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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.

(more…)

Tuesday, October 21st, 2014

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. (more…)

Thursday, October 16th, 2014

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.

Wednesday, October 15th, 2014

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.

(more…)

Wednesday, October 15th, 2014

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.

(more…)

Tuesday, October 14th, 2014

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.

(more…)

Thursday, October 9th, 2014

Federal Officials Unveil Streamlined Marketplace Website

Consumers using the federal healthcare.gov 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.”

(more…)

Wednesday, October 8th, 2014

Study: Robotic Surgery More Costly For Ovarian Problems

We’ve heard it before — the robots are coming to save the day. But for certain medical procedures, that day may not be as close as you’d think.

A study published today in the journal Obstetrics & Gynecology suggests that robot-assisted surgeries to remove ovaries or ovarian cysts were more expensive and had more complications than traditional minimally invasive surgeries.

Removing ovaries and cysts with the help of a robot cost about $2,500 and $3,300 more, respectively, than laparoscopic or “keyhole” surgeries. That can add  upward of 80 percent to the cost of a surgery.

What’s more, women whose surgeries had been performed with the help of a robot were slightly more likely to have complications such as a bladder injury, bowel obstruction or excessive bleeding.

The study “really questions the utility of using robotic-assisted surgery,” says Dr. Jason Wright, the chief of gynecologic oncology at Columbia University and the lead author.  “More studies need to be done” he said, “before it’s accepted as the standard of care.”

The data didn’t offer any clue as to why the complications arose. But in the past two months, there have been reports of software glitches, battery malfunctions, and difficulties in seeing through the robotic system’s lens, according to the U.S. Food and Drug Administration’s Manufacturer and User Facility Device Experience database, which documents issues with medical devices. In some cases, these problems occurred after the patient had been put under anesthesia. Last year, the Associated Press reported “freak incidents” during which robots wouldn’t let go of tissue or accidentally hit patients on the operating table.

Wright’s study looked at nearly 90,000 women 18 years and older who’d gone under the knife between 2009 and 2012 to have ovaries or cysts removed, and compared the cost and safety of robotic surgeries to those which used laparoscopic methods.

(more…)

Tuesday, October 7th, 2014

Poll: Californians Support Health Coverage For Undocumented Immigrants

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

A majority of the state’s voters support extending current health insurance programs to all low-income Californians, including undocumented immigrants, according to a new statewide poll released today.

The poll was commissioned by The California Endowment, a foundation that has been actively working to expand health insurance access to all people, regardless of immigration status. The Affordable Care Act expressly bars undocumented immigrants from receiving any of its benefits, including subsidies to purchase health insurance. (Note: The California Endowment funds some of KHN’s coverage.)

In the poll, 54 percent of those surveyed said they support covering the undocumented. Support was strongest among younger voters as well as Latino and African-American respondents.

Pollsters drilled down on specific aspects of coverage. Total support for those issues was:

  • 86 percent support important access to preventive care to reduce overall health costs and prevent spread of disease
  • 69 percent support ensuring that working undocumented immigrants can purchase affordable health insurance
  • 56 percent support expanding Medi-Cal, the state’s version of Medicaid, to undocumented residents
  • 54 percent support making subsidies to purchase Covered California plans available to working undocumented immigrants. Covered California is the state’s Obamacare marketplace.

(more…)

Monday, October 6th, 2014

Long-Acting Contraceptives Help Reduce Teen Pregnancy Rates, Study Finds

Teenage girls who are given access to long-acting contraceptives such as IUDs or hormonal implants at no cost are less likely to become pregnant, according to a study in the New England Journal of Medicine released Wednesday.

The findings come just two days after the American Academy of Pediatrics recommended that health providers should consider IUDs and implants first when discussing contraception choices with teen girls.

Although there are not as many teenage pregnancies as there once were — rates have been cut by more than half since 1991 — they still pose serious public health issues because of the costs associated with child birth and public assistance for young mothers. These pregnancies can also stunt education and income opportunities for teenage moms.

Each year, 750,000 teenage girls become pregnant, and 80 percent of those pregnancies are unintended. The most common forms of contraception — 52 percent of teenage girls use male condoms and 31 percent use birth control pills — are unfortunately the most susceptible to mistakes. For example, oral contraceptives work best if women remember to take the pills at the same time every day.

An implant is a plastic rod the size of a matchstick inserted into the inside of the upper arm by a health provider, and the IUD is a small, T-shaped plastic device inserted into the uterus. The initial cost for each of these methods is significantly higher than for oral contraceptives, but long-term costs for them even out over time because the devices last from three to 12 years.

(more…)

Wednesday, October 1st, 2014

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