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Daily Archives: December 11, 2015

California Exchange Targets “Hot Spots” With High Rates Of Uninsured

As the deadline for January health care coverage nears, California’s insurance exchange is intensifying efforts to sign people up in pockets of the state with exceptionally high numbers of uninsured residents.

Covered California is targeting such “hot spots” as San Francisco’s Mission district, Oakland’s Fruitvale neighborhood and the East San Jose and Berryessa communities of Silicon Valley, officials said.

Exchange officials this week released maps and information about communities with high numbers of uninsured people who likely qualify for subsidized health insurance based on their income.

The enrollment period ends Jan. 31, but people who sign up by Dec. 15 will get benefits starting Jan. 1.

Other “hot spots” around the state can be found in Santa Ana and Ontario, San Diego’s East County district, and Eureka and Arcata in Northern California. Many of their residents are Latino, a population that has been challenging for Covered California to reach.

“These are areas where people have really adapted to a culture of coping for years – they have made the best of a bad situation of living without insurance,” said Peter Lee, Covered California’s executive director.

This KHN story also ran in the San Jose Mercury News. It can be republished for free (details). San Jose Mercury News logo

Focusing on the “hot spots,” he said, “helps us get the word out at a community level where it can make the most difference.”

Covered California estimates that 750,000 Californians are eligible for the health insurance subsidies but remain uninsured. An additional 1.4 million residents are believed to qualify for Medi-Cal.

As of last Monday more than 83,000 Californians had selected plans through the health insurance exchange since Nov. 1, when open enrollment began.

About 2.5 percent of Californians are eligible for insurance subsidies and are believed to be uninsured, but the “hot spot” maps reveal higher percentages of eligible residents in certain places — 3.2 percent in San Francisco’s five hot spots 4.3 percent of the population in Oakland’s six hot spots; 3.8 percent in the South Bay’s eight hot spots, and 5.1 percent in Contra Costa County’s three hot spots.

Covered California is working with community organizations around the state to schedule more enrollment events in the hot spots, as well as increasing door-to-door canvassing, and adding storefront offices where people can enroll. It also has a robust broadcast and print advertising campaign in those areas.

One of those organizations is the San Jose-based Community Health Partnership, which puts on health fairs and other outreach events. It also provides space for health navigators to enroll people directly for Covered California insurance or Medi-Cal.

Recently the group worked with San Jose City Councilwoman Magdalena Carrasco to put on a health fair at James Lick High School in East San Jose, a hot spot district, offering free Christmas trees to draw people. At the fair, attendees could get medical screenings as well as sign up for coverage, said Grace-Sonia Melanio, the partnership’s director of communications and health policy.

The nonprofit has seen an uptick in the number of people asking for help because residents are becoming more aware of the financial penalty for not signing up for insurance, she said.

“When folks do come to us, they’re pretty hopeful the insurance will be affordable,” Melanio said.

But, she added, “we find that we just can’t sit back in the office and wait for them to make an appointment. We have to go out to the community.”

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Connecticut Governor Targets Hospital Funds To Close Budget Gap

This week Connecticut’s leaders had to close a $350 million hole in the state’s budget. One place they cut is hospital funding, and that’s making hospital executives furious.

The battles lines are clear. Gov. Dannel Malloy, a Democrat, says the hospitals are getting rich off taxpayers, making more money than in past years — thanks, in part, to the Affordable Care Act. So he thinks hospitals can afford to give some money back.

“If you make almost a billion dollars a year, how bad are things?” Malloy asks. “If you’re having the best results in recent history in hospital performance, why do you need the citizens of Connecticut to give you an additional $500 million?”

Malloy is making his argument personal — taking aim at the high salaries of hospital CEOs. Many of the executives of the state’s nonprofit medical institutions make at least a million dollars a year, he points out.

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

“If they’re hurting so bad,” Malloy says, “why are they paying their chief executives $3.5 million dollars?”

But where the governor sees bloat, the hospitals see a politician using them as easy targets. The medical institutions are paying for political-style advertising to tell constituents that his cuts will have a serious, negative effect on patient care.

“Longer wait times, fewer cancer screenings, and nurses will be let go,” one ad says. “Tell Gov. Malloy to stop cutting our hospital care. Lives depend on it.”

The hospitals say bringing up CEO pay is an irrelevant distraction. Cut it in half and you’d barely make a dent in the state’s budget problem, they say.

Dr. John Murphy, who runs Western Connecticut Health Network, says there’s a bigger problem — the governor is either misrepresenting hospital economics, or he doesn’t understand them.

“If you look at, how much money did you really make — operating income? If that’s the number,” Murphy says, “and it’s a pure accounting number, we lost tens of millions of dollars last year.” As for 2015, he says, “I’m sure it’s worse.”

The governor’s staff sees the hospital’s balance sheet differently. If lower-paid hospital employees and small programs are taking a hit because of the state cuts, Malloy’s office argues the blame should be on hospital boardrooms — not the state government. It’s the board members who are prioritizing executive salaries over other financial needs.

This public fight between the state and its medical institutions is playing out largely because of what the hospitals say is a broken promise.

In 20Ǭ, the state of Connecticut implemented a new hospital tax. The hospitals would pay around $350 million a year to the state, and all of that money — if not more — was supposed to be returned to them as Medicaid payments.

But that was then. Until Tuesday, the state budget was out of balance. To help fix it, Malloy wanted to cut another $63 million to hospitals; lawmakers put about half of that back. But the numbers still seem out of whack to Patrick Charmel, the CEO at Griffin Hospital, an independent nonprofit in Derby, Conn.

“So, now we’re talking over half a billion dollars,” Charmel says. “That’s what hospitals are paying in terms of the tax. And, essentially, we’re not getting any of that back.”

He thinks hospitals have cut all they can, despite what Malloy thinks.

“When there’s a cut in state payments to hospitals or federal payments to hospitals, it’s got to come out of care delivery,” Charmel says. “There’s nobody else to shift it to.”

Medicaid is lurking in the background of the discussion. The state says more people than ever are getting Medicaid, and Medicaid payments to hospitals have more than doubled in Ǫ years.

But don’t tell that to Murphy. Hospitals lose about 60 cents on every dollar of Medicaid service, the hospital CEO says. “The fact that we’re getting more Medicaid patients to take care of, and on every one of them we have financial challenges associated with that care — it really isn’t a windfall for us,” Murphy says. “In fact, it’s a greater economic burden.”

While this year’s budget may be back in balance, the hospitals are gearing up for a long-term fight. They want the tax ruled invalid — a move that could take the fight from the capitol to the courtroom.

This story is part of a partnership that includes WNPR, NPR and Kaiser Health News.

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Viewpoints: Dems And Cadillac Tax; Health Law Alternative; ‘Folly’ Of Challenging Drug Makers

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Research Roundup: Medicaid And Prisoners; Enrollment Assisters; Medicare Drug Costs

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State Highlights: Vermont Moves To Establish ‘All-Payer’ System; Pennsylvania Lawmakers Renew CHIP For 2 Years

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Dreaming Big: Hospitals Turn To Partnerships To Survive New Cost, Quality Demands

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Utah Medicaid Director Stepping Down

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Recent Shootings May Push States To Share Mental Health Records With FBI

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Although Often Overlooked, Small Breaches Of Medical Privacy Harm Many Patients

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Rubio, Who Touts Efforts Against Obamacare, Uses Law’s Congressional Option For Insurance

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