Short Takes On News & Events

Uninsured Still Know Little About Health Law As 2nd Enrollment Period Draws Near

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

Health law?  What health law?

Almost nine of 10 uninsured Americans – the group most likely to benefit — don’t know that the law’s second open enrollment period begins Nov. 15, according to a poll released Tuesday. Two-thirds of the uninsured say they know “only a little” or “nothing at all” about the law’s online insurance marketplaces where they can buy coverage if they don’t get it through their jobs. Just over half are unaware the law might give them financial help to buy coverage, according to a new poll.

Despite that lack of awareness, nearly 60 percent of those uninsured people say they plan to get coverage in the next few months, including 15 percent who say they’ll get it through an employer, 15 percent who say they’ll purchase it themselves and 8 percent who expect to get it through Medicaid. One in five respondents in the latest monthly tracking poll by the Kaiser Family Foundation say they expect to get coverage but they’re not sure where. (Kaiser Health News is an editorially independent program of the foundation).

The poll found that most of those who expect to remain uninsured say they don’t think they can afford coverage (18 percent) or don’t want to be forced into buying a plan (12 percent).  Three percent say they would rather pay the fine than pay for coverage.

Political prognostications earlier this year that the Affordable Care Act could be pivotal in the midterm elections have proven largely untrue. While about 6 in 10 voters say they’ve seen ads trying to influence their vote, 27 percent said the health law will be “extremely” important and just 8 percent picked it as the most important issue. Ranking higher were the economy (16 percent), dissatisfaction with government (12 percent) and education (10 percent), among other issues.

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October 21st, 2014, 8:37 AM by Mary Agnes Carey

Health Care In The States

California Nurses’ Union Pulls Ebola Into Contract Talks

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

The powerful California Nurses Association has put Ebola on the bargaining table in its negotiations for a new contract with Kaiser Permanente.

Members of the California Nurses Association rally in May in Sacramento (Photo by April Dembosky/KQED).

Contract talks have been going on for months and the nurses’ most recent demands are all about Ebola — better training, more staffing, protective gear that goes beyond what’s recommended by federal officials and even a special life insurance policy.

“We’d like to have an extra supplemental coverage, for specifically Ebola, if we were to contract Ebola while we’re at work,” says Diane McClure, a nurse at Kaiser Permanente’s hospital in Sacramento, where a patient suspected of having Ebola was treated in August. He later tested negative for the virus. (KHN is not affiliated with Kaiser Permanente).

And, she says even a month after the Ebola scare at her hospital, nurses had not received any meaningful, hands-on training.

“They felt that all they had to do was pull up some [Centers for Disease Control and Prevention] information online and put some flyers on the tables and in the bathroom and that was it,” says McClure, who is a member of the nurses’ bargaining team.

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October 20th, 2014, 7:55 AM by April Dembosky, KQED

Health Care In The States

California’s Insurance Exchange Gears Up For Round Two

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

California’s insurance exchange began mailing renewal notices this week to more than 1.1 million people already enrolled in health plans, officials announced Thursday.

Consumers who want to make changes must do so by Dec. 15 for coverage effective Jan. 1, while those who want to keep their current plans will be renewed automatically.

The renewals are occurring as the state’s marketplace, Covered California, gears up for the open enrollment period for new consumers. Between Nov. 15 and Feb. 15, Covered California hopes to enroll more than 500,000 new people, which would bring the total to about 1.7 million.

Covered California also announced several changes Thursday designed to improve the enrollment process. It will nearly double the number of representatives at the call centers, including operators that speak Spanish and Korean, and extend the centers’ hours.

“Last year people waited too long on the phone,” said Peter Lee, executive director of Covered California. “We don’t want that to be the case this year.”

About 200 storefronts will be available in malls and shopping centers for people to get in-person help. And Covered California plans to work more closely with insurance providers. More than 12,000 insurance agents, 10,000 county workers and 6,400 enrollment counselors will be on hand to help enroll consumers.

Covered California said it is making improvements to its website, to meet the demand. In addition, those who want to pay for their premiums immediately upon signing up will be able to do so rather than wait for a bill.

The agency released a report Thursday about the lessons learned from the first open enrollment, including that affordability means different things to different populations and that many consumers need extensive education about health insurance.

“We didn’t do everything perfectly,” Lee said. “We’ve taken those lessons and are now applying them as we move into open enrollment for next year.”

About 80 percent of those who signed up for insurance coverage last round paid their premiums. Just over 10,000 people will have their coverage cancelled by the end of the month because they failed to prove they were in the U.S. legally.

October 16th, 2014, 6:44 PM by Anna Gorman

Short Takes On News & Events

Poll: Many Unaware How Ebola Is Spread

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

A new survey finds the public has a lot to learn about how the Ebola virus is transmitted, which could help explain the growing fears of the disease.

The survey by the Kaiser Family Foundation found that while nearly  all adults (97 percent) know a person can become infected through direct contact with the blood or other body fluids of someone who is sick with Ebola, there are still misconceptions.  (KHN is an editorially independent program of the foundation.)

One third of respondents are unaware they cannot become infected through the air.  About 45  percent are unaware they cannot contract Ebola by shaking hands with someone who has been exposed to the virus but who does not have symptoms. Read the rest of this entry »

October 16th, 2014, 12:50 PM by Phil Galewitz

Short Takes On News & Events

Calif. ‘Report Cards’ Are Out In Time For Open Enrollment

The California Office of the Patient Advocate Wednesday released “report cards” that rate major health plans on selected clinical care services, including cancer treatment, mental health, chronic disease management and patient satisfaction.

The assessments, which also include data on selected medical groups, are available online in multiple languages.

The state timed the release of this year’s report cards to coincide with the second round of open enrollment in Covered California, the state’s online health exchange, which kicks off Nov. 15.  Several plans included in the report cards are offered on the exchange.

“Consumers can make more informed health care decisions,” said California Health and Human Services Agency Secretary Diana Dooley during a conference call with reporters. “I hope all Californians who are faced with competing health plan enrollment choices during the weeks ahead will find these report cards to be a helpful resource.”

This is the 14th year the agency has generated health care quality report cards. This year, the organization aggregated claims and electronic medical record data and patient satisfaction surveys for the state’s biggest insurance plans and more than 200 medical groups. In total, these organizations serve upward of 16 million Californians, officials said.

The report cards rate 10 health maintenance organizations, six preferred provider organizations and 200 medical groups on a four-star scale. All HMOS rated “good” or “excellent” on their ability to provide quality clinical services compared to national standards. Ratings from patients on their experience  were not as favorable. For instance,  all HMOs were rated “poor” in terms of “getting services easily’” with the exception of Kaiser Permanente. (Kaiser Health News is not affiliated with Kaiser Permanente.)

All PPOs rated “good” or “fair” on the quality of clinical services. Only Aetna and Cigna received “poor” ratings in “getting services easily.”

The report cards are part of a larger national push to bring greater transparency to the health care industry and help consumers choose services that best fit their needs.

The California health care report cards are freely available to all consumers online and through mobile applications.

“The availability of data … allows us to create products that allow people to make better decisions in almost every circumstance,” said Bryan Sivak, the chief technology officer at the U.S. Department for Health and Human Services. And as a result, insurance companies “will have to compete on the things that matter to people.”

Experts say that while patient satisfaction measures may provide insights into bedside manner, they may not not provide reliable information on the quality of care.

The California health care ratings don’t include information on individual doctors. Instead, they provide a snapshot of a health plan’s or medical group’s strengths and weaknesses. More granular data on individual providers could be useful, experts say, especially if physician reviews of other physicians are incorporated.

“I would put ton of credibility on that,” said Scott Decker, president of health care transparency company HealthSparq, earlier this year.

October 15th, 2014, 5:49 PM by Daniela Hernandez

Short Takes On News & Events

Spike in ER, Hospitalization Use Short-Lived After Medicaid Expansion

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

While the Medicaid expansion may lead to a dramatic rise in emergency room use and hospitalizations for previously uninsured people, that increase is largely temporary and should not lead to a dramatic impact on state budgets, according to an analysis from the UCLA Center for Health Policy Research released Wednesday.

Researchers reviewed two years of claims data from nearly 200,000 Californians, including a group  who had enrolled in public programs well in advance of the expansion of Medi-Cal,the state’s version of Medicaid, in January. These programs were designed to ease the expansion of Medicaid by providing insurance to low-income adults who were not eligible for Medi-Cal at that point but would be when the health law’s expansion went into effect earlier this year. The researchers  divided the group into four categories, based on the researchers’ assessment of each group’s pent-up demand for health care.

In July 2011, after being enrolled in California’s Low Income Health Program, the so-called “bridge to reform,” the group with the highest pent-up demand had a rate of costly emergency room visits triple — or more — that of the other groups. But from 2011 to 2013, that high rate dropped by more than two-thirds and has remained “relatively constant,” according to the analysis.

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October 15th, 2014, 4:58 PM by Lisa Aliferis, KQED

Short Takes On News & Events

Many On Medicaid See Boost In Benefits As Economy Improves

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

With an improving fiscal climate, many states are increasing benefits for Medicaid recipients and paying their providers more.

The trend is continuing into fiscal year 2015 for those who rely on Medicaid, the state and federal health insurance program for the poor, according to a survey of 50 state Medicaid programs released Tuesday by the Kaiser Family Foundation and the National Association of Medicaid Directors. (KHN is an editorially independent program of the foundation.)

The report found that 22 states were expanding Medicaid benefits compared to just two states restricting them in fiscal 2015, which for most states started July 1, 2014. That’s the fewest states cutting or restricting benefits in at least 9 years. The most commonly added benefits were dental coverage, along with mental health and substance abuse services.

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October 14th, 2014, 9:36 AM by Phil Galewitz

Short Takes On News & Events

Study Finds Savings Low For Employers Capping Their Payments For Treatments

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

In an effort to slow health care spending, more employers are looking at capping what they pay for certain procedures — like joint replacements — and requiring insured workers who choose hospitals or medical facilities that exceed the cap to pay the difference themselves.

But a study out Thursday finds employers might be disappointed with the overall savings. While the idea, known as “reference pricing,” does highlight the huge variation in what hospitals and other medical providers charge for the same services, the report says, it does little to lower overall health care spending.

“It’s zeroing in on a piece of the health spending puzzle that is critical, the unreasonably high negotiated prices paid by health plans … but it’s not going to get you there if you need to save a lot of money,” said co-author Chapin White. The study was done by the National Institute for Health Care Reform, a nonprofit, nonpartisan research group sponsored by auto makers and the United Auto Workers union.

The use of price limits has also drawn concern from consumer groups that it might lead to confusion — and end up sticking patients with large, unexpected bills if the programs are not clearly explained.

The Obama administration, in a document about health law implementation in May, essentially gave its blessing to large or self-insured employers to use reference pricing in their health plans.

While only about 10 percent of employers currently have such programs, about 68 percent plan to do so soon, according to a recent survey by Aon Hewitt, a management consulting firm.

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October 9th, 2014, 4:03 PM by Julie Appleby

Reporter's Notebook

Burwell Meets The Press: Managing Expectations On Ebola,, ACA Year 2

We’re working on it.

No matter what the topic – from improving consumers’ experience with, the health law’s Medicaid expansion, narrow networks and even Ebola — Department of Health and Human Services Secretary Sylvia Mathews Burwell told reporters Thursday her agency is on it.

During a breakfast with reporters sponsored by Kaiser Health News and the health policy journal Health Affairs, Burwell tried to manage expectations about the health law’s next open enrollment season and declined to make a prediction about how many people would enroll this time around. She also cautioned that we are likely to see the number of Ebola cases rise before the crisis subsides.

A year ago Thursday, then Office of Management and Budget chief Burwell was in the middle of a government shutdown caused by a battle with Republicans over funding for the very health care law she’s now charged with implementing.  Her success — or failure — over the next year in fixing problems with and shaping public perception of the law may define its role in the 2016 presidential elections and well beyond.

The themes Burwell expressed during her question-and-answer session with reporters were familiar to those who have followed the secretary, who just passed her first 100 days in office. Expect improvement – but not perfection – when enrollment on begins again Nov. 15. HHS officials are working with insurers, consumer groups, state officials and others to find out what’s right and what’s wrong with the website to make the user experience faster and simpler.

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October 9th, 2014, 2:45 PM by Mary Agnes Carey

Short Takes On News & Events

Federal Officials Unveil Streamlined Marketplace Website

Consumers using the federal website when open enrollment begins next month should expect a faster website with a shorter application form and features making it easier to use on mobile devices, Obama administration officials said Wednesday.

In a briefing with reporters, they showed off a live version of the updated site and said it has already been used to enroll about 20,000 people.

Still, they did not promise that the website will be glitch-free when it opens for purchases on Nov. 15.

Nonetheless, the administration is focused on “everyone having a good consumer experience,” said Andrew Slavitt, the principal deputy administrator at the Centers for Medicare & Medicaid Services.

Last year, the website’s debut was disastrous: Consumers could not start or complete their applications and faced almost daily website crashes. Problems lasted for months before experts were able to stabilize the system. Eventually, more than 7 million people enrolled and paid premiums on their policies.

This year, the administration officials said they have spent far more time — five and half weeks — testing the revamped website, rather than the 10 days they tested it before last year’s launch.  The most intense testing began this week and officials said full “load testing” — determining how many consumers the site can handle at one time — won’t begin in earnest until late October.

Slavitt would not release specific numbers, but said the website aims “to handle significantly more [consumers] than the highest peak day last year.”

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October 8th, 2014, 5:10 PM by Julie Appleby