Amid the Uproar Over the Health Law, Voices of Quiet Optimism and Relief
By ABBY GOODNOUGH, KATIE THOMAS and REED ABELSON
Since his chronic leukemia was diagnosed in 2010, Ray Acosta has paid dearly for health insurance: more than $800 a month in premiums, plus steep co-payments for the drug that helps keep him alive.
Mr. Acosta, 57, owns a small moving company in Sierra Vista, Ariz., which he said had barely made it through the recession. He was thinking about dropping his coverage, but the insurance company beat him to it, informing him recently that it would cancel his policy at year’s end.
He sought advice from an insurance agent who had used his moving company. She connected him with an application counselor at a community health center, who found — to Mr. Acosta’s astonishment — that he qualified for Medicaid under the new health care law, the Affordable Care Act, which gives states the option of expanding the program to include more low-income adults.
“I’m kind of in a disbelieving fog,” Mr. Acosta said last week, two days after completing an application. “I’m just hoping, keeping my fingers crossed, that this might really help me out.”
The rollout of the health care law has been plagued with problems so deep that even some of its strongest supporters have soured on its potential. The bottlenecks in the federal online insurance exchange, which serves 36 states; the cancellation of hundreds of thousands of policies that did not comply with the minimum requirements of the new law; and the high price of some plans sold through both federal and state-run exchanges have all cast a pall over President Obama’s efforts to win support for the law.
But for all those problems, people are enrolling. More than 243,000 have signed up for private coverage through the exchanges, according to the Kaiser Family Foundation, and more than 567,000 have been determined eligible for Medicaid since the exchanges opened on Oct. 1. For many, particularly people with existing medical conditions like Mr. Acosta, the coverage is proving less expensive than what they had. Many others are getting health insurance for the first time in years, giving them alternatives to seeking care through free clinics or emergency rooms — or putting it off indefinitely.
On Health Exchanges, Premiums May Be Low, but Other Costs Can Be High
By ROBERT PEAR
WASHINGTON — For months, the Obama administration has heralded the low premiums of medical insurance policies on sale in the insurance exchanges created by the new health law. But as consumers dig into the details, they are finding that the deductibles and other out-of-pocket costs are often much higher than what is typical in employer-sponsored health plans.
Until now, it was almost impossible for people using the federal health care website to see the deductible amounts, which consumers pay before coverage kicks in. But federal officials finally relented last week and added a “window shopping” feature that displays data on deductibles.
For policies offered in the federal exchange, as in many states, the annual deductible often tops $5,000 for an individual and $10,000 for a couple.
Insurers devised the new policies on the assumption that consumers would pick a plan based mainly on price, as reflected in the premium. But insurance plans with lower premiums generally have higher deductibles.
In El Paso, Tex., for example, for a husband and wife both age 35, one of the cheapest plans on the federal exchange, offered by Blue Cross and Blue Shield, has a premium less than $300 a month, but the annual deductible is more than $12,000. For a 45-year-old couple seeking insurance on the federal exchange in Saginaw, Mich., a policy with a premium of $515 a month has a deductible of $10,000.
In Santa Cruz, Calif., where the exchange is run by the state, Robert Aaron, a self-employed 56-year-old engineer, said he was looking for a low-cost plan. The best one he could find had a premium of $488 a month. But the annual deductible was $5,000, and that, he said, “sounds really high.”
By contrast, according to the Kaiser Family Foundation, the average deductible in employer-sponsored health plans is $1,135.
“Deductibles for many plans in the insurance exchanges are pretty high,” said Stan Dorn, a health policy expert at the Urban Institute. “These plans are more generous than what’s prevalent in the current individual insurance market, but significantly less generous than most employer-sponsored insurance.”
Caroline F. Pearson, a vice president of Avalere Health, a consulting company that has analyzed hundreds of plans, said: “The premiums are lower than expected, but consumers on the exchange will often face high deductibles and high co-payments for medical services and prescription drugs before they reach the cap on out-of-pocket costs,” $6,350 for an individual and $12,700 for a family.
What Obama Left Out of His Inequality Speech: Regulation
By THOMAS O. MCGARITY
AUSTIN, Tex. — President Obama’s speech on inequality last Wednesday was important in several respects. He identified the threat to economic stability, social cohesion and democratic legitimacy posed by soaring inequality of income and wealth. He put to rest the myths that inequality is mostly a problem afflicting poor minorities, that expanding the economy and reducing inequality are conflicting goals, and that the government cannot do much about the matter.
Mr. Obama also outlined several principles to expand opportunity: strengthening economic productivity and competitiveness; improving education, from prekindergarten to college access to vocational training; empowering workers through collective bargaining and antidiscrimination laws and a higher minimum wage; targeting aid at the communities hardest hit by economic change and the Great Recession; and repairing the social safety net.
But there’s a crucial dimension the president left out: the revival, since the mid-1970s, of the laissez-faire ideology that prevailed in the Gilded Age, roughly the 1870s through the 1910s. It’s no coincidence that this laissez-faire revival — an all-out assault on government regulation — has unfolded over the very period in which inequality has soared to levels not seen since the Gilded Age.
History tells us that in periods when protective governmental institutions are weak, irresponsible companies tend to abuse their economic freedom in ways that harm ordinary workers and consumers. The victims are often less affluent citizens who lack the power either to protect themselves from harm or to hold companies accountable in the courts. We are in such a period today.
The laissez-faire revival of the past 35 years was no accident. The protective statutes and liberal common-law doctrines of the late 1960s and early 1970s — what can be called the Public Interest Era — had a profound impact in such areas as occupational safety and health, environmental protection, consumer finance and the safety of food, drugs and consumer products. This legislative and judicial activism placed far more constraints on the economic freedom of corporate America than had any legal regime preceding it.
It also galvanized a “divert and delay” strategy of resistance by businesses, which lobbied against the new statutes and resisted the efforts of newly empowered regulators and plaintiffs. The laissez-faire revival, however, required more than resistance to change. It also took the determined efforts of a relatively small number of philanthropists and academics to create what I call an “idea infrastructure” around minimalist regulation, popularizing that ideology and persuading Congress, the executive branch, and the courts to scale back constraints on corporations.
Got Obamacare? Only the Oracle knows.
By Marc A. Thiessen,
Just as ancient Greeks trekked the slopes of Mount Parnassus to have the Oracle of Delphi divine their future, so Senate staffers are now trekking the halls of Congress to meet the Oracle of Obamacare, who can divine whether they will have health coverage in their future.Like most Americans, members and staff on Capitol Hill have been tied in knots trying to sign up for Obamacare. The D.C. exchange has been crashing, sending error messages and creating multiple applications — leaving senators and aides unsure whether they actually managed to get coverage.
But unlike most Americans, they don’t have to worry or wait.
They can just ask the Oracle.
Last Thursday, a Democratic staffer sent an e-mail alerting colleagues to her existence. “There is a woman in Hart [Senate Office Building] 216 who will tell you if your health care application went through. Takes about 30 seconds,” the staffer wrote. “They call her the Oracle.”
Apparently, the Oracle moves around, and Senate aides track her movements by e-mail. “Moved to SVC-201 today,” one message declared Friday, adding, “We are told she never stays in one place for more than 24 hrs.” Another advised, “On Monday, the Oracle will be in Dirksen room G50!”
While the Oracle may be telling congressional staff whether they will have health insurance on Jan. 1, the rest of America is not so lucky. In a late Friday bad-news dump, the Obama administration admitted last week that 25 percent of applications on the federal Obamacare Web site in October and November had errors. The Post reported, “In some instances, the system wasnot sending insurers records of people who had enrolled. Other errors have included duplicative enrollment and cancellation notices for the same person, incorrect information about family members and mistakes involving federal subsidies.”
What this means is one in four Americans who think they signed up for Obamacare through HealthCare.gov may not actually have signed up at all.
Even after re-launching the Web site last week and assuring Americans that it was working with “private-sector velocity and effectiveness,” the Obama administration now admits that the system continues to mess up one in 10 applications. Since the volume of people trying to sign up will likely grow each day as the Dec. 23 deadline to enroll for Jan. 1 coverage approaches, a significant number could be in for a rude New Year’s awakening when they learn that they are uninsured. At least when Americans could not access Obamacare on the Web, they knew they had no insurance. Now many think they have signed up for health coverage but really have not.
The same problem appears to be happening in the state exchanges, as well. Insurers in Minnesota recently complained to state exchange officials, “At this late date, the health plan companies do not have most of the names or information on individuals who have enrolled through MNsure.” The state exchanges in Hawaii and Maryland have been such a disaster that their directors have both resigned. In Washington state, the exchange has been giving thousands of people incorrect subsidy data. Insurers in New York and Kentucky (held up as model exchanges) have alsoreported receiving erroneous data similar to that coming from the federal Web site.
In other words, Jan. 1 is going to be a train wreck for many Americans.
How will the Obama administration fix this impending disaster before the end of the year? Apparently, the plan is for the Centers for Medicare and Medicaid to send insurers a list on Dec. 23 of all the people who signed up in December. Insurers will then have to check that government list against their own roster of customers — many by hand. They will have eight days to identify and correct all the enrollment errors.
Keep in mind that millions of Americans have lost their insurance because of Obamacare and need to be enrolled before the new year to avoid gaps in coverage. It will be nearly impossible for insurers to process all those new applications in eight days, much less find and fix the mistakes generated by the federal and state exchanges, which means it is probable that many Americans may not learn whether they are insured until well after Jan. 1.
Indeed, there is a growing possibility that there will be more uninsured Americans at the start of the new year than there were before the launch of Obamacare.
How will Americans know whether that nightmare came to pass? For many, it could be when they try to visit their doctor or hospital next year — and find out they are not covered after all.
Too bad they can’t ask the Oracle.
Health Care Exchange Is Vastly Improved, Users Say
By LIZETTE ALVAREZ and JENNIFER PRESTON
MIAMI — After two months of false starts, error messages and pleas for patience from the once-hobbled federal online health care exchange, Karen Egozi, the chief executive of the Epilepsy Foundation of Florida, watched on Monday as counselors navigated the website’s pages with relative ease.
Click. Next page. Click. Next page. The website, HealthCare.gov, was working so well that Ms. Egozi, who oversees the 45 navigators in eight locations who help consumers enroll in health plans, said her team gave the system an 8 on a scale of 1 to 10, meaning that most people got as far as selecting a plan or taking home information to select a plan. It felt like a champagne moment.
“I’m 80 percent satisfied,” Ms. Egozi said. “I think it will be great when it’s 100 percent.”
A little over a week after the deadline that President Obama gave for fixing the federal health care exchange, the system is definitely working better, according to consumers and navigators interviewed in several states. The technical errors that had bedeviled visitors to the site for weeks seemed to have been tamed by the patchwork of hardware and software fixes ordered by the administration, and applicants were finally selecting health care plans under the president’s new law, the Affordable Care Act. By last week, the number of applicants who dropped a plan into their virtual grocery carts was climbing at a rapid clip.
Still, the interviews indicated, some technical obstacles persist. After shoppers clicked all the way to the plans, for example, the system was not letting some people actually choose one. In other cases, people were asked to try again later.
Improved entry into the online marketplace has also exposed a new layer of problems and confusion for applicants who are suddenly finding their efforts to buy insurance delayed by requirements that they provide proof of identity or citizenship or that they wait for determinations on Medicaid eligibility.
For the most part, though, the news for the beleaguered online exchange, which serves 36 states, is improving. Since early December, the federal exchange website has run without crashing, officials said. In the first week of December, about 112,000 people selected plans — compared with about 100,000 in all of November and only 27,000 in October. Last week, more than half a million people created accounts on the federal website, according to people familiar with the health care project.
Technical experts involved with the exchange said they are now preparing for a surge of applications before Dec. 23, the enrollment deadline to receive coverage by the first of the year. Although those preparations will require some significant changes to the system, the work will be easier now that the site seems stable during heavy use, the experts said.
In offices spread across the country, from Florida and Pennsylvania to Wyoming and Wisconsin, all of them states that rely on the federal government’s insurance exchange, navigators and applicants reported far fewer problems.
AIDS advocates say drug coverage in some marketplace plans is inadequate
By Ariana Eunjung Cha,
The nation’s new health-care law says insurers can’t turn anyone away, even people who are sick. But some companies, patient advocates say, have found a way to discourage the chronically ill from enrolling in their plans: offer drug coverage too skimpy for those with expensive conditions.Some plans sold on the online insurance exchanges, for instance, don’t cover key medications for HIV, or they require patients to pay as much as 50 percent of the cost per prescription in co-insurance — sometimes more than $1,000 a month.
“The fear is that they are putting discriminatory plan designs into place to try to deter certain people from enrolling by not covering the medications they need, or putting policies in place that make them jump through hoops to get care,” said John Peller, vice president of policy for the AIDS Foundation of Chicago.
As the details of the benefits offered by the new health-care plans become clear, patients with cancer, multiple sclerosis, rheumatoid arthritis and autoimmune diseases also are raising concerns, said Marc Boutin, executive vice president of the National Health Council, a coalition of advocacy groups for the chronically ill.
“The easiest way [for insurers] to identify a core group of people that is going to cost you a lot of money is to look at the medicines they need and the easiest way to make your plan less appealing is to put limitations on these products,” Boutin said.
Insurers say that such accusations are unfounded, and that the drug coverage is more than adequate, with many plans exceeding the minimum levels required by the Affordable Care Act. But they acknowledge that to keep premiums low, they must restrict the use of some costly drugs if there are alternatives. And they say that when high-priced medications must be used, it’s reasonable to expect patients to pick up more of the cost.
Robert Zirkelbach, a spokesman for American’s Health Insurance Plans, an industry group, said the exchange plans are designed “to try to give consumers better value for their health-care dollars.”
Joanne Peters, a spokeswoman for the Department of Health and Human Services, said that the new health-care law will give many consumers access to the medicines they need for the first time but that if a plan doesn’t cover a particular drug, patients can ask insurers for an exception. She said the government is asking the companies to respond to such requests within three days.
The health-care law has been celebrated by people with serious illnesses, some of whom have been unable until now to obtain coverage. Starting Jan. 1, insurers must take all comers and are barred from imposing lifetime limits on reimbursements. For those who purchase on the marketplace, annual out-of-pocket costs will be limited to $6,350 for individuals and $12,700 for families. (The Obama administration granted a one-year grace period for some group plans to implement the new limit.)
But people who expected the new plans to provide pharmaceutical coverage comparable with that of employer-sponsored plans have been disappointed. In recent years, employers have compelled workers to pick up a growing share of the costs, especially for brand-name drugs. But insurers selling policies on the exchanges have pared their drug benefits significantly more, according to health advocates, patients and industry analysts. The plans are curbing their lists of covered drugs and limiting quantities, requiring prior authorizations and insisting on “fail first” or “step therapy” protocols that compel doctors to prescribe a certain drug first before moving on to another — even if it’s not the physician’s and patient’s drug of choice.
LIVES AND
LIVELIHOODS LOST
The High Cost of Rejecting Medicaid Expansion
The High Cost of Rejecting Medicaid Expansion
THE AffoRDAblE CARE ACT (ACA) gives 16 million
uninsured Americans access to non-emergency
health care for the first time by offering more than
$800 billion in federal funding to states over the
next 10 years to expand Medicaid. So far, 25 states
and the District of Columbia have opted to take
advantage of this money to provide health coverage
to adults with incomes of up to 138 percent of the
federal Poverty level. This Medicaid expansion will
improve individuals’ health, extend thousands of
lives, increase economic growth and strengthen the
financial stability of hospitals on which both rich
and poor rely.
In the rest of the states, political leaders who are openly hostile to the law are prioritizing their anti-ACA agenda and callously denying health benefits to millions of adults who would otherwise be eligible for Medicaid. The states that so far have opted out of Medicaid expansion are rejecting a breathtaking $426 billion in federal funds over 10 years. These infusions of federal funds would spark regional economies by increasing employment, boosting household spending and generating significant tax revenue to support state and local services.1
When uninsured people gain Medicaid coverage, they become healthier and life expectancy increases.2 but in states that refuse to expand Medicaid, nearly 5 million people will find themselves in limbo— unable to afford unsubsidized private insurance
and also ineligible for both the public safety-net program and subsidies to purchase plans in the ACA marketplaces. Significantly, research shows that closing this “coverage gap” could
In the rest of the states, political leaders who are openly hostile to the law are prioritizing their anti-ACA agenda and callously denying health benefits to millions of adults who would otherwise be eligible for Medicaid. The states that so far have opted out of Medicaid expansion are rejecting a breathtaking $426 billion in federal funds over 10 years. These infusions of federal funds would spark regional economies by increasing employment, boosting household spending and generating significant tax revenue to support state and local services.1
When uninsured people gain Medicaid coverage, they become healthier and life expectancy increases.2 but in states that refuse to expand Medicaid, nearly 5 million people will find themselves in limbo— unable to afford unsubsidized private insurance
and also ineligible for both the public safety-net program and subsidies to purchase plans in the ACA marketplaces. Significantly, research shows that closing this “coverage gap” could
save the lives of more than 27,000 people
in 2014. Governors and legislators who refuse to fully participate in Medicaid must face up to the moral and ethical implications of blocking health coverage for their most vulnerable constituents. This policy choice is not only unconscionable, it harms everyone in those states, whether insured or not.
Governors and state legislators who fight the health care law by failing to use available federal funds
to expand Medicaid enrollment also compromise the economic competitiveness and fiscal outlook
of their states, according to data developed by health care advocates, hospital associations, think tanks, universities and researchers. Hospitals in non-expansion states will be put at a severe competitive disadvantage that will result
in insurers excluding them from their networks, which in turn will force hospital administrators to offset lost business with increased out-of-pocket costs for people with private insurance. Rejection may satisfy the ideological fervor of officeholders averse to the ACA, but it does not relieve health care providers of the legal obligation to provide emergency care and stabilization to the uninsured under the Emergency Medical Treatment and labor Act, which was signed into law by President Ronald Reagan in 1986. State and local governments, private insurers, hospitals and doctors must shoulder the costs of caring for the uninsured. While expansion states enjoy new federal investment and economic growth, residents of non-expansion states will face a declining
quality of life, a weaker economy, and destabilized hospitals—including some that will be forced to close their doors.
http://healthcareforamericanow.org/wp-content/uploads/2013/12/Medicaid10.pdf
in 2014. Governors and legislators who refuse to fully participate in Medicaid must face up to the moral and ethical implications of blocking health coverage for their most vulnerable constituents. This policy choice is not only unconscionable, it harms everyone in those states, whether insured or not.
Governors and state legislators who fight the health care law by failing to use available federal funds
to expand Medicaid enrollment also compromise the economic competitiveness and fiscal outlook
of their states, according to data developed by health care advocates, hospital associations, think tanks, universities and researchers. Hospitals in non-expansion states will be put at a severe competitive disadvantage that will result
in insurers excluding them from their networks, which in turn will force hospital administrators to offset lost business with increased out-of-pocket costs for people with private insurance. Rejection may satisfy the ideological fervor of officeholders averse to the ACA, but it does not relieve health care providers of the legal obligation to provide emergency care and stabilization to the uninsured under the Emergency Medical Treatment and labor Act, which was signed into law by President Ronald Reagan in 1986. State and local governments, private insurers, hospitals and doctors must shoulder the costs of caring for the uninsured. While expansion states enjoy new federal investment and economic growth, residents of non-expansion states will face a declining
quality of life, a weaker economy, and destabilized hospitals—including some that will be forced to close their doors.
http://healthcareforamericanow.org/wp-content/uploads/2013/12/Medicaid10.pdf
HCAN Report Reveals Human, Economic Costs of States’ Rejection of Expanded Medicaid Funding
GOP Governors, Lawmakers Sacrifice Thousands of Lives, Raise Out-Of-Pocket Costs for People With Private Plans, Destabilize Hospitals By Forgoing $426 Billion in Committed Federal Funds
Washington, D.C. – Governors and lawmakers in 25 states who reject federal support to expand state Medicaid programs are sacrificing thousands of lives and pushing away enormous economic development benefits that come with $426 billion in direct funding over 10 years, according to a new report by Health Care for America Now (HCAN), the nation’s leading grassroots health care advocacy group. While states that fully participate in Medicaid provisions of the Affordable Care Act (ACA) will enjoy new federal investment and improved economic growth, residents of states rejecting Medicaid expansion face a declining quality of life, a weaker economy and destabilized hospitals—including some that will be forced to close, according to the report. Research at the Harvard School of Public Health suggests that the 25 states’ refusal to accept the Medicaid funds may result in the deaths of 27,452 Americans in 2014 as those states forgo funding of health benefits that are expected to reduce mortality rates for low-income adults.
“Governors and legislators who refuse to fully participate in Medicaid must face up to the moral and ethical implications of blocking health coverage for their most vulnerable constituents,” said Ethan Rome, HCAN’s executive director. “In addition to rejecting billions and denying care to millions, they're consigning thousands to death. This policy choice is not only unconscionable, it harms everyone in those states whether insured or not. Perhaps the greatest irony of refusing the ACA funding is that it will impose higher costs on insured people in states that claim they can’t afford to expand Medicaid.”
Yesterday supporters of the ACA around the nation talked about the benefits of Medicaid expansion. Today in LIVES AND LIVELIHOODS LOST: The High Cost of Rejecting Medicaid Expansion, HCAN reports these key findings:
· Medicaid expansion can be expected to reduce mortality rates among low-income adults to 6.1 percent below that of neighboring states that reject the program. Extending Medicaid benefits to this population prevents 2,840 deaths per year for each 500,000 adults gaining coverage, according to a study by Harvard researchers in the New England Journal of Medicine. Based on this formula, governors and state lawmakers who are blocking access to health care for 4.8 million low-income people will prevent Medicaid from saving 27,452 lives in 2014 alone.
· Hospitals in non-expansion states will be put at a significant competitive disadvantage, resulting in insurance companies excluding them from provider networks because the hospitals must charge insured patients higher fees to cover uncompensated care costs. Hospital administrators will offset lost network business by increasing out-of-pocket costs for people with private insurance, according to a hospital finance expert and medical school professor at Johns Hopkins University Bloomberg School Public Health. Hospitals in those states are already being negatively affected with higher borrowing costs in Wall Street bond markets from which they obtain funds for construction and other major projects.
· While rejection of Medicaid expansion and other ACA programs may satisfy the ideological fervor of many Republican officeholders, it does not relieve health care providers of the legal and ethical obligation to provide emergency care and stabilization to the uninsured under the Emergency Medical Treatment and Labor Act. That law was enacted with President Ronald Reagan’s approval in 1986. The cost of complying with emergency treatment laws will not go away, and the burden of uncompensated care must be borne by hospitals, doctors, local taxpayers and charities.
“In 2009, extremist Republicans intentionally spread phony stories about ‘death panels’ to scare Americans into thinking the law would block their medical care when they needed it most,” said HCAN Executive Director Ethan Rome. “Now it’s clear that the only real death panels consist of Republican governors and lawmakers who are choosing to block the doorway to state Medicaid expansion and keep nearly 5 million Americans away from the medical care they need.”
Health care providers across the country witness the damage caused by unaffordable care and are pushing states to cover more people through Medicaid. “Every day, SEIU’s nurses and doctors see what happens when patients delay or forgo necessary health care because they can't afford it,” said Dr. L. Toni Lewis, Chair of SEIU Healthcare and a board certified family physician. “By refusing to expand Medicaid, extremist politicians have chosen to deny millions of families the care they desperately need and deserve.”
Key provisions of the ACA will take effect on Jan. 1, 2014, when millions of uninsured Americans will begin using subsidized private health plans or expanded Medicaid eligibility to protect themselves and their families from disastrous medical costs. Washington has devoted five years of raucous public debate to the law so far, and the controversy has shown no sign of letting up as implementation of the ACA’s broadest provisions draws nearer. In October, Republicans shut down the government in a failed effort to force repeal of the ACA. Opponents of health reform, including special interest groups spending unprecedented sums of money to undermine the law and its base of public support, have tried every available weapon in their arsenal of legislative, political, legal, regulatory and communications tactics. These include putting intense political pressure on governors deliberating over whether to fully participate in Medicaid. The question for leaders in those states is whether they will rationalize politically motivated policy choices that will inflict serious harm on their own economies and the quality of life for millions of people.
Florida is one of the largest states to say no to Medicaid expansion, and progressive advocates are putting the spotlight on this historic failure of leadership. “Shame on Gov. Scott and House Republican leaders for failing to expand Medicaid,” said Mishell Warner, a Miami Gardens nurse and member of AFSCME. “I know how devastating this is for the working poor who desperately need health care coverage. There is federal money on the table to get this done, but our political leaders are failing to put the needs of Florida ahead of their political agenda.”
.
Several Maine towns far from health insurance sign-up help
By Alanna Durkin
The Associated Press
The Associated Press
AUGUSTA — Nearly a dozen of Maine’s largest communities are more than 15 miles from the nearest navigator or counselor who can help residents sign up for coverage on the health insurance marketplace, according to an analysis presented to lawmakers Monday.
RELATED HEADLINES
Of the 77 Maine communities where most people work and shop and where most hospitals and colleges are, 11 don’t have navigators or certified application counselors within 15 miles, the Maine Health Access Foundation found.
Counselors and navigators walk people through the online application for the marketplace, a key part of the Affordable Care Act, and answer questions about the plans being offered in Maine.
Health care groups say people who live in those areas have other resources, like statewide help lines, and aren’t on their own in signing up for coverage.
But the lack of helpers in some areas across the large, rural state is raising concerns that not everyone who needs help is getting it.
“We have lots of people that aren’t super-familiar with using the Internet and using computers and are just not comfortable with it, and so we need to have a way to reach out to those people, and I think with so few navigators that’s very challenging,” said Democratic Rep. Sharon Treat of Hallowell, co-chair of the panel of lawmakers and health care experts that’s overseeing the roll-out of the health care overhaul in Maine.
Dirigo Health board forgoes monthlong extension
Posted Dec. 09, 2013, at 1:13 p.m.
AUGUSTA, Maine — Maine’s Dirigo Health insurance program will end Dec. 31 as planned, after its trustees opted against extending the program to help enrollees transition to new coverage.
At a Monday morning meeting, members of Dirigo’s board of trustees decided to forego a one-month extension, a move that was under discussion given the troubled rollout of Healthcare.gov, according to Joe Bruno, the board’s chairman The federal website, the online gateway for a new health insurance marketplace set up under the Affordable Care Act, has been beset by technical problems since its launch on Oct. 1, preventing many Americans, including Dirigo beneficiaries, from enrolling.
Now that the website appears to be improving and more people have been able to sign up for coverage, the Dirigo extension isn’t needed, Bruno said. Dirigo has 2,800 beneficiaries left, and many of its small business customers are shifting to other policies, he said.
Dirigo Health, signed into law a decade ago, was a signature initiative of former Maine Gov. John Baldacci and an effort to make health insurance more affordable for individuals and small businesses. The program offers coverage through Harvard Pilgrim Health Care.
Under Gov. Paul LePage, Republicans stripped Dirigo of funding, paving the way for the program to phase out at the end of this month.
If they’re terminal, let Mainers choose how they die
Posted Dec. 09, 2013, at 11:38 a.m.
Despite the controversy surrounding assisted suicide, and the recent rejection of a bill trying to legalize it, there are still many people who, chances are, would actively seek out the means to end their lives rather than live with a terminal illness.
The bill — entitled “An Act Regarding Patient-directed Care at the End of Life” — was sponsored by Rep. Joseph Brooks, I-Winterport, and laid out what looks like, to me, very clear, strict circumstances in which an individual could end his or her life, many of which centered on the patient’s decisions and awareness. It also would have given medical professionals the ability to prescribe lethal doses of medication while freeing them from legal recourse.
And yet it was still shot down, by a vote of 95-43 in the Maine House. Legislators should review the issue because the choice should remain with the individual.
Every day there are people suffering and dying from terminal illnesses. Some would prefer to die natural deaths, and that’s OK, because they’re the ones choosing to do so. But then there are others who would pick assisted suicide, were it available to them. And yet they don’t have that choice. Why should they be denied the right to make choices regarding their own lives? Because that’s what it really comes down to: a choice.
Palliative and hospice care are not horrible, but some people remain in agony regardless of any comforts that can be provided to them, and they don’t have the option — or the ability — to end their lives if they wanted to. Worse, they are condemned for their desire to end their lives with dignity.
People should not be euthanized without their consent; that is murder, no matter what disguise you put it under. What I’m talking about is the choice someone makes regarding his or her own life when that life becomes unbearable due to terminal illness. Even if I don’t think I myself would ever choose to do it, I can see why others would. I can only imagine what a struggle it would be for someone to know that he or she is dying in a manner that will likely not be very peaceful. Assisted suicide would give these people the chance to say their goodbyes while they are still able.
Should you get surgery for your back pain or physical therapy? When is heart surgery preferable to drug treatment? Before too long, you might get some answers.
Doctors, hospitals and researchers often don’t have the information they need to gauge the effectiveness of one test or treatment against another — or against none.
One little-heralded part of President Obama’s health care reform law proposes to change that, possibly transforming medical practice for the better — but also probably inciting renewed political warfare over health-care “rationing.”
In July, the government began collecting a small tax on health insurers and sending the proceeds to the Patient-Centered Outcomes Research Institute, an advisory committee tasked with, basically, rigorous review of what works and what doesn’t. One of PCORI’s latest grants went to set up a research network that will pull in data on patient experiences across the country.
The concept is simple enough. The government should have delved into this sort of research with such ambition many years ago, as health care costs rose steadily above inflation. Yet there are challenges. Maybe a treatment affects women differently from men, or the young more than the old. The statisticians will have to tease out those and other confounding effects. Results will not always be clear.
Even when they are, people will have to be convinced. Many will resist giving up a test or a drug they have come to trust, even if it’s proven ineffective.
PCORI will encounter its share of political dogfights. Removing ineffective treatment from the health care system will be far from painless.
But the alternative should be much less tolerable.
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