Tagged Insurance

Podcast: KHN’s ‘What The Health?’ You Have Questions, We Have Answers

This week, KHN’s “What the Health?” panelists answered questions submitted by listeners.

Among the topics covered were what might happen to parts of the Affordable Care Act if a lawsuit now working its way through the courts succeeds in declaring the health law unconstitutional, and how Medicare and Medicaid deal with surprise medical bills from out-of-network providers.

This week’s panelists are Julie Rovner of Kaiser Health News, Jennifer Haberkorn of the Los Angeles Times, Joanne Kenen of Politico and Kimberly Leonard of the Washington Examiner.

The panel addressed questions including the following:

  • What would happen to the Medicare Part D “doughnut hole” if the entire ACA is struck down, and would newer bills, such as the Bipartisan Budget Act, which helped close the coverage gap for brand-name drugs one year early, prevent this feature of the ACA from being eliminated?
  • Will the Health Insurance Portability and Accountability Act (HIPAA) of 1996 remain if the ACA is completely overturned?
  • Since surprise medical bills aren’t allowed in Medicare and Medicaid, what happens when an anesthesiologist or contract emergency room doctor who doesn’t accept Medicare or Medicaid treats an enrolled patient? Do they take a lower rate? Does the hospital make up the difference? Why can’t this be applied to all out-of-network arrangements?
  • Statistics show that approximately 5% to 10% of the population accounts for about 50% of total health care spending. Who makes up this population? Are there any reasonable proposals to address the health of this population and perhaps reduce spending while improving outcomes?

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Kaiser Health News’ “Lethal Plans: When Seniors Turn To Suicide In Long-Term Care,” by Melissa Bailey and JoNel Aleccia

Jennifer Haberkorn: The New York Times’ “Insurers Want to Know How Many Steps You Took Today,” by Sarah Jeong

Joanne Kenen: Vox.com’s “Walmart’s $25 Insulin Can’t Fix the Diabetes Drug Price Crisis,” by Julia Belluz

Kimberly Leonard: The [Columbia, S.C.] State’s “SC Inmate’s Baby Died in Toilet: Lawsuits Allege Rampant Medical Neglect in Prisons,” by Emily Bohatch

And, The Atlanta Journal-Constitution’s “For Some in Ga. Prisons and Jails, Diabetes Has Meant a Death Sentence,” by Danny Robbins

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher, Google Play or Spotify.

Podcast: KHN’s ‘What The Health?’ You Have Questions, We Have Answers

This week, KHN’s “What the Health?” panelists answered questions submitted by listeners.

Among the topics covered were what might happen to parts of the Affordable Care Act if a lawsuit now working its way through the courts succeeds in declaring the health law unconstitutional, and how Medicare and Medicaid deal with surprise medical bills from out-of-network providers.

This week’s panelists are Julie Rovner of Kaiser Health News, Jennifer Haberkorn of the Los Angeles Times, Joanne Kenen of Politico and Kimberly Leonard of the Washington Examiner.

The panel addressed questions including the following:

  • What would happen to the Medicare Part D “doughnut hole” if the entire ACA is struck down, and would newer bills, such as the Bipartisan Budget Act, which helped close the coverage gap for brand-name drugs one year early, prevent this feature of the ACA from being eliminated?
  • Will the Health Insurance Portability and Accountability Act (HIPAA) of 1996 remain if the ACA is completely overturned?
  • Since surprise medical bills aren’t allowed in Medicare and Medicaid, what happens when an anesthesiologist or contract emergency room doctor who doesn’t accept Medicare or Medicaid treats an enrolled patient? Do they take a lower rate? Does the hospital make up the difference? Why can’t this be applied to all out-of-network arrangements?
  • Statistics show that approximately 5% to 10% of the population accounts for about 50% of total health care spending. Who makes up this population? Are there any reasonable proposals to address the health of this population and perhaps reduce spending while improving outcomes?

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Kaiser Health News’ “Lethal Plans: When Seniors Turn To Suicide In Long-Term Care,” by Melissa Bailey and JoNel Aleccia

Jennifer Haberkorn: The New York Times’ “Insurers Want to Know How Many Steps You Took Today,” by Sarah Jeong

Joanne Kenen: Vox.com’s “Walmart’s $25 Insulin Can’t Fix the Diabetes Drug Price Crisis,” by Julia Belluz

Kimberly Leonard: The [Columbia, S.C.] State’s “SC Inmate’s Baby Died in Toilet: Lawsuits Allege Rampant Medical Neglect in Prisons,” by Emily Bohatch

And, The Atlanta Journal-Constitution’s “For Some in Ga. Prisons and Jails, Diabetes Has Meant a Death Sentence,” by Danny Robbins

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher, Google Play or Spotify.

Faced With High Deductibles, Patients Are Delaying Health Care So As Not To Rack Up High Bills

Even with insurance, health care bills can be daunting and prompt people to delay care for problems that could have been caught earlier. Women with low incomes who had high-deductible insurance plans waited an average of 1.6 months longer for diagnostic breast imaging, 2.7 months for first biopsy, 6.6 months for first early-stage breast cancer diagnosis and 8.7 months for first chemotherapy, compared with low-income women with low-deductible plans.

Faced With High Deductibles, Patients Are Delaying Health Care So As Not To Rack Up High Bills

Even with insurance, health care bills can be daunting and prompt people to delay care for problems that could have been caught earlier. Women with low incomes who had high-deductible insurance plans waited an average of 1.6 months longer for diagnostic breast imaging, 2.7 months for first biopsy, 6.6 months for first early-stage breast cancer diagnosis and 8.7 months for first chemotherapy, compared with low-income women with low-deductible plans.

Hickenlooper Expanded Medicaid, Created State-Run Marketplace To Insure Nearly All Coloradans

Former two-term Colorado Gov. John Hickenlooper is a rare breed in the 2020 presidential race — he’s running as a moderate.

On health care, he supports universal coverage and boasts about Colorado’s record-low uninsured rate. But unlike many of his competitors for the Democratic nomination, he opposes “Medicare-for-all,” the single-payer federal system that would guarantee health care coverage to every American.

Hickenlooper has been making the rounds on cable talk shows and is trying to distinguish himself as a compromiser. In an interview on MSNBC’s “Meet the Press,” Hickenlooper said, “We got to almost universal coverage in health care in Colorado. We expanded Medicaid. We created one of the most innovative exchanges in the country.” His campaign website claims that “nearly 95 percent” of Coloradans currently have health care coverage.

We wondered how Colorado’s uninsured rate changed during Hickenlooper’s time in the governor’s mansion and how it compares with the rest of the country.

How Did Hickenlooper Do It?

The Affordable Care Act, or ACA, authorizes states to expand Medicaid to include health care coverage for all adults earning up to 138% of the federal poverty level. Colorado is one of 37 states that have opted to do so.

In 2013, then-governor Hickenlooper announced his proposal to expand Medicaid at no cost to the state general fund. Under the ACA, the federal government would pay for the program until 2016, after which states had to pay a portion. Hickenlooper planned to cover future expenses with cost-cutting efforts and existing revenues, including a hospital provider fee rolled out in 2009.

After Hickenlooper launched the Medicaid expansion, Colorado’s uninsured rate dropped from 14.3% in 2013 to 6.5% in 2017, according to the Colorado Health Institute.

However, about 350,000 Coloradans still don’t have health insurance — one-quarter of whom are undocumented, making them ineligible for public insurance. Also, the price of coverage continues to rise in Colorado, where people pay some of the highest premiums in the United States.

Hickenlooper saw Medicaid expansion as a step toward his goal of making Colorado the “healthiest state in America.” But he hasn’t always supported policies that could give more people health care coverage. In 2016, he opposed a ballot measure that would have created a single-payer state health care system called ColoradoCare. Then, he said he’d be open to a Trump administration-backed policy to implement a work requirement for Medicaid recipients.

How Does Colorado Compare?

Hickenlooper’s Medicaid expansion more than halved Colorado’s uninsured rate. But if a 6.5% uninsured rate counts as “almost universal coverage,” then how many other states can tout that accomplishment?

According to the Kaiser Family Foundation, Colorado’s uninsured rate positions it squarely in the upper half of the pack, with a national average uninsured rate of 9%. (It’s important to note that the Kaiser Family Foundation measured Colorado’s uninsured rate differently, pegging it at 8%. The Colorado Health Institute said its rate is slightly lower because it includes more data on children. Kaiser Health News is an editorially independent program of the foundation.)

The foundation lists 20 states with even lower uninsured rates than Colorado, including Massachusetts at 3% and Iowa at 4%.

In an email to PolitiFact, Michele Lueck, the president of the Colorado Health Institute, called Hickenlooper’s claim that “nearly 95 percent” of Coloradans currently have health care coverage a “friendly rounding error.”

Enrollment Numbers In Decline Nationwide, But Not In Colorado

About 300,000 fewer Americans bought insurance through healthcare.gov during the enrollment period in 2018 than in the previous year. Meanwhile, Colorado’s enrollment numbers were up.

The Affordable Care Act allowed states to create their own marketplaces to sell insurance plans to people who aren’t covered by their employer, Medicaid or Medicare — which includes about 8% of the total market in Colorado. Twelve states, including Colorado, run their own marketplaces.

Some credit lower enrollment across the country to the Trump administration’s policies to stymie the Affordable Care Act. It cut funding for healthcare.gov’s budget for marketing and eliminated the penalty for not having insurance.

But in Colorado, nearly 6% more people purchased a plan on Connect for Health Colorado, the state-run marketplace that operates independently of the federal government. While healthcare.gov released fewer ads and shut down weekly for maintenance, Connect for Health Colorado continued to reach out to eligible customers.

Our Ruling

Hickenlooper said, “We got to almost universal coverage in health care in Colorado.” Though Colorado is much closer to universal health care coverage than before the Affordable Care Act, hundreds of thousands of Coloradans remain uninsured and other states have even lower uninsured rates. Nevertheless, the state has an uninsured rate of 6.5%, which is close to universal coverage, as Hickenlooper said. The state achieved this by expanding Medicaid and running its own health care marketplace.

We rate the claim Mostly True.

Watch: ACA’s Future And ‘Medicare-For-All’ Front And Center As Candidates Line Up For 2020

Julie Rovner, KHN’s chief Washington correspondent, joined C-SPAN host Bill Scanlan Tuesday morning on “Washington Journal” to discuss how health care is playing out in the current political debate. They talked about the Republican-sponsored lawsuit to overturn the Affordable Care Act and the backing by many Democratic candidates of a “Medicare-for-all” health plan, and took questions from viewers about a wide variety of health issues. The video is available on the C-SPAN website.

Rovner also was on NPR’s “Weekend Edition Saturday” with host Scott Simon to talk about Sen. Bernie Sander’s “Medicare-for-all” proposal. That is available on the NPR website.

Watch: ACA’s Future And ‘Medicare-For-All’ Front And Center As Candidates Line Up For 2020

Julie Rovner, KHN’s chief Washington correspondent, joined C-SPAN host Bill Scanlan Tuesday morning on “Washington Journal” to discuss how health care is playing out in the current political debate. They talked about the Republican-sponsored lawsuit to overturn the Affordable Care Act and the backing by many Democratic candidates of a “Medicare-for-all” health plan, and took questions from viewers about a wide variety of health issues. The video is available on the C-SPAN website.

Rovner also was on NPR’s “Weekend Edition Saturday” with host Scott Simon to talk about Sen. Bernie Sander’s “Medicare-for-all” proposal. That is available on the NPR website.

Even People With Employer-Sponsored Plans Are Spending A Big Chunk Of Income On Health Insurance

“The affordability trends in the employer market are driven by healthcare costs rising a lot faster than the median income,” said Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund. The trends may be fueling some of the “Medicare for All” interest, experts say.

Even People With Employer-Sponsored Plans Are Spending A Big Chunk Of Income On Health Insurance

“The affordability trends in the employer market are driven by healthcare costs rising a lot faster than the median income,” said Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund. The trends may be fueling some of the “Medicare for All” interest, experts say.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

Town Hall Audience Erupts In Cheers When Asked About Support For Sanders’ ‘Medicare For All’ Plan

The slice of public opinion at the town hall for 2020 hopeful Sen. Bernie Sanders (I-Vt.) reflects broader polling that shows support for a system that guarantees universal coverage. However, when details about paying for the plan are revealed, that support has, in the past, dropped.

Many Patients Facing Surprise Medical Bills Just Give In And Pay Rather Than Undertake Behemoth Battle Against Charges

There’s a growing scrutiny over what to do about surprise medical bills, that may be more common than people think. Often times, faced with mountains of paperwork and an endless black hole of phone calls to insurers, patients just pay the charges. But that may eventually change as legislation is introduced to curb the practice.

Many Patients Facing Surprise Medical Bills Just Give In And Pay Rather Than Undertake Behemoth Battle Against Charges

There’s a growing scrutiny over what to do about surprise medical bills, that may be more common than people think. Often times, faced with mountains of paperwork and an endless black hole of phone calls to insurers, patients just pay the charges. But that may eventually change as legislation is introduced to curb the practice.

Watch: Sanders Re-Ups ‘Medicare-For-All,’ Gets More Mileage On Campaign Trail

KHN chief Washington correspondent Julie Rovner appeared on two CNN programs to help explain what’s known and what’s still to be figured out about the “Medicare-for-all” plan Sen. Bernie Sanders (I-Vt.) reintroduced this week in the Senate. The plan by Sanders, who is among the front-runners in the Democratic presidential primary race, has drawn a lot of attention on the campaign trail and Capitol Hill.

Watch CNN’s “New Day” with Alisyn Camerota and John Berman.

Watch “CNN Newsroom” with Brooke Baldwin.

Podcast: KHN’s ‘What The Health’: Still More ‘Medicare-For-All’

Vermont Sen. Bernie Sanders, a presidential candidate, unveiled the 2019 version of his “Medicare-for-all” bill this week. But even more than two decades after first proposing a single-payer plan for the U.S., Sanders still has not proposed a way to finance such a major undertaking.

Congress continued to pursue its examination of high prescription drug prices this week by calling to testify both insulin makers and the drug “middlemen” known as pharmacy benefit managers.

And Idaho is following Utah in trying to scale back an expansion of Medicaid under the Affordable Care Act approved by voters last November.

This week’s panelists are Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post.

Also, Rovner interviews Ceci Connolly, president and CEO of the Alliance of Community Health Plans.

Among the takeaways from this week’s podcast:

  • “Medicare-for-all” was in the spotlight again this week with the release of Sanders’ bill, which is co-sponsored by four of the five other Senate Democrats running for president. Still, neither Sanders nor any other candidates — or their proposals — focus on how to pay for it. Experts differ on how much expanding Medicare would cost. But, whether it’s moving around money already being spent or raising new taxes, expanding Medicare to more people would result in winners and losers, a key political factor going forward.
  • Both parties face internal divisions over health care, revolving around whether to create something new or stick with the status quo. Within the GOP, the split is between Republicans who point to years of unsuccessful efforts to repeal and maybe replace the ACA and want to move on to other things, and others — including some in the White House — who are continuing the push. Democrats’ division is between those who back House Speaker Nancy Pelosi’s call to strengthen and improve the ACA and those who back various efforts to create a Medicare-for-all system.
  • The GOP is playing both offense and defense on the ACA. Leaders say they want to be the party of health care and protect people with preexisting medical conditions, even as the Justice Department is officially backing a court ruling in Texas that would invalidate the entire law, including those protections.
  • There was lots of talk but little action on drug prices at hearings before Congress. Lawmakers heard from drug companies and pharmacy benefit managers, but are no closer to answering the question about what to do about high drug prices. While there may be incremental changes that can be adopted, few expect legislation that would fundamentally change business practices, intellectual property rights or the ability for Medicare to negotiate drug prices.
  • Action in the Utah and Idaho legislatures around Medicaid expansion show that even successful ballot initiatives to expand the program can be changed by lawmakers in ways voters may not have expected. In both state capitols, elected officials reduced the number of people eligible for expansion below what voters approved.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The New York Times’ “Would ‘Medicare for All’ Save Billions or Cost Billions?” By Josh Katz, Kevin Quealy and Margot Sanger-Katz

Sarah Kliff: Politico’s “Public Option Hits a Wall in Blue States,” by Rachana Pradhan and Dan Goldberg

Margot Sanger-Katz: Politico’s “Obamacare Fight Obscures America’s Real Health Care Crisis: Money,” by Joanne Kenen

Paige Winfield Cunningham: STAT News’ “Amazon Alexa Is Now HIPAA-Compliant. Tech Giant Says Health Data Can Now Be Accessed Securely,” by Casey Ross

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

State Highlights: On Brink Of Nurses Strike, New York Hospitals Agree To Increase Staffing Levels; Use Of Urgent Care Clinics Expands In New Orleans, Nationwide, Report Finds

Media outlets report on news from New York, Louisiana, Georgia, California, Ohio, New York, North Carolina, Iowa, Florida, Wisconsin, Michigan, Arizona and Massachusetts.