts, Iowa, Wisconsin, Pennsylvania, California, Georgia, North Carolina, Delaware and Kansas.

WBUR: Groups Resist Baker Push On MassHealth

Groups representing people dependent on state health insurance programs are resisting Gov. Charlie Baker’s push for authority to make major changes in the MassHealth program. Advocacy groups on Monday were delivering letters to Baker administration officials and legislative leaders expressing opposition to powers sought by Baker in his emergency legislation (H 49) to balance the state budget. Baker has requested authority to restructure MassHealth benefits “to the extent permitted by federal law.” (Dumcius and Norton, 2/9)

Georgia Health News: Emory, WellStar Discuss A Blockbuster Merger

In the turbulent business of health care, bigger is often better. Nowhere is that more evident than in the stunning announcement Monday that Emory University and WellStar Health System are talking about merging their medical assets in metro Atlanta. If a deal is consummated, the resulting nonprofit health system would clearly be Georgia’s biggest and would comprise one of the largest such organizations in the nation. (Miller, 2/9)

The News Journal: Delaware Health System To Close Inpatient, Outpatient Psychiatric Services

Christiana Care Health System will close Rosenblum Center on Feb. 20, and progressively close its outpatient psychiatric services in a move company officials say is part of a plan to overhaul its behavioral health care services. Parents, advocates and many medical professionals say the effects will be heart-wrenching and throw people living with issues ranging from bipolar disorder to post traumatic stress disorder into a potential tailspin. (Rini, 2/9)

The Des Moines Register: Supporters: Mental Hospital Is Irreplaceable

Closing down the state mental-health institute [in Mount Pleasant, Iowa] would erase intensive services that some people need to turn their lives around, supporters said Saturday. Brian Ingram of Boone, who went through an addiction treatment program here years ago, said he’d failed other attempts to get sober. Ingram stood up next to his old counselor and recounted how he’s now a homeowner with a steady job who’s been sober nearly 14 years. “I wouldn’t be here today if it wasn’t for Kim and Mount Pleasant. That’s the truth,” he said, drawing applause from about 200 people. (Leys, 2/9)

The Des Moines Register: Supreme Court To Hear Telemed-Abortion Case March 11

Planned Parenthood of the Heartland’s quest to keep dispensing abortion pills via a unique telemedicine system will be considered next month by the Iowa Supreme Court. Planned Parenthood wants the high court to overturn rulings by state regulators and a district judge, which would effectively ban use of the system. Doctors using it in Des Moines or Iowa City visit via closed-circuit video with patients in outlying clinics, then dispense abortion-inducing pills. (Leys, 2/9)

Center for Investigative Reporting: VA Inspector General Finally Releases Report On Wisconsin Hospital

The U.S. Department of Veterans Affairs’ Office of Inspector General has publicly released its scathing report documenting runaway painkiller prescriptions and abuse of administrative authority at the VA hospital in Tomah, Wisconsin. But the move, which came nearly a year after the independent watchdog closed its case, is unlikely to satisfy veterans’ advocates and members of Congress, who have expressed outrage that the findings weren’t shared with them and the public earlier. (Glantz, 2/9)

Milwaukee Journal-Sentinel: Access To Dental Care Still A Problem For Low-Income People In Wisconsin

In 2013, the most recent year for which figures are available, emergency departments at Wisconsin hospitals saw 27,741 patients who were in pain because of dental problems, such as abscesses — an average of 533 a week. The total was an improvement, but not by much. In 2009, emergency departments in the state saw 29,592 patients for dental problems — an average of 569 a week. Most of the visits stem from the limited access to dental care for people who are covered by BadgerCare Plus, the state’s largest Medicaid program, or for people who are uninsured. (Boulton, 2/9)

The Associated Press: Wolf Begins Unwinding Corbett Changes To Medicaid Benefits

[Pennsylvania] Gov. Tom Wolf’s administration said Monday it is taking steps to simplify the benefits packages for more than 1 million adult Medicaid recipients and undo what advocates for the poor had called a severe cutback for some adults under a plan advocated by former Gov. Tom Corbett. The administration released a Monday letter to a federal Centers for Medicare and Medicaid Services official saying it is withdrawing a Corbett request for approval to create a low-risk benefits package for healthier adults on Medicaid. (Levy, 2/9)

California Healthline: How Immigration Changes, Proposal For Undocumented Could Affect Medi-Cal

The number of uninsured in California has been cut by about half in the past two years, in part because of the expansion of Medi-Cal benefits. The last big group of uninsured is the undocumented, who are excluded from participating in state health benefit exchanges like Covered California. Medi-Cal is California’s Medicaid program. … Two recent developments could change that picture dramatically. (Gorn, 2/9)

North Carolina Health News: Return On Health Care Investment In Rural NC County

Karen Daniels’ husband used to fly airplanes and would sometimes remind her that velocity is irrelevant without direction. Daniels, vice president of nursing services at Halifax Regional Medical Center in Roanoke Rapids, references this principle in describing her community’s past efforts at improving the health and well-being of its residents. (Sisk, 2/9)

The Des Moines Register: Biofeedback Practitioner Resists Order To Quit

A former high-school English teacher says Iowa regulators had no right to make her stop charging people hundreds of dollars to analyze their brain waves via electronic sensors. … [Amy] Putney has asked a judge to overturn a “cease and desist” order that the Iowa Board of Medicine sent her in December. The board accused her of practicing medicine without a license or training as a physician. It said that if she continued to do so, she could face a court order or a felony criminal charge. (Leys, 2/9)

The Kansas Health Institute News Service: Kansas Home Health Provider Sentenced For Medicaid Fraud

A Kansas City, Kan., home health attendant was sentenced last week in U.S. District Court in a federal case based on fraudulent Medicaid billing practices. Doris Betts was charged in April 2014 with six counts of health care fraud. She pleaded guilty and was convicted in November in a joint enforcement effort between the U.S. Department of Health and Human Services/Office of Inspector General and Kansas Attorney General’s Office. (2/9)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Recommended article: Chomsky: We Are All – Fill in the Blank.
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Kaiser Health News » Insurance

GOP’s plan for the future would take us backward

If Republicans have their way with health insurance reform and you live in a Red state, you are screwed. Why? Because Republicans would like to turn over much of the decision making about your health insurance to individual states, and the overwhelming majority of states with Republican legislatures don’t have much of a track record when it comes to expanding health insurance.

This past week, several Republican Senators (Orrin Hatch, Fred Upton and Richard Burr) reintroduced a damaging set of recommendations called the Patient CARE Act for replacing Obamacare.

The so-called ‘new’ ideas

What are these so-called “new” ideas? They are actually old ideas … ones we have been hearing about for over a decade. They didn’t work back then and they won’t work now. I wrote about this in 2010 and again a few months ago. The Republican plan rests on three basic concepts they have been pushing for a long time:

  1. give patients more responsibility for their care,
  2. fix medical malpractice, and
  3. let states decide what kind of insurance to offer.

I think we all know what “giving people more responsibility for their care” means – it means offering them the splendid opportunity to set up a health savings account where they can sock away all their extra money so they can spend it on a high deductible plan.

Fix medical malpractice? It sounds like an important issue because Republicans keep mentioning it, but in fact malpractice insurance costs represent less than 2.4% of rising medical costs, so it’s hardly an issue central to cost control.

Leaving coverage up to the states?

Let states decide what insurance you can buy? This is the part that is profoundly unfair and a very bad idea. Why should there be variation across states about what health care people need? Why should states decide whether or not your pregnancy is covered or whether or not you should have prescription drug coverage?

And why should state legislators in each state make those decisions, when they are so vulnerable to lobbying by drug companies or different medical specialists? The Hatch plan would give each state the right to decide what kind of services you need, in contrast to Obamacare, which defined a set of “essential benefits” for everyone.

Coverage for maternity care is a good example of what might happen if coverage were left to the states. Before last year, only 12 states mandated coverage for maternity care. It was only in 2014 that Obamacare required maternity coverage as an essential benefit for everyone.

Arlene Karidis wrote about this in back in 2011 before the mandatory maternity coverage in the ACA kicked in:

… starting in 2014, new individual, small business and health insurance exchange plans will be required to cover maternity care as an “essential benefit.” In addition, employer-sponsored plans and new individual plans will not be allowed to deny coverage for a pre-existing condition – and that includes pregnancy.

The Republican mantra is “get the federal government out of my business” (unless they want to regulate your use of birth control). Federal mandates are bad. (But state mandates are OK? There are hundreds of thousands of them). Patients should pay more (even though our health care is more expensive than any other country and our population is not healthier). If you just tell patients what things cost, they will make wise choices (like delaying care they need because it’s too expensive).

How we move backward with GOP’s plan

What would this replacement plan let states do? Let me describe a few ways:

  1. Require insurance plans to extend coverage to dependents to age 26 (like Obamacare does now) UNLESS a state wants to opt out.
  2. Prohibit insurance companies from denying you for a pre-existing condition (but only if you have continuous coverage and keep it ), but not prohibit them from charging you more for it.
  3. Allow states to drop maternity coverage; in fact, states could repeal many of the benefits that many insurance plans now include routinely.
  4. Allow states to charge older people five times more than younger people (instead of the three times Obamacare stipulates). This would hit people between 55 and 65 especially hard since they would not yet have the protection of Medicare.
  5. Cap the Medicaid program allotment and encourage poor enrollees to sign up for those terrific Health Savings Accounts, all the time telling them that “private insurance” is the best thing ever. Actually, Medicaid patients have an easier time seeing a doctor now because the ACA raised reimbursement rates to doctors who treat these patients. The end result of a cap on Medicaid is less money for the people who need it.

But there’s more …

  1. Allow subsidies in the form of means-tested tax credits up to three times the FPL (federal poverty level) – which is $ 11,770 a year – instead of the slightly more generous four times of the FPL in the ACA.
  2. You don’t “have” to be insured. And your employer does not “have” to provide insurance to you. NO mandates. Those of you who remain uninsured but get sick will count on the rest of us to pay more to cover your care. Removing the individual and employer mandates will only mean fewer people insured and higher costs.
  3. And this one should make every working American furious: You, as an employee, would be taxed on the value of the insurance you receive from your employer, but … your employer would still be allowed their tax break to provide it. I love that conservative economist Avik Roy heartily endorses taxing the employee side of the insurance exclusion, but believes that a cap on the employer exclusion will solve the problem.

Sending decisions about insurance back to the states will only result in less gain and a lot more pain for people in red states with Republican controlled legislatures. You may not be able to control where you live, but you shouldn’t be punished for it!

Recommended article: Chomsky: We Are All – Fill in the Blank.
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