A Plea to Avoid Crush of Users at Health Site
By MICHAEL D. SHEAR and ROBERT PEAR
WASHINGTON — White House officials, fearful that the federal health care website may again be overwhelmed this weekend, have urged their allies to hold back enrollment efforts so the insurance marketplace does not collapse under a crush of new users.
At the same time, administration officials said Tuesday that they had decided not to inaugurate a big health care marketing campaign planned for December out of concern that it might drive too many people to the still-fragile HealthCare.gov.
With a self-imposed deadline for repairs to the website approaching on Saturday, the administration is trying to strike a delicate balance. It is encouraging people to go or return to the website but does not want to create too much demand. It boasts that the website is vastly improved, but does not want to raise expectations that it will work for everyone.
“We are definitely on track to have a significantly different user experience by the end of this month,” Kathleen Sebelius, the secretary of health and human services, said Tuesday. “That was our commitment.”
Ms. Sebelius, who supervised development of the troubled website, tried to rally state and local elected officials in a conference call organized by the White House. “I would urge you and your folks on the ground to not hesitate to recommend that people go to HealthCare.gov and get signed up,” she said.
Officials said the website was now able to handle 50,000 users at a time, providing enough capacity on a daily basis to enroll millions of people in the next four months.
But those charged with fixing the site worry that 250,000 people might try to use the site simultaneously at times on Saturday and in the days ahead. They say that pent-up demand for insurance in the federal marketplace, combined with a surge of interest among people merely curious about whether it is working, could bring the website to a crawl.
“Our concern is that we want to make sure that people have the right expectation going into this,” said Jennifer Palmieri, the White House communications director.
To Changing Landscape, Add Private Health Care Exchanges
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We've been reporting a lot lately on the troubled rollout of President Obama's signature health care law. But at the same time, there are rumblings of a major shift in the way companies offer private health insurance to workers.
It involves what are called "private health care exchanges." These are similar to — but completely separate from — the public exchanges you've heard so much about.
Some experts say this new approach soon could change how millions of Americans receive their health care.
Dean Carter is the chief human resources officer for Sears Holdings, which means he's shifted more than 50,000 employees onto this new kind of health care system. And he thinks this is the future. "In my 20 years of HR and working with benefits," Dean says, "this fundamentally changes the game."
The change Dean's talking about is kind of like what happened when most companies stopped offering pensions. Instead, many just contribute money to their workers' retirement accounts.
With health care now, some companies are saying: "Here's $300 to $400 a paycheck. Go use that toward buying insurance on a 'private exchange.' "
For years at big conferences that benefits managers attend, there has been talk about private health care exchanges with four, five or six different carriers competing on price to offer people insurance. But it seemed to be something maybe 10 years in the future. Then the Affordable Care Act passed. And that made exchanges seem more doable right away for the private sector, too.
"When we began to look at it, and it looked like it was a good idea for our associates and Sears holdings, we leaned in fast," says Carter.
Medicaid Drives Expansion Of Health Care Coverage
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After years of wide spread fretting about the size of the federal debt and angst about new federal regulations for health care, one federal program is enjoying widespread popularity: Medicaid. Morning Edition examines this political paradox.
People are Signing up in Droves for Obamacare, but not for Private Insurance
Much of the news lately about the Affordable Care Act, also called Obamacare, has been about the troubled rollout of the web marketplace enrollment and the cancellation notices going out to a segment of the 5% of Americans who get coverage from the individual health insurance market. (Read this for an accurate explanation of what is going on with the cancellations. And this about President Obama’s announcement of a policy change that may allow some people to keep their cancelled policies for at least another year.) But there is another Obamacare story that has gotten much less attention: enrollment in Medicaid, which is being expanded in many states, is going like gangbusters.
Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only “a trickle of sign-ups for private insurance.” Oregon, for instance, cut its uninsured “without signing up a single person for private health insurance.”
This is a potentially watershed development, because Medicaid is Obamacare’s only true public option: a program jointly administered and funded by federal and state governments. (Although many liberals had sought to have another public option added to compete directly with the private plans offered in the state marketplaces, that version of a public option never made it into the final law). But Medicaid, which even before the ACA was the largest insurance program in the United States with 62 million enrollees, is central to Obamacare’s goal of providing health insurance to nearly all Americans.
Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only “a trickle of sign-ups for private insurance.” Oregon, for instance, cut its uninsured “without signing up a single person for private health insurance.”
This is a potentially watershed development, because Medicaid is Obamacare’s only true public option: a program jointly administered and funded by federal and state governments. (Although many liberals had sought to have another public option added to compete directly with the private plans offered in the state marketplaces, that version of a public option never made it into the final law). But Medicaid, which even before the ACA was the largest insurance program in the United States with 62 million enrollees, is central to Obamacare’s goal of providing health insurance to nearly all Americans.
The Power of a Daily Bout of Exercise
By GRETCHEN REYNOLDS
This week marks the start of the annual eat-too-much and move-too-little holiday season, with its attendant declining health and surging regrets. But a well-timed new study suggests that a daily bout of exercise should erase or lessen many of the injurious effects, even if you otherwise lounge all day on the couch and load up on pie.
To undertake this valuable experiment, which was published online last month in The Journal of Physiology, scientists at the University of Bath in England rounded up a group of 26 healthy young men. All exercised regularly. None were obese. Baseline health assessments, including biopsies of fat tissue, confirmed that each had normal metabolisms and blood sugar control, with no symptoms of incipient diabetes.
The scientists then asked their volunteers to impair their laudable health by doing a lot of sitting and gorging themselves.
Energy surplus is the technical name for those occasions when people consume more energy, in the form of calories, than they burn. If unchecked, energy surplus contributes, as we all know, to a variety of poor health outcomes, including insulin resistance — often the first step toward diabetes — and other metabolic problems.
Overeating and inactivity can each, on its own, produce an energy surplus. Together, their ill effects are exacerbated, often in a very short period of time. Earlier studies have found that even a few days of inactivity and overeating spark detrimental changes in previously healthy bodies.
Some of these experiments have also concluded that exercise blunts the ill effects of these behaviors, in large part, it has been assumed, by reducing the energy surplus. It burns some of the excess calories. But a few scientists have suspected that exercise might do more; it might have physiological effects that extend beyond just incinerating surplus energy.
To test that possibility, of course, it would be necessary to maintain an energy surplus, even with exercise. So that is what the University of Bath researchers decided to do.
Their method was simple. They randomly divided their volunteers into two groups, one of which was assigned to run every day at a moderately intense pace on a treadmill for 45 minutes. The other group did not exercise.
Curing Insomnia to Treat Depression
By THE EDITORIAL BOARD
Psychiatrists have long thought that depression causes insomnia, but new research suggests that insomnia can actually precede and contribute to causing depression. The causal link works in both directions. Two small studies have shown that a small amount of cognitive behavioral therapy to treat insomnia, when added to a standard antidepressant pill to treat depression, can make a huge difference in curing both insomnia and depression in many patients. If the results hold up in other studies already underway at major medical centers, this could be the most dramatic advance in treating depression in decades.
A study of 66 patients by a team at Ryerson University in Toronto found that the cognitive therapy for insomnia, a brief and less intense form of talk therapy than many psychiatric patients are accustomed to, worked surprisingly well. Some 87 percent of the patients whose insomnia was resolved in four treatment sessions also had their depression symptoms disappear, almost twice the rate of those whose insomnia was not cured. The new results were reported by Benedict Carey in The Times last Tuesday.
The brief course of sleep therapy teaches patients to establish a regular wake-up time; get out of bed during waking periods; avoid reading, watching TV or other activities in bed; and eliminate daytime napping, among other tactics. It is distinct from standard sleep advice, like avoiding coffee and strenuous exercise too close to bedtime.
The Toronto study is consistent with a 2008 study of 30 patients at Stanford University, all of whom suffered from insomnia and depression and were taking an antidepressant pill. Some 60 percent of those given seven sessions of behavioral therapy for insomnia in addition to the pill recovered fully from their depression, compared with only 33 percent in a control group that got the standard advice for treating sleeplessness.
Other studies involving roughly 70 patients each are being conducted at Stanford, Duke University and the University of Pittsburgh, all financed by the National Institute of Mental Health. Those results are expected to be published next year.
LePage’s study on Medicaid expansion is a wasteful sham
Posted Nov. 27, 2013, at 7:55 a.m.
Most would agree that while the nation’s financial crisis is behind us, Maine has not yet recovered. Financial resources are stretched; budgets are cash-strapped. And we are all being asked to do more with less.
In state government, there’s an even higher responsibility to ensure judicious spending — because our budget is a budget of the people, the taxpayer.
Last week, the Legislature and the people of Maine discovered through newspaper reports that Gov. Paul LePage paid nearly $1 million to hire a tea party consultant to review the state’s health insurance program, MaineCare.
In a time when every dollar is being stretched, we have to ask: Can the state afford to pay $1 million to an out-of-stater to write a report, especially when we already know what that report will say?
In the Legislature, when we draft budgets, we expect, and we know, that every penny will be scrutinized — and it should be. Over the last few years, structural changes have been made. And, as a result, we haven’t been able to fund everything we want — or even everything that needs to be funded.
So why then, is LePage spending $1 million on a no-bid contract to a man whose stance on MaineCare is already well-known and well-documented? In fact, under his direction, the state ofPennsylvania kicked nearly 90,000 children off of its state-run health care program.
This $1 million out-of-state consultant is cut from the same tea party cloth as LePage. So it’s not clear why we need to pay someone else $1 million to hear the same rhetoric we hear every day from LePage.
The state’s financial priorities need to reflect the priorities of the people of Maine — not the ideology of a fringe group.
A million dollars can go a long way.
It could go toward providing property tax relief to Maine homeowners.
As we approach another cold Maine winter, it could go toward fuel assistance for needy Maine families.
It could go toward worker retraining for Mainers who were laid off and haven’t yet returned to the workforce.
It could help more Maine children enroll in early childhood programs such as Head Start. Or it could provide more free lunches to hungry students.
Maine allows Anthem to renew health plans due for cancellation under Obamacare
Posted Nov. 26, 2013, at 4:22 p.m.
AUGUSTA, Maine — Many Mainers facing cancellation of their health insurance can keep plans that don’t comply with Obamacare for another year, under a decision issued Tuesday by Maine’s top insurance official.
The decision by Maine Insurance Superintendent Eric Cioppa affects at least 8,500 Mainers who buy their health insurance from Anthem BlueCross BlueShield in the “individual market,” made up of consumers who can’t access coverage through work or government programs such as Medicaid and Medicare. Those Anthem policyholders now have another year to find a plan that complies with the Affordable Care Act, often called Obamacare.
“This decision is meant to give several thousand Maine policyholders another option for 2014,” Cioppa said in the release. “It will also result in a smaller premium increase for those choosing to continue their current plan, and provide more time for those individuals to evaluate plans for future years.”
Cioppa’s decision to allow Anthem to renew plans due for cancellation came two weeks after President Barack Obama asked states to allow insurance companies to renew through 2014 policies that fall short of new requirements set forth in his signature health reform law. The move was a retreat from a central goal of the law, to put an end to insurance plans that don’t offer adequate coverage. Obama proposed the fix amid the prospect that millions of Americans could see their plans canceled, despite his promises that Americans could keep their plans if they liked them.
The onslaught of cancellations nationally came about because insurers must stop selling plans that don’t meet certain requirements of the health reform law. The existing plans may not cover maternity care, for example, one of several required health benefits, or may carry overly high deductibles.
While the federal government won’t punish insurers for renewing the noncompliant plans, carriers also need the greenlight from state regulators. Insurance officials are under the gun to decide, with just five weeks to go before the policies would take effect on Jan. 1, 2014.
Even with Cioppa’s decision, Anthem could have chosen not to renew the plans, but the health insurer said in a statement late Tuesday that it will keep offering the noncompliant plans in Maine.
Some of Anthem’s individual policyholders already could choose to keep their plan, provided their coverage was “grandfathered” — or in place before the health reform law passed in March 2010 and unchanged since then — and exempt from many of its provisions.
For 8,500 other “nongrandfathered” Anthem customers with newer plans, their coverage faced cancellation. The largest insurer in Maine’s individual market, Anthem notified its Maine policyholders that their plans would be canceled and replaced with the most comparable ACA-compliant plan, according to the state insurance bureau.
Those cancellations are now on hold for a year.
Affordable Care: Separate plans for domestic partners
“My domestic partner and I are not legally married in any state and the state in which we live does not allow gay marriage. We are both 22 years old. Will we need to apply for two separate insurance plans, or may we purchase one and have both of on the plan?”
Two South Carolina Peaches
Dear South Carolina Peaches,
Here is what I can surmise from the plan summaries available on South Carolina Blue Cross’s website.
Since you are not legally married (and not living in a state that recognizes same-sex marriage), you will be buying two separate plans. This is not a huge disadvantage, however. The rates for a married couple are two times the individual rate; they don’t get a “discount” for having a legal union. The deductible for the plan also applies to each person separately. So, there is no extra benefit here either.
Because you will be under age 30 as of January 1, 2014, you may be able to choose a catastrophic plan. This plan has a $6,350 deductible. In addition to being under 30, you also have to get a hardship exemption showing that you cannot afford another plan. To check this out, call 800-318-2596 or go to healthcare.gov when it is working.
Your state is not expanding Medicaid to new groups, but you may want to keep an ear to the ground on this. Health economists believe that eventually all of the states will expand Medicaid. This means that people would be able to join based simply on their income, not based upon whether they are pregnant, have small children, etc. etc.
Even Without Expansion, S.C. Will See 16% Jump In Medicaid Enrollment
This KHN story was produced in collaboration with 
Like half the states, South Carolina chose not to expand Medicaid under the federal health law next year, citing the program’s high costs and inefficiency.
Yet, state officials still forecast a 16 percent enrollment jump by the end of June, 2015, triple that of a typical year and even higher than the 12 percent average increase expected in states that are expanding eligibility.
What’s going on?
South Carolina officials say publicity for the Affordable Care Act and its requirement that most people get insurance will attract tens of thousands of people who are currently eligible for Medicaid but have not enrolled.
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