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Daily Archives: February 14, 2018

Idaho Blue Cross Jumps Into Controversial Market For Plans That Bypass ACA Rules

That didn’t take long.

It’s barely been two weeks since Idaho regulators said they would allow the sale of health insurance that does not meet all of the Affordable Care Act’s requirements — a controversial step some experts said would likely draw legal scrutiny and, potentially, federal fines for any insurer that jumped in.

On Wednesday, Blue Cross of Idaho unveiled a menu of new health plans that break with federal health law rules in several ways, including setting premiums based on applicants’ health.

“We’re trying to offer a choice that allows the middle class to get back into insurance coverage,” said Dave Jeppesen, the insurer’s executive vice president for consumer health care.

The firm filed five plans to the state for approval and hopes to start selling them as soon as next month.

The Blue Cross decision ups the ante for Alex Azar, the Trump administration’s new Health and Human Services secretary. Will he use his authority under federal law to compel Idaho to follow the ACA and reject the Blues plans? Or will he allow state regulators to move forward, perhaps prompting other states to take more sweeping actions?

At a congressional hearing Wednesday, even as Blue Cross rolled out its plans, Azar faced such questions.

“There are rules. There is a rule of law that we need to enforce,” Azar said. Observers noted, however, he did not specifically indicate whether the federal government would step in.

Robert Laszewski, a consultant and former insurance industry executive, thinks it should.

If Idaho is able to do this, it will mean other … states will do the same thing,” he said. “If a state can ignore federal law on this, it can ignore federal law on everything.”

Idaho’s move stirs up more issues about individual insurance market stability.

Policy experts say that allowing lower-cost plans that don’t meet the ACA€™s standards to become more widespread will pull younger and healthier people out of Obamacare, raising prices for those who remain. Supporters say that is already happening, so this simply provides more choices for people who earn too much to qualify for subsidies to help them purchase ACA coverage.

The state’s move to allow such plans, announced in January, drew harsh and swift criticism.

“Crazypants illegal,” tweeted Nicholas Bagley, a law professor at the University of Michigan and former attorney with the civil division of the U.S. Department of Justice, who said that states can’t pick and choose which parts of federal law to follow. Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, pointed out that health insurers could be liable for sharp fines if they are found to be in violation of the ACA.

But both Idaho regulators and Blue Cross officials say they are not worried.

Jeppesen said the ACA gives states regulatory authority “to make sure the market works and is stable, and the insurer is simply “following what the state has given us guidance” to do.

Other insurers in Idaho are taking a much more cautious approach, telling The Wall Street Journal they are not stepping up immediately to offer their own plans.

Laszewski said they are likely waiting to see what legal challenges develop.

“If I were running an insurance company, there€™s no way I would stick my neck out until the high court has ruled in favor of this — and they’re not going to,” he said.

Jeppesen said his company has consulted with legal experts and is moving ahead with confidence. The aim is to bring people back into the market, particularly the young, the healthy and those who don’t get a tax credit subsidy and can’t afford an ACA plan.

For some people — especially younger or healthier applicants — the new plans, which the insurer has named Freedom Blue, cost less per month than policies that meet all ACA rules.

They accomplish that by limiting coverage. If they are allowed to be sold, consumers will need to weigh the lower premiums against some of the coverage restrictions and varying premiums and deductibles, policy experts say.

The plans, for example, will include a “waiting period” of up to 12 months for any preexisting conditions if the applicant has been without coverage for more than 63 days, Jeppesen said.

Additionally, they cap total medical care coverage at $1 million annually. And premiums are based, in part, on a person’s health: The healthiest consumers get rates 50 percent below standard levels, while those deemed unhealthy would be charged 50 percent more.

All those caveats violate ACA rules, which forbid insurers from rejecting coverage of preexisting conditions or setting dollar caps on benefits or higher premiums for people with health problems.

But the rates may prove attractive to some.

Premiums for a healthy 45-year-old, for example, could be as low as $195 a month, according to a comparison issued by the insurer, while a 45-year-old with health problems could be charged $526. In that case, the 45-year old would find a lower price tag — $343 a month — for an ACA-compliant bronze plan.

While Freedom Blues plans cover many of the “essential health benefits” required under the ACA, such as hospitalization, emergency care and mental health treatment, they do not include pediatric dental or vision coverage. One of the five plans does not include maternity coverage.

When compared with one of the Blues€™ ACA-compliant plans — called the Bronze 5500 — the new standard Freedom Blue plan’s annual deductibles are a mixed bag.

That’s because they have two separate deductibles — one for medical care and one for drugs. If a consumer took only generic drugs, the new plan would be less expensive, according to details provided by the plan. But with a $4,000 deductible for brand-name drugs, the Freedom Blue plan requires more upfront money before full coverage kicks in than the ACA-compliant plan it was compared with.

Jeppesen said the insurer hopes to attract many of the œ1Ǫ,000 uninsured state residents who cannot afford [ACA] coverage.”

That’s the total number of uninsured people who earn more than 100 percent of the federal poverty level in the state, he said.

Sarah Lueck, senior policy analyst for the Center on Budget and Policy Priorities, cautioned that some of those residents might actually be eligible for subsidies under the ACA, which are available to people earning up to four times as much.

“Many … could be getting subsidies for more comprehensive coverage through the [ACA-compliant state exchange] and would be better off, Lueck said.

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Work-For-Medicaid Lifts Off In Indiana, But Even Fans Fret About Red Tape

Indiana is one of the states poised to enact work requirements for some citizens with Medicaid coverage â a controversial policy and long-sought goal for Republicans. But advocates for the poor have protested loudly in recent months, saying many will lose coverage or be ensnared by bureaucratic mistakes. KHN’s Sarah Varney reports in collaboration with PBS NewsHour.

Read the full transcript:

Judy Woodruff: Republicans in Washington and around the nation are poised to achieve a long-sought goal: reshaping Medicaid. That’s medical assistance mainly for those with low incomes.

The Trump administration has given the go-ahead to Indiana and other states to require many adult Medicaid recipients to do work or community service in order to qualify.

The idea is popular in Indiana, but some exemptions will be granted for groups like caregivers, students, those in addiction recovery programs.

Still, as special correspondent Sarah Varney reports, advocates for the poor say they are worried that the requirements will jeopardize medical care for more than 30,000 people there.

This story was produced in collaboration with our partner Kaiser Health News.

Sarah Varney: Katie Josway is a songwriter and the front woman for the Indianapolis band Gypsy Moonshine. Over the past few years, she’s been covered by Medicaid. The public insurance program is largely free to patients in other states.

But, in Indiana, Josway pays about $25 a month. If she misses too many payments, the state will drop her insurance.

Katie Josway: I think that it’s fair to expect people to contribute based on their level of income and their ability to do so. So, I think that’s kind of what we do in a society. Right?

Varney: But Josway, who also works as a massage therapist, worries about changes coming to Medicaid in Indiana. And even though she earns about $16,000 a year, near the federal poverty level, she will have to prove that she’s working at least 20 hours a week to stay insured, a tough bet when her hours fluctuate each week.

Katie Josway: I’m trying to get people to book with me, but if they don’t, then I don’t want to be penalized and potentially lose my insurance as well. Like, that seems really harsh.

And I am concerned about that growing trend of assuming that anyone who is on an assistance program somehow is mooching off the government or doesn’t try hard enough.

Varney: Under former Gov. Mike Pence, now vice president, Indiana became the first state to enact a much more conservative approach to Medicaid.

But the idea of requiring most adults in the program to work was stopped by the Obama administration. Now the Trump White House is allowing Indiana to move ahead.

Seema Verma: What is going on in the Medicaid program today is that we have a very inflexible system.

Varney:ÂThe effort is being led by Seema Verma, whom President Trump appointed to lead the Centers for Medicare & Medicaid Services.

Verma once worked for Gov. Pence in Indiana, where she tested out her conservative policies, like coverage lockouts and monthly premiums. Now shes taking her vision even further, by allowing states to impose work requirements and making smokers pay more for public insurance.

The administration has approved Kentucky and Indiana’s plans and at least eight other states have submitted similar requests. But advocates for the poor have protested loudly in recent months, saying many will lose coverage.

Nationwide, 60 percent of Medicaid recipients already work. And advocates say the ones that don’t usually have a good reason for not having a job, because they’re caregivers, students or in drug recovery.

At the heart of the debate are people like Antonio Berlanga. He’s 60 years old and lives in Clinton, Ind., and spent most of his adult life without health insurance. Indiana first expanded Medicaid coverage to a small number of poor adults in 2008, as the recession decimated the state’s economy.

Then, in 2015, Gov. Pence expanded it even further under the Affordable Care Act to about 4Ȋ,000 adults. That allowed Berlanga, a janitor at a local church, to enroll in coverage. Now he’s been treated for severe shoulder pain, cirrhosis of the liver and hepatitis C at the Valley Professionals Community Health Center.

Like a lot of Hoosiers, he’s worried about what the changes could mean for him, but he’s willing to do his part.

Antonio Berlanga: Yes, I just don’t want it for nothing. If I’m still able to do something and give something back, then lets go. I have still got a heart. I might not be able to, you know, totally do things. But I will do what I can, you know?

Varney: Dr. John Wernert, one of the architects of Indiana’s Medicaid plan, says that’s what he’s heard in every part of the state, that people on Medicaid want to feel like they’re contributing in some way.

Dr. John Wernert: It doesn’t have to be a lot of money for people to feel like they have some ownership and take some responsibility for the administration of their program.

One of the things I can say with confidence as a psychiatrist that has practiced for 30 years is, stigma is real. And theres a great stigma that folks that are living at or near the poverty level dont care about their health. Well, that’s completely wrong. They have just not been put in a position where they could take some ownership of that.

Varney: Revenues at Indianaâ€s hospitals have jumped as more Hoosiers have become insured.

The CEO of Margaret Mary Health, Tim Putnam, hired a company called ClaimAid to enroll uninsured patients into Medicaid and help them comply with Indiana’s complicated rules.

Now they will have to add the work requirements to their checklist. Putnam says the new rules aren’t designed to be punitive.

Tim Putnam: If it was purposefully trying to get people off of HIP, off of Medicaid and onto no coverage at all, that would be a detrimental program for us.

But as it is, it’s trying to get people to get work experience or get some job training to move on and transition to full employment, full insurance.

Varney: But Indiana’s conservative plan has added layers of bureaucracy that has ensnared people like Allen Wilson. He and his wife paid their monthly premium,but a paperwork glitch locked him out of coverage, to the point that his wife started to panic.

Allen Wilson: And she told them two or three times, I think you’re just trying to kill my husband, because he’s going to be too much money out of your pocket.

Varney: And you got stuck with thousands of dollars of bills.

Allen Wilson: Yes, I did. Yes, I did.

Varney: Some 25ꯠ Hoosiers were disenrolled from Medicaid from 2015 to 2017 because they didn’t pay their premiums. But it’s unclear why. Some may have moved out of state, found jobs with insurance, or even died.

Advocates like Alan Witchey say, now that Indiana is adding a work requirement, bureaucratic mistakes become much more common, especially for vulnerable populations like the homeless.

Alan Witchey: Even though we have been told there’s an exemption for homelessness, we haven’t heard, how is that going to work? What does that look like? How are we going to get it? What proof do you have to provide?

Varney: Those living in isolated rural areas, where jobs are few, have many of the same questions.

Niki Carty moved into her brother’s rented farmhouse here in the town of Dana after getting out of prison in 2015. She was convicted of selling meth, opioids and other drugs. Before prison, she became addicted to fentanyl prescribed by a doctor, and soon her two daughters were hooked on opioids as well.

Now the family is in recovery, and Carty is taking online classes to become an addiction counselor. But even though most students are exempt from the work requirement, Carty worries her courses won’t qualify, and she will be forced to drop out of school and get a dead-end job.

Niki Carty: I am concerned, because I got screwed once before. I really did get screwed.

Varney: In the 1990s, when Indiana forced people on welfare to work, Carty says the state didn’t recognize the classes she was taking then. She quit school and ended up getting injured on the job.

Niki Carty: I look at this way: If I had not had to go to a full-time job where I was being a full-time student then back in the ’90s, I would have never been in that factory to get hit by two forklifts. I mean, 20-some years later, I’m having this surgery, and this is pretty much the results.

Varney: State Rep. Ed Clere, a Republican from New Albany, is one of the few lawmakers raising these kinds of issues at the Statehouse.

I know one of your big concerns is creating more bureaucracy here in Indiana.

Rep. Ed Clere: Right. I think we have to be concerned about that and we need to be realistic. What it’s going to cost to administer this?

Varney: Clere says those added administrative costs will pull money away from medical care. And although he supports the work requirements in theory, he says the new rules are unlikely to improve health outcomes.

Rep. Ed Clere: And, in fact, it may over time take us in the other direction.

Varney: But many here say people who work live healthier lives and the changes will benefit the entire state.

Dr. John Wernert: We’re now starting to move the big battleship in a different direction, more towards what’s needed in our economy and what’s needed in our society now.

Varney: Back in Dana, a world away from the booming economy in Indianapolis, Niki Carty says the message from lawmakers to people like her is pretty clear.

Niki Carty: They think we’re trash, that we’re just garbage to throw away. They’re all worried about the money and all that. And I can understand that. But at the same time, there’s a lot of us that are trying to pick our lives up and put them back together.

Varney: For Carty, that means planning her weekly Narcotics Anonymous meeting with a local pastor. She’s determined, she says, to set her life straight and hopes the upcoming changes to Medicaid won’t get in her way.

For the “PBS NewsHour and Kaiser Health News, I’m Sarah Varney in Indiana.

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Viewpoints: As Flu Deaths Rise, Why Hasn’t Trump Taken Action?; Ways To Battle Opioid Crisis With $100 Billion

Editorial pages highlight these and other health care issues.

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Perspectives: Drug Prices Problem In U.S. Requires Major Surgery. Trump Just Gave Us A Band-Aid.

Read recent commentaries about drug-cost issues.

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Drugmakers On Edge As States Begin To Target Specific Medicines Using Transparency Laws

News outlets report on stories related to pharmaceutical pricing.

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State Highlights: Ga. Bill Passed In House Would Boost Rural Health Care; ‘Patient Dumping’ In Sacramento Is ‘Systemic,’ Group Says

Media outlets report on news from Georgia, California, Oklahoma, Minnesota, Texas, New Hampshire, Colorado, Wisconsin, Oregon and Missouri.

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Oregon Takes Steps Toward Enshrining Right To Health Care In State Constitution

The state’s House of Representatives approved the measure, sending it to the Senate. If the upper chamber passes the bill, the question will go in front of voters on November’s ballot. The legislation declares, “It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable health care as a fundamental right.”

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Olympian Throws Spotlight On Often-Overlooked Problem Of Eating Disorders In Men

Figure skater Adam Rippon opens up about his relationship with food and weight. In other public health news: the health benefits of chocolate, Alzheimer’s, antibiotics, obesity and dementia.

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More Than 320 Counties, Cities And States Are Suing Drugmakers For Role In Opioid Epidemic

Local and state leaders have been turning toward the legal system in their battle against the opioid crisis. In other news, the White House has approved research into which addiction treatments actually work best doctors say Purdue’s decision to stop marketing OxyContin is “20 years late”; and experts react to Attorney General Jeff Session’s comments that patients should just “take some aspirin sometimes and tough it out a little bit.”

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Google Says It Can Predict When Patients Are Going To Die, But Not Many Impressed By ‘Breakthrough’

Predicting adverse events, in and of itself, is old hat for software vendors. Meanwhile, a small business has developed a website to help people navigate end-of-life practicalities, but they’re faced with the problem that few people actually want to think about that kind of stuff.

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