Reform

How the Washington rollout of health care reform is changing the landscape of health care in California

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April 2, 2013 | 8:09 AM | By

No ‘Rate Shock’ in Vermont, First State with Proposed 2014 Premiums

By Phil Galewitz, Kaiser Health News

Vermont may not see rate shock, but its insurance market is strikingly different from that in California. (herzog/Flickr)

Vermont may not see rate shock, but its insurance market is strikingly different from that in California. (herzog/Flickr)

After years of anticipation, Vermont became the first state Monday to publish proposed 2014 individual health insurance rates under the federal health law. Despite Republican and insurers’ predictions, there was no “rate shock” in the new premiums, according to the Vermont governor’s office and insurance representatives.

That state may not be the best barometer of the impact of the heath overhaul on premiums, however, because it already prohibits insurers from using health status to determine an individual’s premiums. It is one of only seven states in the country which have so-called community rating regulations.

Unlike California, Vermont already prohibits insurers from using health status to determine an individual’s premiums.
California does not currently have community rating regulations. A major study last week concluded that individual premiums will likely go down substantially for many Californians and up for others on the individual market, once the new online marketplace for health insurance opens later this year. Premiums are expected to be announced for California in several weeks.

Vermont also requires prices to be the same regardless of person’s age. Two of the health law’s biggest changes include prohibiting insurers from using health status to determine premiums and prohibiting insurers from charging older people more than three times the rates of younger people.

Continue reading →

FILED UNDER: Reform, Affordable Care Act, Health Insurance Premiums
March 28, 2013 | 12:06 PM | By

Health Care Overhaul to Dramatically Reduce Premiums for Many Individuals, Study Finds

(Caroline_1: Flickr)

(Caroline_1: Flickr)

A major new analysis shows that hundreds of thousands of Californians will see their monthly insurance premiums fall an average 47 percent under President Obama’s health care overhaul, in large part due to tax credits and subsidies. It is the first detailed look at how health insurance premiums could change under President Obama’s Affordable Care Act, which goes into effect on Jan. 1, 2014.

Covered California, the agency charged with creating the state’s new health insurance marketplace, commissioned the analysis. The report looked at the individual market only and did not examine the small or large group market.

Under the ACA people with incomes up to four times the federal poverty level (about $94,000 for a family of four; $46,000 for an individual) will be eligible for subsidies from the federal government. That’s about 570,000 people, Covered California said.

Major findings from the study include:

  • Individuals with incomes less than four times the poverty level are “likely to pay” 47 to 84 percent less for their monthly premium compared to this year
  • Premiums would have increased 9 percent in 2014 because of health care inflation, even without the ACA Continue reading →
FILED UNDER: Reform, Affordable Care Act, Covered California, Health Care Costs, Health Insurance Premiums
March 27, 2013 | 10:06 AM | By

Health Care Overhaul: Study Say Costs Could Go Up 32 Percent

(401(k)2012/Flickr)

(401(k)2012/Flickr)

Now the actuaries are weighing in.

In a new analysis, the Society of Actuaries says insurance companies will pay an average 32 percent more for medical claims under the health care overhaul.

That means premiums could go up, especially in the individual market.

The Obama Administration isn’t convinced, though, saying the report didn’t consider all the ways in which the administration says the Affordable Care Act will reduce costs.

More from the AP: Continue reading →

FILED UNDER: Money, Reform, Affordable Care Act, Medical Claims
March 24, 2013 | 5:00 AM | By

Immigration Reform, Maybe; But Long Wait for Health Access by the Undocumented

By John M. Gonzales, CHCF Center for Health Reporting

Fred Bauermeister is executive director of the Free Clinic of Simi Valley, which has been providing health care to undocumented immigrants for years. (Lauren Whaley/CHCF Center for Health Reporting)

Fred Bauermeister is executive director of the Free Clinic of Simi Valley, a health care provider to undocumented immigrants for years. (Lauren Whaley/CHCF Center for Health Reporting)

Clinic director Fred Bauermeister has watched them pass through his doors for decades: chronically ill, uninsured men, women and children, who have delayed medical care because they are in the country illegally.

Now, immigration reform may bring health benefits to millions of formerly undocumented people — although there may still be a years-long wait after they attain legal residency.

But first — the immigration reform piece: a bandwagon of endorsements last week by Congressional Republicans have aligned with vows by President Obama and Senate Democrats to establish comprehensive immigration reform. A road to citizenship for people who entered the country illegally seems more assured by the day, but what is less clear is how the health care landscape of California, and the nation, would also change.

Would California’s estimated 2.5 million undocumented immigrants become eligible for health benefits? How would an already burdened health care system absorb them? Continue reading →

FILED UNDER: Reform, immigration reform, Medicaid Expansion
March 22, 2013 | 10:04 AM | By

What’s Up With the California Health Care Overhaul Bills?

(seliaymiwell/flickr)

(seliaymiwell/flickr)

While President Obama’s health care overhaul turns three on Saturday, many states are scrambling to get everything ready for the full rollout on January 1. California was the first state to pass legislation to set up a marketplace, and the Legislature has done a lot of work since. But there’s still a lot left to do — and fast.

To bring you up to date, three major sets of bills are before the Legislature in its Affordable Care Act special session. (Six bills total; Assembly and Senate have their own versions of three proposals).

Of those, two issues are key:

  • Reforming the individual market
  • Medi-Cal expansion (the state’s health insurance program for the poor.

As David Gorn of the CaliforniaHealthline reports, the California Legislature went on spring recess yesterday. These ACA bills are outstanding, much to the frustration of advocates. These special session bills take effect in 90 days, once they are passed. ACA proponents had hoped passage would have happened already. Continue reading →

FILED UNDER: Reform, Affordable Care Act, Medi-Cal, Obamacare, Science
March 21, 2013 | 9:14 PM | By

Report: 1 Million Californians Already Benefitting from Health Care Overhaul

By Mina Kim, KQED

President Obama signs health care reform law. (Photo: White House)

President Obama signs the Affordable Care Act into law in March 2010. (Photo: White House)

Saturday marks three years since the signing of the federal Affordable Care Act, and state health officials have been celebrating by touting the benefits of the health overhaul law.

On Thursday, the nonprofit group Health Access released a report that determined more than one million Californians have been able to get coverage through new options provided under the ACA. Those residents include adults with low incomes, people with pre-existing health conditions, and young people who can stay on their parent’s insurance plan until the age of 26.

“But much more is needed to be done,” said Health Access director Anthony Wright. Continue reading →

FILED UNDER: Reform, Affordable Care Act, Obamacare
March 21, 2013 | 2:51 PM | By

Health Care Overhaul: Take the (Short!) Quiz

OK, this is not as much fun as “7 Ways to Lose Weight.” But since a national poll this week showed that a majority of Americans don’t understand how the health care overhaul (AKA: Obamacare) will impact them, it seemed like it was time to take a quiz. This one was put together by the Kaiser Family Foundation, and includes (short) helpful answers at the end.

It’s just 10 questions. Click on the box below to get started. Good luck!

(Kaiser Family Foundation)

Continue reading →

FILED UNDER: Reform, Affordable Care Act, Obamacare, Quiz
March 15, 2013 | 12:27 PM | By

What Will California’s Health Benefit Exchange Application Look Like?

DraftImmediately following the Supreme Court’s decision on the Affordable Care Act, the head of California’s Health Benefit Exchange laid out his vision for revolutionizing the health insurance market.

“We know buying insurance is really complicated. We want to make it as easy as buying a book on Amazon,” said Peter Lee, executive director of the California Health Benefit Exchange.

But as the state has worked to create the actual application for health insurance, the idea of a one-click purchase is far from the reality.

“This is a brand new law and it’s complicated,” says Sam Karp, vice president of programs at the California HealthCare Foundation (CHCF). “It’s reasonable to expect the implementation will take not just a year. It will take a few years.” Continue reading →

FILED UNDER: Policy, Reform, California Health Benefit Exchange, Health Insurance Access
March 13, 2013 | 10:14 AM | By

Consumers Don’t View Curbing Costs As Their Job in Treatment Choice

by Michelle Andrews, Kaiser Health News

Consumers don't want to factor costs into their health care decisions (Alex E. Proimos/flickr)

Consumers don’t want to factor costs into their health care decisions (Alex E. Proimos/flickr)

In recent years, consumers have increasingly been encouraged by employers and insurers to help control rising health care costs. That may be by avoiding unnecessary tests, buying generic drugs and reducing visits to the emergency room, among other things. The hope is that a patient better educated and more engaged in health decisions will choose options that will promote better health and decrease costs.

Such “patient engagement” efforts assume that patients welcome the opportunity–or at least are willing–to get more involved in their own care. But as a study published last month in the journal Health Affairs found, a majority of patients didn’t want to factor costs into their medical decisions, nor did they want their doctors to do so.

“One of the beliefs people expressed was that you get what you pay for, that more expensive care is by definition better.”
The study investigated the attitudes of focus group participants in Washington, D.C. and Santa Monica, California. They were asked about weighing their own out-of-pocket costs and the costs borne by their insurer in medical decisions. The participants, researchers said, did not generally understand how insurance works and felt little personal responsibility for helping to solve the problem of rising health care costs. They were unlikely to accept a less expensive treatment option, even if it was nearly as effective as a more expensive choice.

Study co-author Susan Dorr Goold is a professor of internal medicine and health management and policy at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. Dorr Goold says her team was surprised at how frequently people talked about not wanting cost considerations to factor into decision-making at all.

Continue reading →

FILED UNDER: Policy, Reform, Health Care Cost, Patient Engagement
March 8, 2013 | 5:30 AM | By

New Version of Workplace Wellness Programs: Carrot or Stick?

By Kelley Weiss, CHCF Center for Health Reporting

Kimberley Macgregor, a bookkeeper at a Burbank Ralphs, looks over which “healthy activities” she’ll do to offset her health care costs. She says she didn’t know about the new wellness program until KQED contacted her. (Photo: Kelley Weiss)


Kimberley Macgregor, a bookkeeper at a Burbank Ralphs, looks over which “healthy activities” she’ll do to offset her health care costs. She says she didn’t know about the new wellness program until KQED contacted her. (Photo: Kelley Weiss, CHCF Center for Health Reporting)

Kimberley Macgregor, a bookkeeper at a Ralphs in Burbank, says it’s almost impossible to stay up to date on her health benefits.

She flips through a glossy pamphlet which features an array of fruits and vegetables and a woman meditating. It explains her company’s wellness program.

Macgregor is debating over which of the seven “healthy activities” in the wellness program to choose. She says she’ll opt for a biometric screening that uses a blood sample to check things like cholesterol and blood pressure.

“All and all it’s good for you because it gives you awareness of where you stand when it comes to health issues,” Macgregor says. “Maybe it can catch diseases early so that you have enough time to change it.”

If employees don’t participate in the disease management program their deductible goes up by $500.
Macgregor says she didn’t know everything about the changes to the program this year until I contacted her — and she’s her union’s representative in the Ralph’s where she works. If she doesn’t participate in the program, she’s on the hook for more money.

This year Ralphs is giving Macgregor $375 dollars less to offset her health care costs. But if she does four of the seven “healthy activities” she can earn it back.

Macgregor will then only have to pay $250 dollars towards her $1000 health insurance deductible. But she finds the whole thing a bit creepy. Continue reading →

FILED UNDER: Reform, Workplace Wellness Programs