THE first time Melissa Morelli was taken to the hospital, she was suicidal and cutting herself, her mother says. She was just 13, and she had been transferred to a psychiatric hospital, where she stayed for more than a week. Her doctors told Cathy Morelli, her mother, that it was not safe for Melissa to go home. The family’s health insurance carrier would not continue to pay for her to remain in the hospital.
The second time, the same thing happened. And the third and the fourth. Over the course of five months, Ms. Morelli took Melissa to the hospital roughly a dozen times, and each time the insurance company, Anthem Blue Cross, refused to pay for hospital care. “It was just a revolving door,” Ms. Morelli said.
“You had not been getting better in a significant way,” Anthem explained in one letter sent directly to Melissa, then 14, in July 2012. “It does not seem likely that doing the same thing will help you get better.”
Desperate to get help for her daughter, Ms. Morelli sought the help of Connecticut state officials and an outside reviewer. . She eventually won all her appeals, and Anthem was forced to pay for the care it initially denied. All told, Melissa spent nearly 10 months in a hospital; she is now at home. Anthem says its coverage decisions are based on medical evidence.
Melissa’s treatment did not come cheap: it ultimately cost hundreds of thousands of dollars, Ms. Morelli said. Patients often find themselves at odds with health insurers, but the battles are perhaps nowhere so heated as with the treatment of serious mental illness.
It was not supposed to be this way. A federal law, the Mental Health Parity and Addiction Equity Act of 2008, was aimed at avoiding fights like this over coverage by making sure mental illnesses would be covered by insurers just as they cover treatment for diseases like cancer or multiple sclerosis.
Long a priority of Senator Edward M. Kennedy of Massachusetts, it was squeezed into a bank bailout bill with the help of Christopher J. Dodd, then a Democratic senator from Connecticut, after Mr. Kennedy learned that he had brain cancer, which turned out to be fatal. The law requires larger employer-based insurance plans to cover psychiatric illnesses and substance-abuse disorders in the same way they do other illnesses.
But five years after President Obama signed the law, there is widespread agreement that it has fallen short of its goal of creating parity for mental health coverage.
As enrollment in coverage under the Affordable Care Act becomes available on Tuesday, the rules underlying mental health care coverage in general — for both private insurers and the new health care exchanges — are still unclear, mental-health patient advocates say, leaving patients and their families to grind through the process as best they can.


On the Threshold of Obamacare, Warily

By  and 
The insurance marketplaces that form the centerpiece of President Obama’s health care law are scheduled to open on Tuesday, a watershed moment for the Obama administration, but also a crucial turning point for millions of Americans who will finally get the chance to square the law’s lofty ambitions with their own personal needs.
While some people desperate for coverage will need no persuading to sign up, for others the decision will amount to a series of complicated calculations that would challenge an accounting whiz, let alone an ordinary human: Are the new plans less expensive or more generous than existing ones? How do premiums and out-of-pocket costs compare? Are the networks of doctors and hospitals the most desirable? Who qualifies for how much of a subsidy, and what is the tax penalty for a miscalculation?
How millions of people answer these questions over the next six months will be vital to determining whether the Affordable Care Act lives up to its name and its ambitious goal of helping more people buy the coverage they need.
Much is at stake for insurers as well: they must attract enough healthy people to pay for the care of sicker patients and price their offerings to keep premiums low enough to be competitive but high enough to be sustainable.
Health insurance “is a very complex product,” said Lynn Quincy, a senior health policy analyst for Consumers Union in Washington. “It is going to be more complex this time around because things are changing, and people are confused about the changes.”
As the state insurance exchanges are set to open, we talked to people around the country who will be among the first to give them a test drive. For some, the law could provide welcome relief from mounting medical bills; for others, a break from rising premiums. Still others must decide whether insurance is right for them at all.

A Guide to the New Exchanges for Health Insurance

By 
Given all of the rhetoric about the Obama administration’s health care law, it’s not surprising that many consumers are confused about how the new insurance exchanges will actually work. Some states that oppose the law have gone as far as intentionally limiting the information that trickles out to its residents.
But after much anticipation, the curtain will finally rise on the exchanges next week, providing millions of consumers with an online marketplace to compare health insurance plans and then buy the coverage on the spot.
The exchanges are likely to be most attractive to people who qualify for subsidized coverage. Individuals with low and moderate incomes may be eligible for a tax credit, which can be used right away, like a gift card, to reduce their monthly premiums. People with pre-existing conditions will no longer be denied coverage or charged more (this applies to most plans outside the exchanges, too). And all of the plans on the exchanges will be required to cover a list of essential services, from maternity care to mental health care.
“In today’s individual market, it’s like Swiss cheese coverage,” said Sarah Dash, a research fellow at the Health Policy Institute at Georgetown University. “Consumers should have an easier time figuring out what they are getting for their money.”
But it’s still going to take some time to analyze the plans and their costs, which are expected to vary widely across the states. And the coverage may still pinch many families’ budgets. Fortunately, there’s a six-month window, from now to March 31, for people to figure it all out.
Here’s some information to get you started:
Q. Where can I apply or get more information on the exchanges?
A. To avoid fraud artists, enter through the front door: Healthcare.gov. From there, you can find links to the exchange offered in your state. There may be technical glitches as the program gets started, so alternatively, you can call 1-800-318-2596.
Q . When does coverage go into effect?
A. You can apply as early as Oct. 1, but coverage won’t begin until Jan. 1. The enrollment period for coverage in 2014 closes on March 31, 2014. After that, you can enroll only if you have a major life event like a job loss, birth, marriage or divorce.
Q. What sort of coverage will be offered?

Dawn of a Revolution in Health Care

By 
The United States is embarking on a truly historic journey toward near-universal health care coverage this week. Starting Tuesday, the federal government will make it possible for millions of uninsured Americans who can’t get health insurance, or can’t afford it, to obtain coverage with the aid of government subsidies. It is a striking example of what government can do to help people in trouble.
The health care reform law, known as the Affordable Care Act, requires the creation in every state of new health insurance exchanges on which people can shop for health plans. Insurers selling plans on exchanges will have to provide a set of “essential benefits” and virtually anyone will be allowed to buy on exchanges (except undocumented immigrants), though few people who are covered by employer health plans or by public programs like Medicare and Medicaid are likely to switch.
For the first time last week, federal officials reported what health insurance will probably cost in the 36 states where the federal government will fully or partly run the exchanges. The prospects are promising. It looks as if most uninsured people, including young people whose participation is crucial, will be able to find very affordable coverage with the help of government subsidies.
The insurers will offer four levels of plans that will basically have the same essential services, but differ in the premiums charged and the amount of the bill that the insurance will pay. “Bronze” plans will pay 60 percent of an enrollee’s covered medical expenses; “silver,” 70 percent; “gold,” 80 percent; and “platinum,” 90 percent.
Federal subsidies will help enrollees pay for the premiums based on their incomes. A family of four with income between $23,550 and $31,400, will pay only 2 percent of that income for coverage, while a family of four with income between $70,650 and $94,200, will pay 9.5 percent.
Under the program, the federal government pays for the full cost of the premium — beyond the enrollee’s contribution — for the second-lowest-cost silver plan in a specific area, considered the “benchmark” plan. If people want to sign up for a cheaper bronze plan, they would pay a smaller contribution. If they want to buy a gold or platinum plan, they would have to pay more from their own pockets.
Thanks to the subsidies, more than half of the uninsured Americans may pay less than $100 a month per person for coverage.

Examining your health insurance options under Obamacare

With open enrollment in the state's new health insurance marketplace beginning this week, it's a good time to answer some commonly asked questions.

By Lisa Zamosky and Chad Terhune
1:07 PM PDT, September 27, 2013
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Starting Oct. 1, millions of Californians can start signing up for health insurance under the federal Affordable Care Act.
In addition to new coverage options, the healthcare law changes the rules of the insurance game for many consumers. It also requires most Americans to get health insurance or pay a penalty.
Here are some answers to commonly asked questions. Please share your comments or ask questions at healthcare@latimes.com. Submissions must include names and phone numbers.
Do I need to do anything right now?
You have time to consider your options. You can start signing up for health insurance Tuesday through Covered California, the state's new marketplace.
The earliest policies take effect is Jan. 1. You'll need to buy a health plan no later than Dec. 15 if you want your benefits to kick in at the start of the year. Enrollment for the state exchange runs through March 31. Medi-Cal, the state's Medicaid program, accepts applicants year round.
Where do I go to enroll?
In California, go to the Covered California website or call the health marketplace at (800) 300-1506. The state can also refer you to community groups, insurance agents and government offices that offer enrollment help in person.
Outside California, visit HealthCare.gov to find the link and other contact information for the marketplace in your state.
I get my insurance through work. Will that be affected next year because of all this?
http://www.latimes.com/business/la-fi-healthcare-watch-20130929,0,3787441,print.story


Sign-ups for insurance will put health care law to the test

Consumers weighing costs and benefits of health plans starting this week will decide the controversial reform's impact.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer
In two days, the health insurance marketplace will open for business, a pivotal moment in the short history of the Affordable Care Act.
After a three-year barrage of multimillion-dollar ad campaigns and seemingly nonstop political rhetoric since President Obama signed the act into law in 2010, people will soon begin seeing for themselves how the law works.
That's because starting Tuesday, the uninsured and underinsured can sign up for discounted health benefits in the new marketplace.
While there's a wide range of options and prices that consumers will pay -- based on income, age, subsidies and family size -- a typical out-of-pocket cost for individual insurance premiums, including subsidies, would be about $150 per month for a mid-level plan, according to state and federal figures released in the last few months. The subsidies kick in for those earning between 100 percent and 400 percent of the federal poverty level.
The bottom line of dollars and cents may trump the ad campaigns, 21-hour talkathons on the U.S. Senate floor, television news pundits and YouTube videos. Personal experience and word of mouth are likely to carry weight, even in the digital age.

House Republicans OK bill delaying health care law

Posted:Today
Updated: 12:55 AM 

Senate Democrats vow to reject the House measure as a partial government shutdown looms Tuesday.

By DAVID ESPO / The Associated Press
WASHINGTON — Locked in a deepening struggle with President Barack Obama, the Republican-controlled House approved legislation early Sunday imposing a one-year delay in key parts of the nation's health care law and repealing a tax on medical devices as the price for avoiding a partial government shutdown in a few days' time.
Even before the House voted, Senate Democrats pledged to reject the measure and the White House issued a statement vowing a veto in any event. Republicans are pursuing "a narrow ideological agenda ... and pushing the government towards shutdown," it said.
The Senate is not scheduled to meet until mid-afternoon on Monday, 10 hours before a shutdown would begin, and even some Republicans said privately they feared that Senate Majority Leader Harry Reid, D-Nev., held the advantage in the fast-approaching end game. If so, a House Republican rank and file that includes numerous tea party allies would soon have to choose between triggering the first partial shutdown in nearly two decades — or coming away empty-handed from their latest confrontation with Obama.
http://www.pressherald.com/politics/house-republicans-demand-one-year-delay-on-health-care_2013-09-29.html



One Maine family’s struggle for health care

By Sandy Butler and Luisa Deprez, Special to the BDN
Posted Sept. 27, 2013, at 12:11 p.m.
Editor’s note: In this yearlong series, to appear monthly, the authors will introduce you to people who are apt to be your neighbors, are struggling to make ends meet and have been affected by specific state policies. To share your story, write to Sandy.Butler@umit.maine.edu or call 581-2382.
The Daniels-Perez family is, like many Maine families, struggling to make do despite full-time employment.
Samarali “Sam” Daniels, her husband Ramon Perez, and their two children, Hector, 5, and Marrianna, 3, live in Augusta. Ramon works 40 hours a week at Sam’s Club, walks two miles to and from his job every day, as they do not own a car, and makes about $11 per hour. That’s more than the state minimum wage of $7.50 but far less than the $17.15 calculated by the Maine Department of Labor in 2010 as a livable wage for a family of four.
While his company offers health benefits, they are unaffordable. Premiums to cover the family would eat up about a quarter of their income. The coverage would be minimal and each family member would have a $1,500 deductible.
While the family is currently covered by MaineCare — Maine’s Medicaid program — Gov. Paul LePage’s veto of Medicaid expansion in June means that Sam and her husband will likely lose this coverage at the start of 2014. The Ramon-Perez family is among 25,000 Mainers that are teetering on the edge and now in jeopardy of losing access to affordable health care.
Legislative decisions affect real people and can have severe consequences.
For many years, Ramon went without health insurance. There were many consequences. Earlier in his life, for example, he suffered an occupational injury at a factory job when a steel beam fell on and pinned his leg. Sam feels her husband was told to return to work too soon after that injury without getting adequate medical treatment — something that has contributed to the current problems with his knees and legs.
Knee pain is an ongoing health issue for Ramon. Medical testing indicated he has cartilage loss and fluid pockets in his knees. Sam worries, “We are always talking about what will happen if his knees give out on the way to work or something. What are we going to do? And the biggest issue is what are we going to do if we don’t have insurance? How are we going to pay for it?”

Untangling Obamacare: Shopping the insurance exchanges

What journos need to tell the public about signing up

By Trudy Lieberman
Columbia Journalism Review, Sept. 25, 2013
Not long ago, freelance health writer Debra Gordon sent out an SOS on a listserv for health reporters. Gordon was writing a consumer piece walking readers through the process of signing up for the new health insurance exchanges. She quickly realized that neither shopping for insurance nor writing about the shopping process was easy. “I spent about four hours just trying to figure out what I’ll need to fill out the application and it still is confusing,” she told the listserv.
Gordon was really speaking for all journalists who will have to explain this complicated chore to the public. While the Secretary of Health and Human Services said signing up for health insurance will be like buying an airline ticket from Travelocity, it won’t be. Buying an airline ticket to Paris is a lot easier and much more fun than understanding coinsurance from Blue Cross.
Inspired by Gordon and other health reporters who have asked about the nitty-gritty of selecting a policy, I stopped by to see Elisabeth Benjamin, a vice president at the Community Service Society in New York City, an organization that currently runs an insurance counseling program and will help navigators help consumers. I figured she knew a thing or two about signing up. My head was spinning after our conversation—the decision points, the trade-offs, the bureaucratic requirements, the mumbo-jumbo to comprehend. Nevertheless, our conversation was useful, and I offer a distillation of her suggestions and some of my own for reporters to use in preparing their stories.
For starters, it’s best to think of buying insurance in the exchanges as a four-step process that includes several key decision points. Forget all that extraneous stuff that is the focus of too many stories—the politics of Obamacare, the prognostications about premiums, the latest academic study. Audiences care little about that as they face the daunting challenge of selecting coverage.
STEP 1 The health insurance buying cycle: A good way to think about shopping for exchange coverage, Benjamin suggests, is a cycle with four phases.
http://www.pnhp.org/print/news/2013/september/untangling-obamacare-shopping-the-insurance-exchanges


People Want Full Medicare for All

By Ralph Nader
Counterpunch, Sept. 27, 2013
Freshman Senator Ted Cruz (R-Texas), who somehow got through Princeton and Harvard Law School, is the best news the defaulting Democratic Party has had in years.
As the Texas bull in the Senate china shop, he has been making a majority of his Republican colleagues cringe with his bare-knuckle antics and language. His 21 hour talkathon on the Senate floor demanding the defunding of Obamacare made his Republican colleagues gasp. His Nazi appeasement analogies, and threats to shut down were especially embarrassing.
After listening to his lengthy rant on the Senate Floor on Tuesday and Wednesday, one comes away with two distinct impressions. Ted Cruz cannot resist inserting himself here, there and everywhere. And nothing is too trivial for Senator Talkathon. He likes White Castle hamburgers, he loves pancakes; he talked about what he liked to read as a little boy, where he’s travelled, what clothes he wears and other trivia.
You’d think he would have used his time to talk specifically about the suffering that uninsured people and their children are going through, especially in the Lone Star State. Or about what could replace Obamacare other than his repeated “free market” solution, which is to say the “pay or die” profiteering, tax-subsidized corporate system.
It was puzzling why he never mentioned that during his two days of talking, over two hundred Americans died, on average, because they couldn’t afford health insurance to get diagnoses and timely treatment. (A peer reviewed study by Harvard Medical School researchers estimated about 45,000 die annually for lack of affordable health insurance every year.)
The other reaction to Senator Cruz was that many of his more specific objections to Obamacare – its mind-numbing complexity, opposition by formerly supportive labor unions, and employers reacting by reducing worker hours below 30 hours a week to escape some of the law’s requirements – are well-taken and completely correctible by single-payer health insurance, as provided in Canada. Single-payer, or full Medicare for all, with free choice of physician and hospital has been the majority choice of Americans for decades. Even a majority of doctors and nurses favor it.
Single-payer’s advantage is that everybody is in, nobody is out. It is far more efficient, allows for better outcomes, saves lives, prevents injuries and illnesses, relieves people of severe anxieties and wasted time spent figuring out often fraud-ridden, inscrutable computerized bills and allows for the collection of pattern-detecting data to spot harmful trends.
http://www.pnhp.org/print/news/2013/september/people-want-full-medicare-for-all


Mine workers are fighting for our health care and basic human rights

By Ed Weisbart, M.D.
The following text represents the prepared remarks of Dr. Ed Weisbart for his speech delivered to a rally sponsored by the United Mine Workers of America in St. Louis on Sept. 24. The event was a protest against Peabody Coal, which is refusing to pay for health care benefits promised to retired miners, their widows and dependents. To see a video of Dr. Weisbart's speech, please click here.
Some of my colleagues have asked me why a physician organization would be participating in a labor rally. Let me explain this.
I am here today because of a 57-year-old woman having what she knew to be her second heart attack. Instead of going to the emergency room as most people would, she went home to die rather than risk a $50,000 hospital bill. She knew that a huge medical bill would mean bankruptcy and eviction, but that if she just died at home her mortgage insurance would pay the house off and her son would have a place to live.

I am here today because of my 32-year-old diabetic patient who can only afford to take his insulin three days a week. Without his insulin he’ll need dialysis in two to three years. Only at that point, when his illness becomes a catastrophe, will our system start to pay for his care, including his dialysis, at $70,000 per year. And, by the way, his insulin.
This is like seeing a small leak in your roof and waiting for it to cave in before doing anything about it. I’ll bet there are even more striking parallels in coal mining.
I am here today because of the 64-year-old grandmother whose blood pressure had been well controlled for many years but now it’s 180/115. I asked her what had changed, and she told me she was on her final eviction notice and could no longer pay her rent, buy food for the three grandchildren living with her, and also continue to buy her medications. She said she cannot permit her grandchildren to be homeless. She asked me, “So, Dr. Weisbart, how long can I live without taking my medications?”
http://www.pnhp.org/print/news/2013/september/mine-workers-are-fighting-for-our-health-care-and-basic-human-rights

As government shutdown looms, Obamacare exchanges still set for launch
By: Paige Winfield Cunningham and David Nather
September 29, 2013 07:04 AM EDT
It’s looking more and more like Tuesday will be a split-screen day: The government will shut down, and Obamacare will open for business.
That’s going to annoy a lot of Republicans —because the ones who are pushing the shutdown are doing so precisely because they want to halt Obamacare.
Barring some last-minute deal, which gets less likely with each passing moment, the federal government will shut down on Tuesday because of the House and Senate’s inability to pass a spending bill that resolves their deep and persistent differences over Obamacare.
(Also on POLITICO: Obama keeps distance from Hill)
But Tuesday is also the day that Obamacare’s new health insurance marketplaces — some run by the states, many run by the feds — are scheduled to start signing up customers. And President Barack Obama has made it clear that, even if the government closes, the health care show will go on.
“On Tuesday, about 40 million more Americans will be able to finally buy quality, affordable health care, just like anybody else,” Obama said on Friday. The new health insurance exchanges, he said, “will be open for business on Tuesday no matter what — even if there’s a government shutdown. That’s a done deal.”
How is that possible? Here’s a guide to how it will work — and what we might see on Tuesday: