OBAMACARE

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August 13, 2013 | 11:02 AM | By Lisa Aliferis

People with Disabilities Face Complex Choices under Obamacare
FILED UNDER: Obamacare, Disabilities, Habilitative Services


We’ve heard a lot about how Obamacare will allow “apples-to-apples” comparisons of health plans. The Affordable Care Act requires insurers to meet what are called essential health benefits which outline what health insurance companies must now cover. But there’s a catch: Insurance firms still have some wiggle room as to specific therapies they’ll cover within some of those essential health benefits categories. And the way insurers interpret the rules could turn out to be a big deal for people with disabilities who need ongoing therapy to improve their day-to-day lives.

People who want to have specific therapies covered are going to have to slog through some fine print.Take a look, for example, at Bryce Vernon. He is a 20-year-old film student in Los Angeles who has cerebral palsy. He speaks only with the aid of a special computer mounted to his wheelchair that tracks his eye movements. Using his eyes, Vernon can indicate on a screen what letters and words he wants the computer’s voice to say.
It’s amazing technology, and Vernon gets a lot more out of it with help from speech-language pathologist Jill Tullman.

“Now Bryce, I want to show you this super cool random button I think you’re going to love,” Tullman tells him during a therapy session at a special camp for young people who use the technology. Vernon’s parents paid out-of-pocket for him to attend the camp.

Tullman helps him pre-load several different ways of saying goodbye.

“Bye, later dude, later. Bye, I’m out of here, see ya later,” Vernon directs the computer’s voice to say, testing it out.

Speech-language pathologists Jill Tullman (left) and Mendi Carroll (right) work with Bryce Vernon at Talking with Technology Camp in Empire, Colo. (Kristen Kidd/KCFR).
Speech-language pathologists Jill Tullman (left) and Mendi Carroll (right) work with Bryce Vernon at Talking with Technology Camp in Empire, Colo. (Kristen Kidd/KCFR).
In the parlance of health policy, the work Tullman is doing with Vernon is called “habilitative services.” It’s different from the more familiar “rehabilitation services” people often get after an injury or surgery. Habilitative services are for people who can benefit from one-on-one time with a therapist to improve daily living skills. But such services can be expensive, and not all insurance plans have covered them.

The Affordable Care Act is changing that, says health economist Lisa Clemans-Cope with the Urban Institute. She says that consumers will be “much more likely to find these benefits in a plan [starting in] 2014 in the individual market than you would be today. Far more likely.”

This is because habilitative services are included within the 10 categories of essential health benefits the ACA will require in those new plans. Still, while some categories are straightforward — such as maternity care and preventive care — the category including habilitative services leaves more room for interpretation.

For instance, insurers could choose to cover physical therapy for someone with a broken bone, but not cover long-term support services for chronic conditions, such as speech therapy for kids with developmental delays.

Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want to have specific therapies covered are going to have to slog through some fine print to figure out if they’ll actually benefit from a particular policy.

“This is a big improvement, but we should emphasize that it’s not totally fixed,” Clemans-Cope says. “And people are really going to have to get help to decide which plans cover the benefits they need.”

Learn more about Obamacare: Check out KQED’s guide for CaliforniansIn California, people can begin formally comparing plans when the Covered California marketplace opens Oct. 1. Plans go into effect Jan. 1, 2014. Covered California has also awarded millions of dollars in grants to help educate consumers about the Affordable Care Act and is certifying “navigators” who will help people understand the differences among plans available to them.
Barbara Vernon, Bryce’s mother, says Bryce is now covered by Medi-Cal, California’s Medicaid program. His primary insurance had been her employer-sponsored plan until she was laid off in 2009. She searched for private coverage for Bryce, but says, “Private was so unbelievably expensive, it was unaffordable.”

Barbara says her family’s insurance is “a patchwork,” with Bryce likely to stay on Medi-Cal even after his 21st birthday. She and her other son have an individual plan they have purchased, and her husband has an employer-sponsored plan — but it covers only the employee, not the family.

For his part, Bryce Vernon says his life is a lot better since getting the kind of help that many others may be able to get from the health law, starting in 2014. He works hard to get the most out of the technology and the therapy that lets him speak. His advice to others, delivered by the computer-generated voice: “Never, ever give up.”

The new rules for what health insurance companies have to cover may still change. Federal regulators plan to review them as the health law rolls out and could make changes in 2016.

This piece is part of a reporting partnership among NPR, Colorado Public Radio and Kaiser Health News.

Related posts:

Just What Are ‘Habilitative Services’? Hint: Think Health Insurance and Chronically Ill Kids
Five New Obamacare Regulations Just Out
State Health Agency Directs Insurers to Stop Discriminating Against Transgender People
Why California’s Obamacare Premiums Are Lower Than Expected
Univision Obamacare Deal Could Put WellPoint Ahead Of Competitors

blogs.kqed.org/stateofhealth/2013/08/13/people-with-disabilities-face-complex-choices-under-obamacare/ 

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COVERED CALIFORNIA

www.coveredca.com/news/101-presentations/101-Region-4.pdf 

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November 20, 2012 | 2:10 PM | By Lisa Aliferis

Five New Obamacare Regulations Just Out
FILED UNDER: Obamacare, Affordable Care Act, Covered California
Comment
PermalinkPresident Obama signs health care reform law. (Photo: White House)
President Obama signs health care reform law. (Photo: White House)
The Department of Health and Human Services issued a whole slew of long-awaited regulations Tuesday about the Affordable Care Act. They are important to consumers because they have to do with both cost and (loosely) what must be covered. States have some latitude in the coverage area, more on that in a moment.

Friendly reminder that most of what the feds released are for the new state based exchanges. Individuals and small businesses will be able to buy insurance through the state’s exchange, Covered California. If you get insurance through your employer, you will continue to do so.

Guaranteed issue and renewal: you no longer can be denied getting insurance due to a pre-existing condition. Insurance companies can no longer jack up rates or drop you completely when it’s time to renew. They may only raise rates annually (on your birthday!) and only by a set amount.
Fair premiums: premiums can only differ based on age, family size, tobacco use and where you live. Adults will be within a 3:1 ratio. In other words, a premium for a 63-year-old can be a maximum of three times the rate of a 21-year-old. Everyone over age 63 is in the same rate band. Women can no longer be charged more than men.
Young adults special option: Younger people tend to be healthier than older people. But, as noted above, older adults are capped at paying a max of three times the premium of a 21-year-old. There was concern that this would mean high premiums for 20-somethings. The new rules allow for catastrophic health insurance plans — plans with lower premiums and higher deductibles for those generally health younger adults.
What’s covered: The feds have already detailed that each state must offer coverage within ten categories. States have some latitude in exactly what they’ll put in their plans. But one question had been around prescription drugs. The federal government had initially indicated that plans need only cover one prescription drug per category in a policy’s “formulary” — which could be problematic for the millions of people with chronic illnesses who take more than one drug. There were concerns that only one drug would be covered in a huge category, such as diabetes for example. The new rules today say that insurance sold in the exchange must match the benefits of the most popular small group health plan in the state (the “benchmark plan”). In other words, in all likelihood, more than one prescription drug will be covered in each category.
Wellness programs: A new rule encourages employers to offer a new kind of wellness program. If employers participate, people who receive insurance through their employer will be able to participate in enhanced wellness programs. Specifically, they can win a reward (real money here, folks: discount on premium or co-pay, for example) if they meet a specific health target: reduce or quit smoking; lower cholesterol; weight loss, etc.
What happens next
These federal rules are in the 30-day public comment period. Then the rules will be finalized. After that, it’s up to states to implement them. California will have a special legislative session (announced, but not yet scheduled) to debate state level laws and regulations, so that Covered California can move forward with creating the exchange.

It’s a tight timeline. The exchange opens for business next October, just over 10 months from now. That’s when people will be able to shop for insurance. The coverage will start January 1, 2014.

There are more regulations to come. On a conference call with reporters today, Gary Cohen, acting director of the Center for Consumer Information and Insurance Oversight, said, “We’re working hard to get everything out as fast as we can.”

blogs.kqed.org/stateofhealth/2012/11/20/five-new-obamacare-rules-just-out/

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The Environmental Impact of Building a Border Fence - See more at:
www.californiareport.org/archive/R201308130850/a

Always the environmentalists mucking-up the issues. Hopefully, they will lose their jobs to illegals crossing inadequate facilities.

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5 Things to Know About the Cost of Obamacare Coverage
By Lisa Scherzer

PostsEmailBy Lisa Scherzer | The Exchange – 5 hours ago

There are about six weeks left until the nationwide launch of health insurance marketplaces, a fundamental piece of the Affordable Care Act.

A handful of states have come out with their estimates of how much insurance premiums will cost on their exchanges, and in some cases, they have raised more questions than they answer. Here are five things to keep in mind when considering your coverage options.

1. The “sticker price” is not what most people will pay.

A few states have released information on what consumers can expect to pay for health coverage on the exchanges in 2014. But for nearly all exchange participants, those rates aren’t what they’ll actually be shelling out, primarily because about 48% of people now buying their own insurance will be eligible for tax credits that would offset these premiums, according to a Kaiser Family Foundation study published this week. (Subsidies will be available for people who have incomes from 100% up to 400% of the poverty level – or about $24,000 to $94,000 a year for a family of four.)

“Only the youngest, healthiest people with very high incomes in the individual market – and mostly people in this category aren’t in the individual market because they qualify for group health benefits at work – will pay more across the board in 2014,” says Karen Pollitz, senior fellow at the Kaiser Family Foundation.

According to Kaiser, the average premium subsidy (in the form of federal tax credits) will be $2,672 for a family of four purchasing a “silver” tier plan on the individual market. That’s a 32% discount from the plan’s average cost of $8,250. Under the ACA, plans on the exchanges must provide coverage at specific “actuarial value levels”: 60% (bronze plan), 70% (sliver), 80% (gold) and 90% (platinum). This means, for example, the bronze plan covers 60% of medical expenses. The higher the actuarial value, the lower the out-of-pocket costs and higher premiums paid by the consumer.

2. Old coverage vs. new coverage makes it hard to compare plans.

Much of the debate over health reform is popping up in states that have estimated consumers will pay higher premiums next year than they do now. For instance, the Ohio Insurance Department said earlier this month that individual exchange plan premiums are expected to climb on average by 41% in 2014 compared to 2013, while plans for small businesses will increase by 18%.

The problem with these comparisons is that “it’s completely different coverage – the type of coverage [under Obamacare] is more valuable,” says Linda Blumberg, senior fellow at the Urban Institute. Consumers might pay more for insurance next year because they’re likely getting a richer plan, she says.

Under the ACA, insurance plans offered in the individual and small group markets will be required to cover a particular set of benefits and services called the “essential health benefits” package. These cover services in at least 10 categories, including prescription drugs; emergency services; hospitalization; mental health disorder services, and others. Some of those benefits haven’t been previously covered by plans. Additionally, consumers can’t be denied coverage because of their health status as they can be now in some states.

3. Premiums on the exchanges won’t affect most consumers.

The new rates cited so far impact primarily consumers who will buy their own coverage. Employment-based health benefits remain the most common form of insurance for most Americans, and most large employers already provide coverage to workers that meets the law’s new requirements. More than half of Americans – 55% – had employment-based insurance in 2011, and among the employed population aged 18 to 64, over two-thirds (68.2%) had insurance through their own employer or another person’s employer, according to the Census Bureau.

4. Rates within individual tiers vary widely.

An early look at the estimated rates on exchanges shows a striking variance. A report published on HealthAffairs.org looked at rates for silver-tier plans (this level plan forms the basis for calculating premium subsidies) for a nonsmoking 40-year-old in four major cities in three different state-based marketplaces. For instance, in Baltimore, the second-highest silver premium was $417 for the consumer, while the second-lowest silver premium was $298 – a difference of $119, or 40%.

“While it is not surprising that rates would vary among states and regions within a large state, it is surprising to see the large variance of rates within the same regional market at the same metal level. All plans in the same metal level within a state are required to offer the same ten essential benefits,” the authors write.

“We are beginning to see plan variations within metal tiers, though they are more uniform with respect to benefits and cost sharing,” says Pollitz, who adds there are likely many reasons for the variation. One is the provider network you have: Plans may offer the same benefits but one might have a narrower network of physicians than another, therefore limiting a consumer’s choice of doctor or hospital, Pollitz says.

5. Some consumers may get hit with large out-of-pocket health costs next year.

The ACA requires that health plans cap the maximum out-of-pocket costs (including copays, coinsurance and deductibles) at $6,350 for individuals and $12,700 for families. But the Obama administration is delaying that provision for some plans for another year. The government published a FAQ in February saying some insurance plans offered by employers have separate policies or benefit managers for different parts of their coverage, such as medical care and drugs, and sometimes a third for children's dental services. Some employer plans have separate out-of-pocket caps for each of the coverage areas, according to Kaiser Health News.

So if plans use more than one company to administer their benefits — as many do — consumers may face separate caps next year. That means someone might have to pay $6,340 for doctor and hospital services and another $6,350 for prescription drugs.

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Aug. 21, 2013, 8:11 a.m. EDT
‘The Amazon of health insurance’
eHealth CEO on what it will take to insure millions under Obamacare

As CEO of eHealth EHTH -1.05% , an online insurance broker that recently received government authorization to enroll people in subsidized health plans in the 36 states with federally operated exchanges next year, Gary Lauer will in effect be in charge of helping many Americans buy health insurance for the first time starting Oct. 1.

The announcement sent eHealth’s stock price soaring more than 30%, but for Lauer, the unveiling of the Affordable Care Act’s new insurance exchange marketplaces also marks a more personal victory: Under the law, which prohibits insurers from rejecting people for pre-existing conditions, he can finally purchase individual health insurance on his own if he needs it, after a bout with cancer a few years ago made him ineligible. “I’m CEO of the largest health insurance source in the country, and even I couldn’t get a health insurance product on it to insure myself,” says Lauer, adding that he is currently insured through the company’s employee health plan.

With 25 million to 30 million more people expected to purchase coverage under the new ACA rules, Lauer is preparing for the individual health insurance market—eHealth’s market—to double or triple in size. Since eHealth sold the first health plan online in 1998, it has enrolled more than 3 million people, 40% of whom were previously uninsured. At least four other online insurance brokers also signed agreements with the government to sell subsidized health plans, but eHealth is by far the largest — in terms of sales volume, product selection and market cap.

Lauer, who says he is now in great health, spoke with MarketWatch about his role in the ACA’s health insurance exchanges, how long it will take to sign up and what the law means for his own health coverage.

MarketWatch: Your recent agreement with the Centers for Medicare and Medicaid Services allows people to buy medical coverage on eHealthInsurance.com instead of just on the federal health insurance exchange in 36 states. What does this mean for consumers?

Gary Lauer: It lets us provide an insurance marketplace not only for the typical consumer but also for people who are eligible for subsidies [roughly, singles making less than $46,000 a year, and families with income below $94,000]. The Affordable Care Act has always been very clear that people who are not eligible for subsidies would have the choice of getting health insurance directly through the government exchange, through an insurance carrier or through a private exchange. Now, lower-income people have the option of coming to us to enroll, too, because we’ll be able to connect directly to the federal exchange to determine whether someone is eligible for subsidies. We think this agreement is also important for the success of the ACA, because the more viable entry points you have into the insurance pool, the more people you’re going to get enrolled.

Why would someone use eHealth instead of the government website to buy health insurance?

There may be several reasons. One is that we provide a lot of decision support tools to help people through the process. For example, we learned years ago that people don’t really care about the brand that’s on their health insurance as much as they care about their relationship with their physician. If you tell us the name of your physician, we’ll show you all the products that support that physician. And after someone is enrolled, we provide tools for using the plan, like figuring out where kids can get their teeth cleaned. Unlike the government, we’re a technology company, and we’ve been in this business for years.

Can people enroll online, or will they still need to talk to a person, or mail a form?

There’s not a shred of paper in the process. We do it all online. And 20% of our volume comes through hand-held devices like phones or tablets. Think of us as the Amazon.com AMZN -0.74% of health insurance. That’s the analogy I like to use, because that’s how the business operates. We were doing this online as an exchange long before the words “exchange” and “health insurance” were in the same sentence.

Over 80% of people who enroll on eHealth have no human interaction: No phone, no online chat—they go through the whole process online. For the other 20% of people, we have customer service over the phone or via online chat to help people through and get them right back online.

So, walk us through it. What happens when someone comes to eHealth to buy health insurance?

When someone comes to us, we ask if they might be eligible for a government subsidy. If they say yes, we take them through the process by which the subsidy is determined. If the government tells them they’re eligible, we’ll show them all the products that the subsidy can apply to.

How long will the process take?

The longest part of the process is taking people into the federal government website to determine if they are subsidy-eligible, because they will have to complete all of the required information. But if the government technology works as planned, the verification should be a matter of seconds. I don’t think you’ll be staring at a screen for more than 10 minutes. It’s not going to take any longer on eHealth than it is on a government exchange. We want this to be one-stop shopping.

How will your selection of health plans differ from the selection on the government exchange?

We’re required to sell all the same subsidy-eligible plans as are available on the government exchange. But we may very well have other plans that are not eligible for subsidies but that do meet the mandate. That’s because those carriers may have chosen not to participate in a given state’s government exchange, but they will still be on eHealth.

Right now, you only sell plans you earn a commission on. But under the ACA, you’ll have to sell all subsidy-eligible plans, even if you make nothing on them?

Most of the brand-name insurance plans that will be eligible for subsidies are already sold on our site. But for some smaller plans, we may not have a relationship with that insurance carrier, and we will still have to sell their plans if they are on the federal exchange. In those cases, we’ll either seek to have a relationship with that carrier [and negotiate a commission] or we’ll just present the product to the consumer and enroll them in it. We just won’t be paid, and that’s fine with us. We will get you enrolled in whatever plan you choose.

What about when someone comes to eHealth who isn't eligible for a health insurance subsidy? (Such as an individual making more than $40,000.)

If they are not subsidy-eligible, we can show them all the subsidy-qualified health plans and other plans as well.

But will you show them the plans that you don’t earn commission on?

Likely not.

Will health reform affect broker commissions?

We earn about 7% of the plan’s premium value every month, on average. I don’t see much change there. Subsidized plans may pay a little less, but I don’t think it will be significant.

Will you be able to enroll people in health insurance in the other 14 states (and D.C.) that are running their own exchanges?

In several states, such as California and Maryland, we expect to operate as an agent or broker. As it stands now, it would be a semi-online process. People could come to us online and see the products available, but we’ve got to work through an agent-broker portal and there may be some paper involved. We are currently talking to those states about the fully Web-based approach, which we think would help to get more people enrolled.

Will the Affordable Care Act impact you personally?

In most states today, carriers don’t have to insure you if you’ve had a chronic medical issue—in my case, I had a bout with cancer several years ago. My son is a Type 1 diabetic. I have coverage because at eHealth we provide health insurance through the company to our employees, but if I’d gone to the individual market, I’d be uninsurable. But starting next year, the ACA mandates guaranteed issue, meaning that people will be able to get health coverage regardless of pre-existing medical conditions.

So will you buy your coverage on eHealthInsurance.com next year?

No. I’ll still get it through my company.

www.marketwatch.com/story/the-amazon-of-health-insurance-2013-08-21?pagenumber=2

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live.wsj.com/video/white-house-releases-animated-explanation-of-obamacare/9D6E0A5C-FB07-409E-857D-FC918C20D9C9.html?mod=WSJ_article_outbrain&obref=obnetwork#!9D6E0A5C-FB07-409E-857D-FC918C20D9C9    

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CLEVELAND CLINIC CEO FEARS HIGHER HEALTH CARE COSTS


www.bloomberg.com/video/cleveland-clinic-ceo-fears-higher-health-care-costs-8MrPvyD~Q_OJo95AKELWCQ.html

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THOUGHT THIS WOULD BE A GOOD PLACE TO POST THIS!  

Friday, November 15, 2013 3:06

Australia Determined To Forcibly Vaccinate By Intentional and Controlled Release of Aerosolized GMO Vaccine


The Office of the Gene Technology Regulator (OGTR) is on its way to approve a licence application from PaxVax Australia (PaxVax) for the intentional release of a GMO vaccine consisting of live bacteria into the environment in Queensland, South Australia, Western Australia and Victoria.



Source: www.preventdisease.com/cgi-bin/cornews11/viewnews.cgi?id=EFluVEAApkAdSruNJD