Monthly Archives: December 2012

After Newtown Shootings: Questions about Mental Health Insurance Coverage

By Jenny Gold, Kaiser Health News

President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).

President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).

On Monday White House spokesman Jay Carney pointed to the federal health law as evidence that the administration has already started to tackle the issue. Mental health issues are “clearly a factor that needs to be addressed in some of these cases of horrific violence,” Carney said. “Obamacare, if you will, has ensured that mental health services are a part of the services” provided under the health law.

While the Affordable Care Act, along with the Mental Health Parity Act of 2008, go a long way toward assuring coverage for most Americans, some gaps remain.

Here are some answers to frequently asked questions about mental health coverage:

Didn’t the Mental Health Parity Act already guarantee coverage for Americans with insurance?

The Mental Health Parity and Addiction Equity Act, signed into law in 2008, made a big dent in the problem of mental health coverage. But it depends on how you get your insurance

  • Large Employers (more than 50 workers): If large companies include mental health services in their insurance plans, they must cover those services at same or higher level as other medical conditions. That means that the plans could not provide fewer inpatient hospital days or require higher out-of-pocket costs, more cost sharing or separate deductibles for mental health conditions. But Paul N. Samuels, director and president of the Legal Action Center, says that some people still aren’t receiving equal coverage, and the law is not always enforced. “That’s a problem we’re really concerned about,” he says. Note that large employers are not required to offer mental health insurance, but most do.
  • Small Business/Individual Plans: Not included in the Parity Act.

In short, whether you have mental health coverage in an employer-sponsored insurance plan depends on where you work.

What if I don’t have mental health coverage in my employer’s insurance plan? Will the ACA change that?

Small group and individual plans will be required to offer the coverage in 2014 through health exchanges created under the law. But employers with 50 or more workers can continue to not offer the benefits.

I’m planning to buy an insurance plan through one of the new exchanges. What kind of mental health coverage will I have?

Again, as noted above, all plans sold in the exchanges will be required to provide coverage for mental health and substance abuse. The exchanges will be open to individuals and small businesses.

The same rules will apply to small group and individual plans purchased outside of the exchange.

In other words, beginning in 2014, if you (or your small employer) are purchasing any new insurance plan, coverage will include mental health benefits on par with any other medical condition.

I’ll be covered under the Medicaid expansion authorized by the law. What kind of mental health coverage will I get?

If you earn less than 138 percent of the federal poverty level (about $32,809 for a family of four), you may be newly eligible for Medicaid coverage in 2014. Like people who purchase coverage through the exchange, new Medicaid beneficiaries will receive mental health benefits on par with other medical or surgical needs.

What problems might arise?

While the ACA “provides enormous potential and opportunity to make sure than many millions more Americans obtain the services they need,” says Samuels, “that will only happen if the implementation of those reforms is effective.” Samuels worries that the rules from HHS will not be clear or strong enough to make the parity laws meaningful. He also worries about getting everyone who is eligible for coverage enrolled, particularly those with severe mental health disorders who be may homeless or living on the fringes of society.

Access to treatment will likely also remain a serious stumbling block. As many as 30 million people are expected to gain insurance coverage beginning in 2014. Of those, the U.S. Substance Abuse and Mental Health Services Administration estimates that 6 to 10 million will have untreated mental illnesses or addiction, adding additional demands to a system that is already overwhelmed. Patients may experience long wait times to see a psychiatrist, for example, and may require additional investments to expand the mental health workforce.

Learn More: KQED Forum Shooting Puts Spotlight on Mental Health

Newtown Shootings: Talk — or Don’t Talk — To Children?

(Douglas Healey/Getty Images)

(Douglas Healey/Getty Images)

I have an 8-year-old son and an 11-year-old daughter. On Friday, like parents across the country, I was shaken. I spent part of the day reading tips about how to talk to children about “scary news.”

Friday afternoon, my son went to a birthday party. I figured he would not hear anything about the shootings. But it was my daughter I worried about. She watches ESPN religiously after school, and I knew there would be some mention of the tragedy. I wanted to be the one who told her about what had happened.

By the time I reached her, I was too late; she’d already heard. But she seemed oddly unaffected, leaving me conflicted. I was glad she wasn’t worried, but concerned that she seemed so unmoved.

Then I caught KJ Dell-Antonia’s blog yesterday in the New York Times Motherlode column. Continue reading

Quick Read: Few Pregnant Women Warned about Chemicals

A new survey of OB/GYNs, conducted by UCSF, found that most do not warn pregnant women about chemicals in food, general products or the environment that could harm the developing fetus. Many say they don’t want to alarm patients and focus more on the risks of obesity and high blood pressure.


When Dr. Darragh Flynn sits down with her pregnant patients, she preaches healthy habits: eat nutritious foods, take vitamins, and don’t smoke or drink. She also advises them to avoid gasoline fumes, pesticides, certain types of fish, and some household cleaners and cosmetics.

Read more at: www.sfgate.com

Fiscal Cliffnotes: Is That Tax Break on Your Job-Based Health Insurance on the Table?

(Karl Eisenhower/Kaiser Health News)

(Karl Eisenhower/Kaiser Health News)

Then-presidential candidate Mitt Romney made headlines when he asserted that 47 percent of Americans were “victims” dependent upon government assistance. I’m guessing he wasn’t thinking of people who receive employer-based health insurance as being the beneficiary of government largess. But, the government loses a lot of money in the benefit.

Here’s how: First, people who receive employer-based health insurance do not pay taxes on its cost. Second, employers deduct the cost of the policies as a business expense.

As the fiscal cliff approaches, some policy wonks are saying the U.S. can’t afford that tax break any more.

As Julie Appleby reports for Kaiser Health News, it’s the largest cost to the U.S. Treasury, “an estimated $246 billion annually, according to Congress’ Joint Committee on Taxation, dwarfing the second-largest break, the mortgage interest deduction, which costs an estimated $98 billion.”

That is a lot of money. Continue reading

California Prepares for Children’s Dental Insurance Mandate

By Laird Harrison

More people may get dental care in Calfornia when the Affordable Care Act is implemented. (heraldpost/Flickr)

More people may get dental care in Calfornia when the Affordable Care Act is implemented. (heraldpost/Flickr)

If you know anything about the Affordable Care Act — otherwise known as Obamacare — you know that it will require everyone to get medical coverage by January 1, 2014.

But did you know that the act could also require millions of families to buy dental benefits for their children?

The dental mandate, if you want to call it that, is indirect and incomplete. Parents who are determined to avoid it can find loopholes. And much depends on regulations that state and federal authorities are still hashing out.

But preliminary estimates show that some five million children nationwide and as many as 1.5 million Californians could gain extensive new dental benefits.

Starting in 2014, the Affordable Care Act says, all medical plans sold to small groups (100 people or fewer) or individuals must include a set of “essential benefits,” and these benefits must include “pediatric services, including oral and vision care.”

In California, the benefits will be pretty extensive. The state has decided to base them on its Healthy Families dental program. Continue reading

Federal Appeals Court Approves Cuts to Medi-Cal Providers

(David Mason/Flickr)

(David Mason/Flickr)

A three-judge panel of the Ninth Circuit Court has upheld payment reductions to Medi-Cal doctors, pharmacists and other providers. The cuts have been tied up in courts for more than a year — and they’re not settled yet. Advocates say they expect to ask for a review of the decision by the full court.

Some history:

  • Medi-Cal cuts must be approved by the federal government.
  • The current reductions, proposed by the Brown Administration, were approved by the Centers for Medicare & Medicaid Services in October, 2011.
  • That approval was promptly challenged by the California Medical Association (and others) in federal court.
  • In January, a federal judge blocked the cuts. Continue reading

Quick Read: Blue Shield of California seeks rate hikes up to 20%

On the heels of proposed rate hikes by Anthem Blue Cross and Kaiser Permanente, now comes the nonprofit Blue Shield. You can also click to read the LA Times story below — or read a summary on California Healthline.


Health insurer Blue Shield of California wants to raise rates as much as 20% for some individual policyholders, prompting calls for the nonprofit to use some of its record-high reserve of $3.9 billion to hold down premiums. In filings with state regulators, Blue Shield is seeking an average rate increase of 12% for more than 300,000 customers, effective in March, with a maximum increase of 20%.

Read more at: www.latimes.com

Expanding Medi-Cal Caseload Leaves State Concerned About Cost

(Daryl Hunt/Flickr)

(Daryl Hunt/Flickr)

The Affordable Care Act calls for an expansion of Medicaid — or Medi-Cal in California. Last week the feds were clear that states must expand to the mandated 138 percent of poverty in order to get federal funds. Feds have promised to pick up 100 percent of the costs of these new enrollees for the first three years. Expanding to 138 percent of poverty means another 1.5 million Medi-Cal recipients.

So now we know who will receive Medi-Cal benefits, but California’s Secretary of Health and Human Services, Diana Dooley has already signaled concern about being “on the hook for promising things we can’t deliver.”

In other words, the Administration is looking at limiting benefits as KPCC’s Julie Small reported this morning on The California Report. For starters, after the three years of federally-funded Medi-Cal expansion, states must pick up 10 percent of the tab — or an estimated $6 billion within the next decade, according to the Kaiser Family Foundation. While California is committed to expanding Medi-Cal, the prospect of limited benefits is a concern to advocates, including Vanessa Cajina with the Western Center on Law and Poverty. From Small’s report:

“We want to provide coverage for people that they can afford and that’s accessible and still having the question open is disconcerting at this point,” Cajina said.

Democratic lawmakers agree. San Gabriel Valley Senator Ed Hernandez – a former optometrist who chairs the Senate Health Committee – told advocates at [a recent] symposium he’s pushing to get California to offer the maximum benefits to the new group of people who qualify for Medi-cal.

“I have every intention to make sure that every single person has the fullest amount of benefits available and draw down as many federal dollars as we possible can,” Hernandez said.

Hernandez thinks California should also raise the rates the state pays providers for treating Medi-Cal patients. California ranks 47th in the nation for the lowest rates — so low that many physicians refuse to participate.

Democrats also want to reinstate some benefits cut in recent years, like dental coverage for adults. Patients can now get covered for a tooth extraction, but not for dentures.

Some Democrats believe they should use their new super-majority status in both houses to reinstate some of these benefits. Small reports that Republicans could get behind some of these ideas — but only “if lawmakers rein in Medi-Cal’s administrative costs.”

A special legislative session about the Affordable Care Act — and the Medi-Cal expansion — is expected in January.

Listen to Julie Small’s piece:

Some Counties Requiring Health Workers to Get Flu Vaccine

Goal is patient protection; unvaccinated workers may have to wear masks around patients

By Katharine Mieszkowski, The Bay Citizen

(USACE Europe District/Flickr)

(USACE Europe District/Flickr)

In an effort to prevent health care workers from spreading the flu to patients this winter, county health officials are mandating that medical staff around the Bay Area receive vaccinations or wear a surgical mask on the job.

Health officials say flu vaccination rates among health care workers are dangerously low – 60 percent [PDF] of those working in California hospitals received the vaccine in the 2010-11 flu season, according to the most recent data available from the California Department of Public Health.

Officials hope the requirements will help prevent the spread of the virus to patients most vulnerable to its life-threatening complications, particularly the elderly, whose weakening immune systems may render the flu vaccine less effective.

However, county health officers say they have few resources to enforce the new orders, leaving it up to the discretion of hospitals, nursing homes, dialysis centers and other health care facilities to make sure their staffs are vaccinated.

Nationally, this year’s flu season has started early and may be shaping up to be a bad one, according to the Centers for Disease Control and Prevention. Among those locally requiring vaccination or masks this year are health officials in San Francisco, Alameda, Contra Costa, Santa Clara and Sonoma counties. Scattered counties around the state are doing the same. Continue reading

Children and the Health Care Overhaul: Where is Coverage Best?

Editor’s note: this post was updated to clarify benefits available to children who receive Medi-Cal and benefits available in the new Health Insurance Exchange.

By Elaine Korry

Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)

Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)

More than a million California children who currently lack health insurance will qualify for coverage under the Affordable Care Act. When the health care overhaul goes into effect in 2014, more children from poor families will qualify for Medi-Cal, and other children will get subsidies for private low-cost insurance through the new state Exchange, Covered California. But children’s advocates are concerned that some kids won’t get the best coverage.

The nation’s pediatricians devised a gold standard of care. The name is a mouthful — the Early and Periodic Screening, Diagnostic and Treatment Services, or EPSDT for short. It’s a standard to meet kids’ medical needs — and it’s the standard of care at the Richmond LifeLong Medical Care, a community clinic in San Francisco’s East Bay that serves low-income families.

On a recent visit, Dr. Porshia Mack, head of pediatrics at the clinic, treated 3-year-old Sania Bettancourt. Dr. Mack listened to Sania’s lungs, checked her heartbeat, and peered into her throat and ears. Mack told Sania’s mother that all seemed well except for one recurring problem. Sania’s mild anemia was back, so Mack prescribed a multi-vitamin. Continue reading