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Daily Archives: January 15, 2015

Limited Insurance Choices Frustrate Patients In Rural California

When Dennie Wright went to sign up for Affordable Care Act insurance last year, it wasn’t a hard decision. His insurance agent told him he had only one insurer – Anthem Blue Cross – that he could buy from on the exchange, Covered California.

Wright lives in a modest house overlooking a pasture in Indian Valley. It’s a tiny alpine community at the northern end of the Sierra Mountains, close to the border with Nevada. He lives in one of more than 200 zip codes where Blue Shield of California has stopped selling individual insurance policies.

Dennie Wright and his wife Kathy go over health bills, related to care he got across the state line in Nevada. (Photo by Pauline Bartolone/Capital Public Radio)

Dennie Wright and his wife Kathy go over health bills, related to care he got across the state line in Nevada. (Photo by Pauline Bartolone/Capital Public Radio)

“That was new to us, you know, Covered California. Anthem Blue Cross was the insurance carrier. Then of course, three months later I have a heart attack,” says Wright.

More than once, he was flown across the state line to Reno for care. Wright and his wife, Kathy, now have piles of medical bills and insurance paperwork. Anthem Blue Cross covers emergencies when they happen out-of-state but not routine doctor care in another state.

But Wright says traveling to doctors within California is not as safe or as convenient for him as going to Reno.

He continues to see the Nevada doctors who put a defibrillator in his chest and saved his life. Anthem Blue Cross will pay for some of the bills, but the Wrights still don’t know if everything will be covered.

There are other insurance options for Wright, but not through Covered California. Although he didn’t need a subsidy, he was left in the same position as people in his area who do need financial help to buy insurance. They cannot take their business to a competitor, because the exchange is the only place customers can use federal subsidies to help them buy health insurance. And for those people, Anthem is the only option.

This story is part of a partnership that includes Capital Public Radio, NPR and Kaiser Health News. It can be republished for free. (details)logo npr

“I mean, you should have some choices, especially if you’re going to have one that’s not going to cover you in the places you choose to go,” Wright says.

Covered California Executive Director Peter Lee offered a different impression of choices in the marketplace last July.

“In every corner of the state, consumers will have at least two plans to choose from, and in most areas, where most of the Californians live, they can choose between five or six plans,” said Lee during an event to announce the marketplace’s 2015 plans and premium rates.

But in twenty-two counties in Northern California, there are zip codes where there is only one choice of insurer. There are areas near Monterey and Santa Cruz on California’s Central Coast that also have only one carrier.

Blue Shield of California said it had to stop selling exchange plans in areas where it couldn’t ensure an adequate network of doctors.

Covered California estimates that statewide, there are 28,896 Covered California customers who have only one choice of insurance carrier, slightly more than 2 percent of the total exchange membership as of November 2014.

Dennie Wright lives in rural Northern California, where many areas have just one insurer selling plans on Covered California. (Photo by Pauline Bartolone/Capital Public Radio)

Lee says now, the exchange is working to increase the range of choices in places where there are none. But he says the situation existed long before the exchange.

“The challenges of northern, rural counties have been there for a long time and are still a challenge that we’re trying to address head-on,” says Lee.

Lee says the exchange is encouraging existing plans to expand to areas where there are enough doctors. And it’s looking to bring new carriers in for 2016.

“We aren’t the solution to all the problems that have always been there in terms of challenges in rural communities, and that’s something we’re certainly looking at how to improve access and choice, and we’ll continue doing that,” says Lee.

Covered California should help increase the number of insurers, says consumer advocate Anthony Wright from Health Access. And he says policy makers should also lean on insurers and providers to participate in that market.

“Some of this is a combination of putting pressure on the insurers, and some of this is trying to do work to actually increase the number of providers on the ground in these areas, whether through more training, [or] incentives to be in some of these more rural areas,” says Anthony Wright.

Wright, the advocate, says more insurers in the marketplace makes it more likely people can get the care they need.

“At one level, we’re trying to make a functioning market, but it still means that consumers are at the mercy of the market.”

This year, people who want more choice than what Covered California offers must venture into the broader health insurance market if they can afford it.

This story is part of a reporting partnership with NPR, Capital Public Radio and Kaiser Health News.

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Burwell Calls For Congress To Work With Her On Health Issues

Department of Health and Human Services Secretary Sylvia M. Burwell Thursday called on Congress to look beyond the Affordable Care Act to find compromise on health care.

In remarks at the New America Foundation, Burwell cited several areas – including opioid abuse, Ebola, medical research and innovation – where Republicans and Democrats have sponsored legislation to work together to solve problems in the nation’s health care system.

As she has before, Burwell defended the health overhaul and urged Congress to “move beyond the back and forth of the Affordable Care Act and focus on the substance of access, affordability and quality.”  She makes no apologies for the law, which Republicans have voted numerous times to repeal in full or in part. That effort is expected to be part of the discussions this week at Republican lawmakers’ retreats.

Senate Health Committee Holds Confirmation Hearing For Sylvia Burwell To Lead The Health And Human Services Dept.

HHS Sec. Sylvia Mathews Burwell testifies during her confirmation hearing before the Senate Health Committee in May. (Photo by Alex Wong/Getty Images)

But those disagreements should not stop Congress from also focusing on “other critical areas in health care where our common interests give us ample opportunities for common good – improving the quality of the care we receive while spending our dollars more wisely, reducing substance use disorders and overdose deaths, strengthening global health security, reaffirming American leadership in research, innovation and science, and building an innovation economy,” Burwell said.

In a statement, Sen. Lamar Alexander, R-Tenn., the new chair of the Senate Health, Education, Labor and Pensions Committee, welcomed Burwell’s remarks and said he looked forward to working with her.

This KHN story can be republished for free (details).

“We have plenty we disagree on, but we also have plenty of issues that are important to millions of Americans upon which we should be able to get results, including, for example, getting life-saving drugs, treatments and devices through the FDA to patients faster; remodeling the health care delivery system; and improving global health security,” he said.

While repealing or replacing the health law is an avowed target for many in the GOP, Republicans are likely more eager to work with the administration on legislation to extend funding for the Children’s Health Insurance Program (CHIP) and to overhaul the way Medicare pays physicians, known as the sustainable growth rate, Burwell said.

“I think those fall into the category of things where I think there will be bipartisan support,” she said. “I think those are very clearly legislative issues that Congress will take the lead in terms of timetable and focus. … I see both of those in that category of greater possibility for working together.”

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Viewpoints: A Health Strategy For GOP; Cutting Medical Bill Stress; Balancing The Budget

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Longer Looks: Opiates For Vets; Taking About Death; A Senior Moment In N.Y.

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State Highlights: Texas Gov.-Elect Steps Up Review Of Medicaid Contracting; Calif. Draft Plan To Reduce Mental Health Care Disparities Takes Shape

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New Report Explores How Medicare Payments Impact Hospice Care

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Federal Agents Raid Florida Medical Supply Firm

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Federal Judge Strikes Down Home Health Care Wage And Overtime Rules

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Obama To Propose Expanded Paid Sick Leave Policies

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As GOP Eyes Rare Procedure To Assail Health Law, Senate Parliamentarian Takes On Key Role

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