Introducing a new series explaining Obamacare
Posted Sept. 06, 2013, at 2:09 p.m.
You have lots of questions about the Affordable Care Act, aka Obamacare. The Bangor Daily News and Lewiston Sun Journal want to help you understand what the ACA will mean for you and your family.
Through a 5-part series that begins this weekend and will run Mondays through Sept. 30, the day before ACA health insurance signups, the papers will explain the comprehensive health care plan and other reform items included in the act.
To keep on top of our ACA coverage, sign up for our email newsletter. You can follow along with all our ACA coverage at bangordailynews.com/series/ACA.
Stories in our series:
Sept. 7/8: Affordable Care, huh? We break down the ACA, what it does and what it requires you to do.
Sept. 9: So you (maybe) want to buy insurance from the exchange: The essentials you should know. When to buy, how, what the heck a subsidy is and how to get it, what to keep in mind and what happens if you don’t get insurance on the exchange (or anywhere).
Sept. 16: It’s raining preventive care! New insurance benefits both on and off the exchange. Plus: Free breast pumps for all! Little-known aspects of the ACA.
Sept. 23: What is a “full-time” worker, really? The ACA for businesses large and small.
Sept. 30: You can’t get there from here: How Maine differs from other states in its ACA implementation and what Maine’s health-care system might look like down the road thanks to the ACA. Because it all has an effect on you and your family.
Interested? Sign up for our email newsletter and get alerts each day as new stories are available.
Highlights of the Affordable Care Act
Posted Sept. 07, 2013, at 5:29 a.m.
You have lots of questions about the Affordable Care Act, aka Obamacare. The Bangor Daily News and Lewiston Sun Journal want to help you understand what the ACA will mean for you and your family.
Through a 5-part series that begins this weekend and will run Mondays through Oct. 1, the day before ACA health insurance signups, the papers will explain the comprehensive health care plan and other reform items included in the act.
To view our full ACA coverage, visit bangordailynews.com/series/ACA, where you also can sign up to receive email notifications of stories that have been published.
Here are highlights of the law to get you started:
Coverage
- Expands Medicaid to more low-income Americans (except in some states, including Maine, that opted out of the expansion).
- Young adults up to age 26 can remain on their parents’ health plan.
- Insurers may no longer deny coverage to people with pre-existing health conditions, or charge them more.
- Requires employers to cover their workers or pay penalties, with exceptions for small businesses.
- Requires individuals to have insurance, with few exceptions.
- Prohibits insurers from applying lifetime monetary caps on insurance coverage and limits the use of yearly caps.
- Prohibits insurance plans from arbitrarily cancelling coverage, except in cases of fraud.
- Requires state reviews for “unreasonable” insurance premium increases.
Costs
- Creates health insurance marketplaces where consumers and small businesses can shop for plans and apply for subsidies and tax credits to help them afford coverage.
- Prescription drug discounts for seniors on Medicare.
- All new plans must cover certain preventive health services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance.
- More money dedicated to reduce fraud and waste in Medicaid, Medicare and CHIP.
- Insurers must spend at least 80 cents of every premium dollar on benefits and quality improvements, rather than overhead costs and profits.
Care
- Coverage for mental health and substance abuse treatment must be comparable to coverage for medical and surgical care.
- Accountable Care Organizations and other programs designed to help doctors and health care providers work together to deliver better, less expensive care.
- A new $15 billion fund will invest in prevention and public health programs, including smoking cessation and combating obesity.
- http://bangordailynews.com/2013/09/07/health/highlights-of-the-affordable-care-act/print/
Just the FAQs, ma’am
Posted Sept. 07, 2013, at 12:20 p.m.
What is this “Affordable Care Act” of which you speak? It’s a controversial 900-plus-page federal law (officially the Patient Protection and Affordable Care Act) that was signed by President Barack Obama on March 23, 2010. It makes some sweeping changes to health care, like requiring almost all Americans to have health insurance. Some people say it goes too far. Others say it doesn’t go far enough.
This is universal health care, right? No. In places with universal health care (think Canada), the government pays for all care. The ACA, on the other hand, requires that people pay for their own care by buying insurance. The ACA did expand government coverage — Medicaid — to some people, but the U.S. Supreme Court ruled that states didn’t have to accept that expansion. So many states, including Maine, didn’t.
So, I must have health insurance now? Yes, unless you are very poor (under the federal poverty level) and live in a state that didn’t expand Medicaid (like Maine). You can also get an exemption to the penalty if:
• Your religion prevents you from accepting insurance benefits.
• You’re part of a health care sharing ministry.
• You are a member of a federally recognized Indian tribe.
• You lack insurance for less than three months in a row.
• You have suffered a certified hardship.
• You can’t afford coverage because you’d have to pay more than 8 percent of your household income for coverage.
• You’re behind bars.
• You are not a U.S. citizen, a U.S. national or an alien lawfully present in the U.S.
For this first year of the ACA, open enrollment for insurance lasts from Oct. 1, 2013, to March 31, 2014. The insurance mandate starts Jan. 1.
Hmm. I need insurance by Jan. 1 but I have until March to buy a plan? That sounds fishy.: The requirement for insurance starts Jan. 1, but there’s no penalty if you’re without insurance for fewer than three months in a row. So you could get insurance after Jan. 1 but before those three months are up and be fine.
Why is the ACA also known as Obamacare? Opponents came up with that name back in 2007 as a dig at Obama. It stuck.
When do the death panels start? There are no death panels and never were. There is a board (the Independent Payment Advisory Board) that was established to recommend Medicare cost-saving changes. However, it is not allowed to recommend rationing care, limiting who or what Medicare covers or raising the cost on patients. An early draft of the ACA also would have allowed patients to talk with their doctors about end-of-life care and have that consultation covered by Medicare. That provision proved so controversial that it was taken out of the bill and is not part of the ACA. The Obama administration brought it up again in 2010, then quickly dropped it.
This ACA thing is really a ploy to install microchips in our brains, isn’t it? Um, no. However, colonoscopies are free.
When does the ACA take effect? Many parts already have. (See timeline.) The insurance mandate, one of the biggest and most controversial parts of the law, starts Jan. 1, 2014. Individuals and small businesses and groups can start buying insurance off the upcoming marketplace (and get subsidies and tax credits to do so) starting Oct. 1, 2013.
Wait, a subsidy? If you can’t get affordable health insurance through your job and you are between 100 percent and 400 percent of the federal poverty level, you can get money from the feds to help pay for insurance. If you’re between 100 percent and 250 percent of the federal poverty level, you can also get a discount on your out-of-pocket health care expenses. This will all be on a sliding scale — the less you earn, the bigger your subsidy.
What’s the federal poverty level? Right now, $11,490 a year for one person (modified adjusted gross income). For a family of four, $23,550.
Affordable What Act? Like it or not, Obamacare is coming. Here’s what to expect
Posted Sept. 08, 2013, at 5:34 a.m.
The nation’s most pivotal health reform in 50 years kicks into high gear this fall. You’ll be affected. Here’s how.
The Patient Protection and Affordable Care Act has been called a lot of things since it became law three years ago. Also known as the ACA or Obamacare, the law is derided as “bad for America” and lauded as a “dream come true,” depending on whom you ask.
Sick of all the rhetoric? Just want to know what will change the next time you visit the doctor’s office or the pharmacy counter? You’re not alone.
Roughly half the public reports that they don’t have enough information about the act to understand how it will affect them and their family, according to an August poll by the Kaiser Family Foundation. Many people remain confused about the law’s status, with 44 percent thinking it has been repealed (8 percent) or overturned by the U.S. Supreme Court (5 percent), or unsure whether it remains the law (31 percent).
(The poll also found that only 8 percent of people said they trust the news media “a lot” for information about the health care law. Ouch. We’ll do our best here to boost that number.)
Sorting through all of the information is no easy feat. Search “Affordable Care Act” on Google and you get a dizzying 111 million results.
Let’s start with the basics — why the act was passed, what it does, and what it doesn’t do.
Insurance Rolls to Rise in State Fighting Plan
By ROBERT PEAR
FLORENCE, S.C. — Brenda B. Culick has two stents in her heart and a severe wound in her right leg, injured while she was doing home repairs six months ago. But she cannot afford to see a cardiologist or go to a wound care center.
Her household income is $1,200 a month, but she does not qualify for Medicaid because she has no dependent children and is not disabled. Ms. Culick, 52, is one of several hundred thousand people left behind by South Carolina’s refusal to expand Medicaid under President Obama’s health care law — a choice made by about half the states.
“If I could get Medicaid, I’d be the happiest person on earth,” Ms. Culick said.
In her State of the State speech in January, Gov. Nikki R. Haley, a Republican, said, “South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.” And she boasted of her stance at a recent rally announcing her bid for re-election. “When it came to Obamacare,” she said, “we didn’t just say ‘no,’ we said ‘never.’ ”
The reality, however, is more complex. South Carolina officials say they welcome the prospect that more than a half-million state residents — out of a population of 4.7 million — could soon gain access to affordable coverage, even without the expansion of Medicaid eligibility. And they are working to remake Medicaid so that it does not just pay claims but produces measurable improvements in the health of poor people.
Even without a change in eligibility rules, enrollment is expected to grow as a result of the new health care law. The law requires most Americans to have coverage, and state officials predict that the mandate will prompt more of those who are currently eligible, but not enrolled, to sign up for Medicaid. Consumers will see many advertisements from the Obama administration and insurers urging them to obtain coverage, and that is also expected to drive Medicaid enrollment.
“If they are eligible for Medicaid, they should get it,” said Dr. William R. Jennings Jr., a medical director at the South Carolina Department of Health and Human Services. “If people are eligible for coverage in the exchange, they should get it.”
Mr. Obama’s health care law was intended to provide coverage in two major ways: by expanding Medicaid eligibility and by setting up an insurance marketplace, or exchange, where people can shop for private insurance.
Ms. Haley and the Republican-controlled Legislature here did neither. But state officials say they recognize that low- and moderate-income residents will get insurance subsidized by the federal government, in a marketplace run by federal officials.
Debating a Fix for Hospitals in Dire Straits
By ANEMONA HARTOCOLLIS
Of all the issues in the Democratic primary for mayor, one of the few that most candidates seem to agree on is that struggling New York City hospitals need to be saved.
Christine C. Quinn, the City Council speaker, said during a debate last month that she would make sure “that the mayor isn’t sitting on the sidelines as it relates to private hospitals.”
William C. Thompson Jr., a former city comptroller, echoed her, saying, “The city can’t sit on the sidelines.”
And Bill de Blasio, the public advocate, who helped make the hospitals a main issue by getting arrested at a rally to save Long Island College Hospital in Brooklyn, said, “We have to end this epidemic of hospital closures.”
Despite the discourse, it is the state that regulates hospitals and gives the grants and loans needed to keep them from failing. And Gov. Andrew M. Cuomo is not throwing the hospitals a lifeline.
That the candidates are even talking about hospitals is, if nothing else, a testament to their vital role in the city’s ecosystem. More than just health care facilities, they are neighborhood institutions where local doctors take care of people they know from birth to death, where politicians can be heroes by providing taxpayer support and patronage, and where unions can count on employment for workers at various levels of schooling.
Hospitals in poor areas have been struggling for years; since 1990, 52 hospitals in New York State, half of them in the city, have closed or been converted into another type of medical center. In that time, the state has tried to keep remaining hospitals alive by authorizing hundreds of millions of dollars in bond sales or direct subsidies. But the Cuomo administration believes that New York State, especially in Brooklyn, still has more hospital beds than it needs and that some of the weakest facilities might have to shut down or be significantly reshaped.
“Years of state financial support and bailouts in the absence of real systemic reform has left Brooklyn residents with an unstable and unaffordable hospital system that falls short of delivering the real primary care that the community actually needs,” Bill Schwarz, a spokesman for the State Health Department, said. “The administration is seeking to end this unsustainable cycle.”
Treasury Issues Proposed Rules for Information Reporting by Employers and Insurers Under the Affordable Care Act
9/5/2013
Requests Public Comments on Additional Ways to Simplify and Streamline Reporting
WASHINGTON - Today, the U.S. Department of the Treasury and the Internal Revenue Service issued proposed regulations to implement the information reporting requirements for insurers and certain employers under the Affordable Care Act (ACA). The regulatory proposals reflect an ongoing dialogue with representatives of employers, insurers, other reporting entities, and individual taxpayers.
“Today’s proposed rules enable us to continue engaging on how best to implement the ACA reporting requirements in a more streamlined and focused manner,” said Assistant Secretary for Tax Policy Mark J. Mazur. “We will continue to consider ways, consistent with the law, to simplify the new information reporting process and bring about a smooth implementation of those new rules. Doing so will help ensure that the ACA effectively and efficiently delivers its historic tax benefits that promote health security for all Americans.”
Background
The ACA provides for information reporting (under Internal Revenue Code section 6055) by insurers, self-insuring employers, and other parties that provide health coverage. It also provides for information reporting (under Code section 6056) by employers that are large enough to be subject to the employer shared responsibility provisions regarding the health coverage they offer their full-time employees. These proposed regulations reflect comments received and an ongoing dialogue with stakeholders, including plan sponsors, many of whom already offer their full-time workforce coverage far exceeding the minimum employer shared responsibility requirements. Nearly 95 percent of employers with more than 50 full-time employees already offer coverage to their employees.
The proposed rules issued today describe a variety of options to potentially reduce or streamline information reporting, such as:
Life Expectancy Grows for Women Age 50 and Up
By DONALD G. McNEIL Jr.
Life expectancy for women who live to age 50 is going up around the world, but poor and middle-income countries could easily make greater gains, according to a new World Health Organization report.
Heart disease, stroke and cancer kill most women over 50, said Dr. John R. Beard, director of the W.H.O.'s department of aging, so countries should focus on lowering blood pressure with inexpensive drugs and screening for cervical and breast cancer. Those diseases can be prevented or treated, said Dr. Beard, who was also an author of the study, which was published in the Bulletin of the World Health Organization.
Getting women to avoid smoking, excessive drinking and being obese is also crucial, he said.
Japanese women live the longest on average. But women in most countries now live longer than they did 40 years ago, thanks to progress against infectious diseases like flu, tuberculosis and pneumonia. Some countries have improved less than others: South Africa has an AIDS epidemic, Russian women suffered when the Soviet health system collapsed, and growing prosperity in Mexico has led to more lung cancer and obesity-related diabetes.
The bulletin also included a report on older women’s right to protected sex, also co-authored by Dr. Beard.
“To some extent, we treat women as vessels of reproduction, and once they’ve done that we don’t pay much attention to them,” he said.
As more women live alone and more older men get drugs for erectile dysfunction, stereotypes about sex and older people need to change, Dr. Beard said, and women should be offered advice on protected sex and screened for sexually transmitted diseases.
The right’s health care 'revolution' is a scam
Conservatives like to trumpet 'consumer-driven' health care plans. Here’s what they’re not telling you about them
By Adam Gaffney. M.D.Salon, Sept. 6, 2013
“The consumer-driven health care revolution,” trumpeted one conservative think tank a few years back, “has only just begun.”
Now, for anyone who has ever been inconvenienced by an encounter with the health care system – or even worse, been on the receiving end of poor quality care, a medical error, or a misdiagnosis – a greater focus on “consumer” satisfaction might sound like just the right medicine for American health care.
So should we celebrate the recent rise of “consumer-driven” or “consumer-directed” health care plans (CDHPs)? The premise of CDHPs – essentially high-deductible plans, with an option for a health savings account – is straight-forward enough: if you shop for services with your “own money,” you’ll use less health care and hunt for better bargains, in the process forcing providers to improve quality.
CDHPs have grown rapidly in recent years. From a trivial 4 percent in 2006, CDHPs now account for a full 20 percent of all employer-based insurance plans. The trend seems set to continue in 2014: a survey from the National Business Group on Health last month found that CDHPs were considered “the most effective tactic to control rising costs” by large employers, with 72 percent already offering a CDHP, and 22 percent planning to offer only CDHPs in 2014.
I’d wait to break out the bubbly, for, despite the utopian claims of its enthusiasts, CDHPs are more about cash than quality, more about cost shifting than consumer empowerment.
The “consumer-driven health care revolution,” it turns out, is likely to be neither revolutionary nor consumer-driven, but instead will only manage – somehow – to make the misfortune of getting sick an even worse experience.
One irony of the current craze with “consumer-driven” care is that its adherents seem surprisingly unaware that we already had an experiment with true market medicine in this country – in the nineteenth century.
“From the beginning,” argues the legal professor T. S. Jost in hiscritique of the consumer-driven movement, Health Care At Risk, ”there was only consumer-directed health care in the United States.” Patients paid out of pocket, there was no health insurance, and there were an impressive variety of equally ineffective practitioners, frequently engaged in brutal competition.
The system (if it can be called that) was basically a disaster, with the presence of a health care marketplace doing little to encourage “quality” in that golden age of quackery. What ultimately did improve quality – at least to some extent – was good old-fashioned regulation: medical licensure laws, the closure of low-quality medical schools, the Pure Food and Drugs Act, and so on
http://www.pnhp.org/print/news/2013/september/the-right’s-health-care-revolution-is-a-scam
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