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Report: Jails House 10 Times More Mentally Ill Than State Hospitals

In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association.

Across the country, an estimated 356,268 people with mental illnesses including bipolar disorder and schizophrenia are in prisons and jails, compared to just 35,000 in state hospitals — a tenfold difference.

That’s similar to the mental health system in 1830, before Dorothea Dix and other advocates pushed to shift people with mental illnesses out of the prisons and into hospital care instead, says Dr. E. Fuller Torrey, a psychiatrist and lead author of the report.

“We’ve basically gone back to where we were 170 years ago,” says Torrey, a prominent critic of the widespread effort to deinstitutionalize psychiatric patients beginning in the 1960s. “We are doing an abysmal job of treating people with serious mental illnesses in this country. It is both inhumane and shocking the way we have dumped them into the state prisons and the local jails.”

The report includes a survey of each state’s mental illness treatment laws in prisons, as well as background on the percentage of prisoners with mental illnesses in each state.  Since 1970, Torrey says that percentage has risen from an average of about 5 percent to 15-20 percent.

“There is not a single state in the United States where you want to go to a jail or prison and be severely mentally ill,” says Torrey.  He adds that many jails and prisons are trying to improve their care of prisoners with mental illnesses, but they are hampered by state laws that make forced treatment difficult.

In 31 states, prisons can administer treatment over a prisoner’s objections by requesting a special treatment review committee, but the process is often difficult and the report calls such efforts “grossly underutilized.” Some people with mental illness refuse treatment, often because they are not aware that they are sick.

“This causes major problems,” the authors write in the report. “Jail officials can thus be legally sued in many states if they forcibly medicate mentally ill prisoners without their consent, yet can also be held legally responsible for the consequences of such prisoners’ psychotic behavior,” including suicide.

Torrey adds that there is often a fundamental mismatch between guards and prisoners with mental illnesses. “People who work in jails and prisons signed up because they wanted to take care of bad people. So you get some personality types that are not compatible with taking care of people with serious mental illnesses,” he says.

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Tuesday, April 8th, 2014

Medicaid Enrollment Increased By 3 Million From October To February

The number of low-income people enrolled in Medicaid rose by 3 million to 62.3 million from October through February as more Americans joined the state-federal insurance program through state and federal online insurance marketplaces, according to a report released Friday by the Department of Health and Human Services.

States that expanded Medicaid eligibility under the health law saw an average 8 percent increase in enrollment, with enrollment leaping almost 35 percent in Oregon and almost 34 percent in West Virginia. The health law expanded the program to include all legal residents with incomes under 138 percent of the federal poverty level, or $15,800 for an individual.

States that chose not to expand the program saw an average increase in enrollment of 1.6 percent, the report found. Florida saw the biggest increase – 8.2 percent — as people who were previously eligible but not enrolled signed up. Montana ranked second with a 6.9 percent increase and Idaho was third with a 6.6 percent jump.

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Friday, April 4th, 2014

As Insurance Enrollment Exceeds 7M, Obama Says Health Law ‘Here To Stay’

The Obama administration took a victory lap Tuesday as enrollment through the health law’s exchanges topped 7 million, a goal previously thought untouchable when the website healthcare.gov sputtered and crashed as sign-ups began last fall.

In a statement in the Rose Garden, President Barack Obama, said, “The debate over repealing this law is over. The Affordable Care Act is here to stay.”

But he alluded to continuing political pressure from Republicans and other opponents of the law and acknowledged challenges still remain. Although the law is bringing coverage to millions of Americans, “that doesn’t mean that all the problems in health care are solved forever.”

White House Press Secretary Jay Carney broke the news of the enrollment tally at his daily press briefing, telling reporters that the last-minute surge of traffic to the website and the call center pushed enrollment to 7,041,000, a figure that does not include sign-ups in the past few days through state-based exchanges.  Healthcare.gov is managing enrollment in 36 states, while 14 states and District of Columbia are running their own exchanges.

“What was predicted to be a failure has been a success … despite the fact that we basically lost two months because of the troubles with the website,” Carney said, adding later that “we crossed one milestone here but there are many more to cross in the future.”

Carney said it is still too early to know how many enrollees did not previously have health care coverage or how many have paid their first premium, although the “overwhelming majority” of people pay premiums on time, he said. Department of Health and Human Services Secretary Kathleen Sebelius said Monday in a television interview that  insurance companies estimate that between 80 and 90 percent of enrollees have paid their premiums.

The Congressional Budget Office originally projected that 7 million people would sign up for the exchanges by the end of the enrollment period. After computer problems botched the Oct. 1 rollout, the CBO revised that estimate down to 6 million.  Rightly or wrongly, the ability of the law to  hit that target had become a bellwether of the law’s success.  But there are practical implications as well. The more enrollees there are, the more likely the risk pool will be balanced between sick and healthy individuals. That calculus will be based on enrollments at the state and local levels where premiums are set, say experts.

“Each state is its own insurance market, whether it uses the federal exchange system or not. These state differences could mean that the Obamacare exchanges are viable in some states and regions of the country, while in other states and regions the numbers remain too low to sustain a stable insurance pool,” James C. Capretta,  a senior fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute, wrote in a column published Tuesday in National Review Online.

Democrats hailed the 7 million tally. “Americans have spoken by the millions in their desire for more affordable, comprehensive health insurance,” said Rep. Sander Levin, D-Mich, the ranking member of the House Ways and Means Committee.  “Insurance that can’t kick them off when they get sick. Insurance that can’t limit lifetime coverage. Insurance that doesn’t threaten to bankrupt their families when an illness strikes. The amount of interest in the insurance exchanges demonstrates that the reality experienced in health care reform refutes the Republican rhetoric to destroy it.”

House Speaker John Boehner, R-Ohio, said House Republicans would continue with their efforts to repeal the law.  “The president’s health care law continues to wreak havoc on American families, small businesses and our economy, and as I’ve said many times, the problem was never just about the website – it’s the whole law,” Boehner said in a statement.  “Millions of Americans are seeing their premiums rise, not the lower prices the president promised.  Many small businesses are afraid to hire new workers, instead cutting hours and dropping health coverage for existing employees. Many Americans can no longer see their family doctor, despite the pledge no one would lose access to their physician.”

Capretta’s column expressed similar concerns.  “The end result will be a reduction in the uninsured of some magnitude, that’s for sure,” he wrote. “But it was never going to be hard to reduce the uninsured if that was all that concerned policymakers. Massive public subsidies and expansion of free public-insurance programs can expand insurance enrollment, so long as others were willing to pay for it.”

Obama acknowledged the health law’s bumpy rollout and warned there may be more days ahead where the website isn’t working and said some parts of the law must be improved. A handful of Senate Democrats – including some facing tough re-election campaigns – have introduced legislation to change some elements of the law, including adding a less generous level of coverage that would be cheaper than those currently on the exchanges and making coverage optional for employers with up to 100 workers.

Addressing an audience that included key congressional Democrats and administration officials, Obama chided Republicans and other critics who have pushed for the law’s repeal without offering alternatives and urged them to work with him and Democrats to make changes. “Why are folks working so hard for people not to have health insurance?” Obama asked, adding later, “there are still no death panels. Armageddon has not arrived. Instead this law is helping millions of Americans and in the coming years it will help millions more.”

Tuesday, April 1st, 2014

Former Young Invincible Becomes Less So

This KHN story was produced in collaboration with NPR

LAKEPORT, Calif.—When we last left Brad Stevens, he was living in Lakeport, Calif., a struggling massage therapist in a struggling town on the southern tip of Clear Lake. Brad has been uninsured his entire adult life and believed firmly that clean living and exercise could stave off any need for medical care. After a bike accident which injured his shoulder and a battle with advanced thyroid cancer, Brad was anxious to enroll in some form of insurance – any kind of insurance – under the Affordable Care Act.

“I talked to an insurance guy who is selling Obamcare and found out I don’t qualify,” Brad said last November. “What I’m going to get is Medi-Cal,” California’s Medicaid program.

Health insurance for Brad Stevens meant taking tons of vitamins and spending three hours at the gym every day. But after hurting his shoulder and a battle with thyroid cancer, the 59-year-old realized he’s not invincible (Photo by Heidi de Marco/KHN).

The insurance broker had warned Brad about long wait times, but when he called the toll-free line for Covered California, the state’s insurance marketplace, Brad said, “I waited four minutes. It was a piece of cake.” The operator didn’t offer to help him apply for Medi-Cal,but instead told Brad to call the social services office in Lake County. “It wasn’t a one-stop shop.”

When Brad finally called the county social services office on January 6, he was worried his two aging cars and the modest home he had bought long ago from his mother would count against him— a common concern. Sure enough, the forms that arrived in the mail asked for details about Brad’s bank account and any cars he owned. “So I called them back up and said, ‘You don’t need half of this stuff that you’re requesting.’ They said, ‘Yes, you’re right. That’s an old form. We haven’t switched over.’”

On January 23, Brad collected his records and made the half hour drive down to the county office. “They were really efficient at the office,” Brad said, sounding surprised. Of the county worker, “She was like, Boom! Boom! Boom! She’s been doing this ten years. I was just signing stuff.” The county worker told him to expect the Medi-Cal enrollment to take 45 days.

When we next talked on February 7, he was anxious to get his insurance card. He needed to refill his thyroid medication—Brad has no thyroid and relies on medication to keep his body functioning. His pharmacist told him that the company that makes his pills had raised the price from $12.99 to $68. “I’m down to 24 pills right now, so I’m counting them daily. If I haven’t gotten my [Medi-Cal] number before I’m out of pills, I’m going to call Walmart to find out what their price is.”

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Monday, March 31st, 2014

Obamacare’s National Enrollment Looks OK, But States Matter More

With this year’s deadline to register for individual health insurance just a weekend away, much attention is being lavished on two numbers — the 6 million Americans who have signed up so far, and the percentage of those folks who are (or aren’t) young.

But experts say the national numbers actually don’t mean very much.

“These are really state-based markets,” says Caroline Pearson, vice president at Avalere Health, a consulting firm based in Washington D.C. Because each insurance market is run within each individual state, big numbers in some states can’t make up for shortfalls in others.

Still, much of the debate has centered around 6 million — the nationwide number the Congressional Budget Office estimated would sign up for insurance through the federal and state health exchanges. (That’s indeed about how many have enrolled so far, the Obama administration confirmed Thursday.)

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Friday, March 28th, 2014

Obama Announces 6 Million Have Signed Up For Insurance

More than 6 million people have signed up for health insurance through the health law’s state and federal online marketplaces, or exchanges, since Oct. 1, the administration announced Thursday.

President Barack Obama, who is traveling in Europe, announced the number in a conference call with groups that are helping consumers sign up for coverage.

In a blog post, Centers for Medicare & Medicaid Administrator Marilyn Tavenner said  the health law’s web site, healthcare.gov, and 800 number, had near record traffic Wednesday, with 1.5 million visitors and more than 430,000 phone calls.

“With 4 days left for consumers to sign up for coverage, we are working hard to ensure that our systems can handle the unprecedented demand as people enroll before the March 31 deadline,” Tavenner wrote.

The Congressional Budget Office originally estimated that 7 million people would sign up for the exchanges by the end of the enrollment period. After computer problems botched the Oct. 1 rollout, the CBO revised that estimate down to 6 million. Federal officials have said they do not yet know how many people who have enrolled have paid their first month’s premium. Insurance industry officials have reported that about 70 to 80 percent of enrollees have paid.

Reaching 6 million has both practical and political significance. The more enrollees there are, the more likely the risk pool will be balanced between sick and healthy individuals. That calculus will be based on enrollments at the state and local levels where premiums are set, say experts. Republicans have expressed skepticism that the law would provide affordable coverage for millions of Americans and called for its repeal.

Thursday, March 27th, 2014

What’s Working, What Isn’t As Healthcare.gov Deadline Is Extended

KHN’s Mary Agnes Carey was on PBS NewsHour Wednesday to talk about the Obama administration’s plan to allow extra time for Americans to sign up for health insurance coverage under the health law.

Thursday, March 27th, 2014

Consumers Get $10B In Subsidies For Health Coverage, Study Finds

Americans have already qualified for about $10 billion in tax credits to help them purchase private health insurance this year through the Affordable Care Act, according to a study from the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

That’s an average of $2,890 for each of the 3.5 million people who qualified for a subsidy as of March 1 — about 83 percent of those who enrolled in an exchange plan.

But four of five Americans who could qualify for a subsidy hadn’t applied for coverage by that date. And sign-up rates varied greatly by state.  More than half of the subsidy money allotted so far will go to consumers in California, Florida, North Carolina, Texas and New York.

“States that are lagging in enrollment are leaving billions of dollars on the table that their residents qualify for,” said Larry Levitt, one of the study authors.  In Hawaii, South Dakota, Iowa, New Mexico, North Dakota, Washington, D.C., and Oklahoma, for example, 10 percent or fewer of those eligible for tax credits signed up.

If all states had been able to enroll people at the rates of the five most successful states (Washington, Connecticut, California, Rhode Island and Vermont), where an average of 39 percent of those eligible signed up, another 3.1 million people would have qualified for an additional $8.6 billion in premium subsidies.

That money could provide a valuable infusion of cash that “not only has a benefit to individuals, but also to state economies as well,” Levitt said.

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Thursday, March 27th, 2014

Half Of Uninsured Not Planning On Getting Coverage, Poll Finds

With less than a week left for customers to apply for insurance through the health care marketplaces, a poll released Wednesday finds that half of the people still without health coverage intend to remain uninsured.

Five million people have signed up for insurance since the marketplaces created by the federal health law opened  in October. The official deadline to sign up without facing a financial penalty is March 31, although federal officials told news organizations Tuesday that consumers who begin the process before then and have had trouble with the technology will an extension of several weeks to finish the process. The Congressional Budget Office estimates by the year’s end, 6 million people will have obtained insurance on the marketplaces.

The Kaiser Family Foundation’s latest poll, conducted in mid-March, found that 50 percent of adults under age 65 who still lack coverage plan to remain without insurance, while 40 percent aim to sign up by the deadline at month’s end. (KHN is an editorially independent program of the foundation.) The other 10 percent said they did not know what they would do or refused to talk about it.

Of the uninsured, two out of three said they have not tried to get coverage yet. The rest said they attempted to get it through an online marketplace such as healthcare.gov, the state-federal Medicaid program, their employer or a private insurance company.

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Wednesday, March 26th, 2014

AHIP President Calls For New Level Of Insurance Under Health Law

A new tier of coverage should be added to the health law’s online marketplaces, or exchanges, that would be less comprehensive than what plans are now required to offer, the head of the health insurance industry’s trade group said Sunday.

“I would create a lower tier, so that people could gradually get into the program, so they could be part of the risk pool, so we don’t hold the healthier people outside,” Karen Ignagni, president and CEO of American’s Health Insurance Plans, said in an interview on C-SPAN’s Newsmakers.  “What I would do is give people more choices.”

Plans on and off the health law’s exchanges are required to cover a package of essential health benefits, including hospitalization, maternity and newborn care, pediatric care and prescription drugs.  Ignagni said that some people who had not purchased that coverage before don’t want to do so now and want other choices.  Requiring such comprehensive coverage may be “a bridge too far” for some people, she said.

The health law features four tiers of coverage – platinum, gold, silver and bronze – plus a catastrophic option open to people under 30, people who qualify for hardship exemptions and some people in the individual market whose plans were cancelled because they did not comply with the health law.

In the interview, Ignagni also said while the health law’s website, healthcare.gov, is working far better now for consumers than at its technologically troubled Oct. 1 launch, “much work remains” on the “back end” functions that insurers depend on to get information about enrollees and payment information.

“The whole finance package is left to be built. How do the plans receive their premium subsidies [from the federal government] for the individuals who are eligible for them and ultimately how do we reconcile with the exchange in terms of the people they think we have and the people we really have,” she said.

Monday, March 24th, 2014

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