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Washington, DC, United States (KaiserHealth) – Kansas and Oklahoma are the seventh and eighth states to get the thumbs down from the federal government on their requests to phase in new regulations that could result in health insurance rebates to consumers. Under the Affordable Care Act, companies that sell individual insurance policies must spend at least 80 cents of each premium dollar on health care or quality improvement for their members. Companies that fall short of the 80 percent standard will have to pay rebates to their customers to make up the difference. Kansas Insurance Commissioner Sandy Praeger and Oklahoma Insurance Commissioner John D. Doak had asked the federal Department of Health and Human Services for waivers that would allow the state to slowly phase in the [...] Continue Reading…

Atlanta, GA, United States (KaiserHealth) – ATLANTA—In Georgia, like many other Southern states, opposition to the federal health overhaul runs deep. Yet an overwhelmingly conservative committee of experts carefully, and without rancor, has outlined a plan to give the state a health insurance exchange, a cornerstone of the sweeping health care law passed by Democrats in Congress and signed by President Obama last year. The panel had the blessing of Republican Gov. Nathan Deal, a former U.S. congressman who describes himself as the first House member to denounce the health law as unconstitutional. Georgia has joined 25 other states in a legal challenge to the law likely to be resolved by the Supreme Court. But if the 2010 health law is not overturned by the court or [...] Continue Reading…

Washington, DC, United States (KaiserHealth) – Signing up for health insurance during your company’s annual enrollment period, which for many plans is right now, may feel like taking a nasty dose of medicine: You know it’s good for you, but it sure doesn’t go down easy. On the plus side, nearly two-thirds of companies are still offering health insurance to their employees, according to the Kaiser Family Foundation’s annual survey of employer health benefits. That’s worth a lot. But that coverage won’t come cheap, as premiums, deductibles and cost sharing continue to rise, sometimes even more steeply than in previous years. More employers are also moving to high-deductible plans that shift increasing expenses onto their employees, requiring them to pay more before benefits kick in. And companies [...] Continue Reading…

United States (KaiserHealth) – Nine Medicare Advantage plans scored top marks on the five-star government rating system for 2012, up from only three plans this year, according to new figures posted by Medicare Wednesday. That’s a small share of the 569 private Medicare plans, but it’s a laurel much of the industry is now chasing. For the first time, Medicare plans will get big cash bonuses for higher scores, a new reward created by the 2010 federal health law. The star ratings are part of a push by the Obama administration to increase the quality of care provided by private plans that contract with Medicare. The ratings are based on 36 measures, ranging from rates of hospital readmissions to the volume of consumer complaints a plan gets. [...] Continue Reading…

Montpelier, VT, United States (KaiserHealth) – Starting now, Vermont begins building a single-payer health system that will move many state residents into a publicly financed insurance program and pay hospitals, doctors and other providers a set fee to care for patients. Proposed by the governor and passed by the Democratic-controlled legislature, the new program will replace the traditional insurance plans currently used in the state and the traditional fee-for-service reimbursements, giving the state a system different from its 49 counterparts and more like its neighbor to the north, Canada. Many of the details of the system, including the key issue of financing, still need to be worked out and more legislation will be required to complete the transformation. But Democratic Gov. Peter Shumlin has moved quickly since [...] Continue Reading…

United States (KaiserHealth) – Worried that the federal government could end up running new insurance marketplaces for dozens of states, the Obama administration is making a new pitch for cooperation to 46 states and the District of Columbia today. Health officials from the states are meeting in the District of Columbia with the administration, which is proposing several models for ways to divvy up exchange duties between Washington and the states. The exchanges, which open in 2014, are a key component of the health law, allowing individuals and small businesses to shop for coverage from a range of insurers, see if they qualify for low-income subsidies to help them buy policies – or enroll in Medicaid if they meet income requirements. The federal government will run exchanges [...] Continue Reading…

Washington, DC, United States (KaiserHealth) – A provision of the 2010 federal health law seeking to increase Medicare beneficiaries’ share of health care costs is meeting resistance from an unlikely group of 33 state insurance regulators, health insurers and consumer advocates charged with revising Medigap insurance policies that cover most out-of-pocket expenses. The National Association of Insurance Commissioners assembled the group to come up with ways to raise the beneficiaries’ cost for the most popular and generous Medigap policies, a task Congress assigned to the association in the health law. Since then, the idea of shifting some costs to beneficiaries in Medigap policies has emerged as one of several proposals to reduce the federal deficit. The proposals suggest that if Medigap policies cover less of beneficiaries’ costs, [...] Continue Reading…

Washington, DC, United States (KaiserHealth) – For Judy Ariba, one of the most harrowing moments in her battle against a rare form of leukemia occurred after she had already endured a long hospital stay and grueling chemotherapy: Her bill for a prescription cancer drug jumped from $10 to $1,700 a month. After Judy Ariba’s former employer switched to a new health plan that required her to pay a percentage of her prescription cancer drug rather than a co-pay, her bill jumped from $10 to $1,700 a month. (Photo by Shane Bevel, for USA Today) “No one has $1,700 a month,” said Ariba, 63, of Siloam Springs, Ark. “I sat here and cried for a while, thinking ‘I’ve gone through all this, and now I will get sicker [...] Continue Reading…

Washington, DC, United States (KaiserHealth) – For many consumers, the ultimate test for the embattled health-care law is simple: Will it push down insurance premiums — or at least slow their relentless rise? It’s a pressing question for the Obama administration, which is hoping its signature domestic policy achievement doesn’t end up as an election year albatross. Officials have been jawboning carriers to refrain from big rate jumps and, beginning in September, will require insurers to undergo additional scrutiny before raising premiums 10 percent or more. But keeping a lid on premiums is hardly a slam dunk: The law doesn’t give the federal government or the states, the traditional regulators of health care, the nuclear option: the power to reject rate increases outright. And states vary widely [...] Continue Reading…

Washington, D.C., United States (KaiserHealth) – Long before the sweeping health law was even a notion on Capitol Hill, HMOs were a force in American medicine. The business model of patients having a primary care doctor, who coordinated care with specialists and hospitals in an established network, was designed to apply best and most effective practices in medicine while controlling spending. Then, when the law was written, a key provision called for insurers, hospitals, doctors’ groups and other providers to form accountable care organizations. The goal: to offer patients unified care systems with electronic health records, quality measurements and best-practices medicine. George Halvorson knows a lot about how to do that. As the chairman and CEO of the country’s largest HMO, Kaiser Permanente [...] Continue Reading…