Archive for the ‘Health Care In The States’ Category

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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Monday, October 20th, 2014

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, www.coveredca.com 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.

agorman@kff.org

Thursday, October 16th, 2014

How One U.S. Hospital Braces For Ebola

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

Dr. Jack Ross is used to seeing potentially lethal viruses, and he is used to putting patients into isolation. Still, Ebola is different.

Dr. Jack Ross, the director of infection control, gives a tour of Hartford Hospital's isolation unit (Photo by Jeff Cohen/WNPR).

“I think, for any hospital today, Ebola represents one step higher than anything else, if we had to do it,” says Ross, who is the director of infection control for Hartford Healthcare’s five hospitals in Connecticut.

On a tour of one of them, Hartford Hospital, Ross explains how the layout of the building is one of the important factors in his Ebola control plan.

“This would be an area that we would close off with plastic sheeting,” Ross says. His plan  includes the emergency room, intensive care unit and patient floors. “Right here, we’d have a security officer, because you want to restrict visitors. You want to have a log of who goes in, who goes out.”

In Connecticut, the idea of taking care of an Ebola patient is still just theoretical. However, one of the reasons that public health officials in the U.S. are confident that American hospitals could contain an outbreak is because they can accommodate the isolation and sanitation needed to keep the virus from spreading.

The best place to put someone who falls ill, for instance, is ideally at the end of a hall in a room with its own bathroom, anteroom, and entrance. “The rest of the floor is safe,” Ross says. “I limit the amount of traffic. I’m able to do the care there.”

Ross and his team are preparing in other ways, too. With the Centers for Disease Control and Prevention’s help, he’s made a specific list of questions doctors and nurses will ask incoming patients about symptoms and travel. He’s inventoried the supplies they would need to treat an Ebola patient.

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Wednesday, October 8th, 2014

Calif. Governor Vetoes Bill To Protect Assets From Medi-Cal


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

With the stroke of a pen, Gov. Jerry Brown rejected an effort to protect the estates of Medicaid beneficiaries in California, the San Jose Mercury News reported Friday. The bill, which the Democratic governor vetoed on Thursday, would have shielded the assets of people who receive Medicaid, known as Medi-Cal in California, from being recouped by the state after their deaths.

In a three-paragraph letter to the state senate, Brown advised legislators to consider the issue during the budget process. Brown wrote: “Allowing more estate protection for the next generation may be a worthy policy goal. The cost of this change, however, needs to be considered alongside other worthwhile policy changes in the budget process next year.”

The issue is important to people like Anne-Louise Vernon, who recently signed up for Medi-Cal under the Affordable Care Act’s expansion of the program. Vernon told Pauline Bartolone of Capitol Public Radio that she fears using her new coverage.  “I feel so unsettled about this whole estate recovery thing that I’m afraid to go to the doctor,” she said.

The law has been on California’s books for two decades, but with the expansion of Medi-Cal it now has the potential to affect many more people.

More from Pauline Bartolone’s story for Kaiser Health News and Capitol Public Radio:

Elizabeth Landsberg of the Western Center on Law and Poverty said it turns what was intended to be a safety net program into a long-term loan program and undermines the security that families might pass on to the next generation.

“So in most cases it’s modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes,” said Landsberg.

Landsberg said the law is unfair under the Affordable Care Act, because other people buying insurance and getting premium subsidies through Covered California aren’t subject to the same rules.

“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publicly-subsidized health coverage have no worries,” said Landsberg.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Friday, September 26th, 2014

Five States To Get Early Access To Small Business Health Insurance Marketplace

This copyrighted story comes from the , produced in partnership with KHN. All rights reserved.

Businesses in five states will get an early look at the federal health insurance marketplace for small businesses, the Centers for Medicare and Medicaid announced Wednesday.

The states are Missouri, Illinois, Ohio, New Jersey and Delaware.

Businesses with fewer than 50 full-time workers in those states will be able to access the Small Business Health Options Program, or SHOP, in late October, ahead of the Nov. 15 start of open enrollment.

The five states were selected based on the agency’s analysis of state insurance markets and the availability of employee choice, among other factors, a department official said.

Employers, agents and brokers in the early access states will be able to complete eligibility applications, upload an employee roster, and view plans and pricing once they become available, the official said.

The administration delayed the SHOP implementation last year in the 36 states using the federal exchange to prioritize fixes to the insurance marketplace for individuals. However, small businesses could still purchase SHOP plans through an agent or broker using paper applications.

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Wednesday, September 3rd, 2014

Victory In Mass. Health Costs May Be Temporary

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

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to for many to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”

Why? It could be the pressure to comply with of the federal health law in its first year.

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Tuesday, September 2nd, 2014

In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday

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

A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers.

The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions.

The laws are collectively known as TRAP laws for “Targeted Regulation of Abortion Providers.”

“They do just that,” said Rochelle Tafolla, a spokeswoman for Planned Parenthood Gulf Coast in Houston. “They ‘trap’ providers into very tight, medically unnecessary restrictions.”

The Texas law that passed in 2013 requires doctors who perform abortions to first obtain admitting privileges at a hospital within 30 miles. Many clinics, especially rural ones, found it difficult to comply with that rule by the November deadline. The number of Texas clinics that perform abortions has dropped from 41 to 20.

Now the law’s final rule requires doctors’ offices to meet the standards of ambulatory surgical centers, including an array of rules that govern hallway widths, the presence of showers and lockers, heating and cooling specifications. The rules also require conformance with other construction codes that can cost millions of dollars.

The rule goes into effect on Labor Day, unless federal Judge Lee Yeakel of the Western district in Austin issues an injunction to stop it. He is expected to issue a decision by Friday. If he stops the surgery center rule, Texas Attorney General Greg Abbott could quickly appeal to reinstate it.

One Houston doctor, who asked not to be identified because he fears being targeted by abortion protestors, says he will have to stop providing abortions if the final rule goes into effect. (more…)

Thursday, August 28th, 2014

Fast Track For Primary Care Docs At One Calif. University

Some doctors in the state of California will soon be able to practice after three years of medical school instead of the traditional four. The American Medical Association is providing seed money for the effort in the form of a $1 million, five-year grant to the University of California at Davis.

UC Davis medical student Ngabo Nzigira interacts with a patient at a Kaiser Permanente clinic in Sacramento. (Andrew Nixon/Capital Public Radio)

Student Ngabo Nzigira is in his sixth week of medical school and he’s already interacting with patients, as he trains under the guidance of a doctor at Kaiser Permanente in Sacramento. (KHN is not affliated with Kaiser Permanente).

In a traditional medical school, Nzigira wouldn’t be in a clinic until his third year.  In this accelerated course, students can shave up to $60,000 off their education debt. Still, Nzigira initially had hesitations.

“I thought ‘Oh man, you want me to put the intensity and stress that is medical school in four years, you want me to condense it down to three years? I’m not sure about that,’” Nzigira says. But, after learning more, he became convinced it was a good path for him.

The curriculum cuts out summer vacations, electives and the residency search. It’s designed to get primary care physicians into the field faster, says Dr. Tonya Fancher, director of the program, called Accelerated Competency-based Education in Primary Care, or ACE-PC .

“There’s a huge problem, a huge shortage of primary care physicians,” Fancher says.

UC Davis says more people gaining health insurance coverage under the Affordable Care Act is expected to compound the need for primary care, and one of the goals of the new curriculum is to make family medicine a more appealing and lasting choice for young doctors.

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Thursday, August 7th, 2014

Large California Insurers Invite Others To Join Data Network

Now that two of California’s biggest health insurers have teamed up on a project to share patients’ digitized medical records, they are planning to invite other companies to join.

The project will initially cover about 9 million Californians, making it possible for doctors and hospitals to quickly access patients’ medical histories and avoid unnecessary tests and procedures.

Heads of the two rival insurers — Blue Shield of California and Anthem Blue Cross – said Tuesday that they eventually want to include as many people as possible in the network, dubbed Cal Index.

“Ultimately our goal is to have all payers and all providers participating in Cal Index,” said Paul Markovich, president of Blue Shield, during a call with reporters. “We are open to anyone and everyone who can and will contribute data.”

Organizers said they plan to reach out to other insurers with the idea of creating a comprehensive, statewide system. The project is set to go live later this year, bringing patients’ digitized lab, pharmacy, outpatient and hospital records into one place that can be accessed by both patients and their medical providers.

California’s Secretary of Health and Human Services Diana Dooley said she was excited about the project but cautioned that it needs to protect the privacy rights of consumers.

“Patients have expectations that their records will be private at the same time they want their providers to have access to enhance their medical options and outcomes,” she said. “This is the balance we are all striving for.”

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Wednesday, August 6th, 2014

Survey: Insurance Rates Lag In Health Law Holdout States

A Gallup poll released Tuesday says that the Affordable Care Act is significantly increasing the number of Americans with health insurance, especially in states that are embracing the law. It echoes previous Gallup surveys, and similar findings by the Urban Institute and RAND Corp.

The latest Gallup survey found that, nationwide, the number of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014. States that chose to follow the ACA’s provisions most closely, both by expanding Medicaid and establishing their own new health insurance marketplaces, as a group saw their uninsured rate drop nearly twice as much as states that declined to do so.

“Those states that have not embraced those two major mechanisms have had about half of the decline in uninsured,” said Gallup’s Dan Witters. “So there’s a clear difference in the states that have implemented those mechanisms versus those who haven’t.”

Arkansas saw the biggest decline in its uninsured rate, from 22 percent to 12 percent. Kentucky, Delaware and Colorado also saw significant declines.

“To drop 10 percent in the uninsured rate within really just six months is really an incredible achievement,” said Arkansas Surgeon General Dr. Joe Thompson. Thompson lobbied for his state’s unique, bipartisan Medicaid expansion, which uses federal funding to buy private insurance for low income people. He says about 80 percent of those with new, private insurance in Arkansas purchased it with Medicaid subsidies.

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Wednesday, August 6th, 2014

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