Millions Gaining Health Coverage Under Law
By ROBERT PEAR and ABBY GOODNOUGH
WASHINGTON — Millions of Americans will begin receiving health insurance coverage under the Affordable Care Act on Wednesday after years of contention and a rollout hobbled by delays and technical problems. The decisively new moment in the effort to overhaul the country’s health care system will test the law’s central premise: that extending coverage to far more Americans will improve the nation’s health and help many avoid crippling medical bills.
Starting Wednesday, health insurance companies can no longer deny coverage to people with pre-existing conditions and cannot charge higher premiums to women than to men for the same coverage. In most cases, insurers must provide a standard set of benefits prescribed by federal law and regulations. And they cannot set dollar limits on what they spend on “essential health benefits” for a policyholder.
Though this is a milestone for the law, it is unlikely to end the constant partisan battles that began even before its passage nearly four years ago. Late Tuesday, Justice Sonia Sotomayor temporarily blocked the Obama administration from forcing some religious-affiliated groups to provide coverage of birth control or face penalties.
Doctors, hospitals and pharmacists say consumers could initially experience some delays and difficulties as they try to use their new insurance.
“I feel a huge sense of relief,” said Katie R. Norvell, 33, a music therapist in St. Louis, who has been uninsured for three and a half years and has a pre-existing gynecological condition, endometriosis. She signed up Dec. 22 for a midlevel silver plan offered by Coventry Health Care, owned by Aetna, and has already begun making doctor’s appointments.
“With coverage,” she said, “I can be my best self. Health insurance won’t control my job choices.”
A series of last-minute changes in rules and deadlines for people to sign up and pay premiums have left less time for insurers to activate coverage and issue identification cards, adding to the uncertainty caused by the troubled rollout of the health exchange.
“There will be a lot of confusion,” said Brian D. Caswell, a former president of the Kansas Pharmacists Association, who owns a drugstore in rural Baxter Springs. “Many people will get insurance cards, but will not have a clue what’s covered, what’s not covered and what they are supposed to pay.”
Others may find their insurance companies have no record of their enrollment because the information was not sent by the online marketplaces where they signed up for coverage. Some of the newly insured may have trouble finding doctors who accept their health plans, many of which are restricting the number of providers in their networks to hold down premium costs.
WASHINGTON — Millions of Americans will begin receiving health insurance coverage under the Affordable Care Act on Wednesday after years of contention and a rollout hobbled by delays and technical problems. The decisively new moment in the effort to overhaul the country’s health care system will test the law’s central premise: that extending coverage to far more Americans will improve the nation’s health and help many avoid crippling medical bills.
Starting Wednesday, health insurance companies can no longer deny coverage to people with pre-existing conditions and cannot charge higher premiums to women than to men for the same coverage. In most cases, insurers must provide a standard set of benefits prescribed by federal law and regulations. And they cannot set dollar limits on what they spend on “essential health benefits” for a policyholder.
Though this is a milestone for the law, it is unlikely to end the constant partisan battles that began even before its passage nearly four years ago. Late Tuesday, Justice Sonia Sotomayor temporarily blocked the Obama administration from forcing some religious-affiliated groups to provide coverage of birth control or face penalties.
Doctors, hospitals and pharmacists say consumers could initially experience some delays and difficulties as they try to use their new insurance.
“I feel a huge sense of relief,” said Katie R. Norvell, 33, a music therapist in St. Louis, who has been uninsured for three and a half years and has a pre-existing gynecological condition, endometriosis. She signed up Dec. 22 for a midlevel silver plan offered by Coventry Health Care, owned by Aetna, and has already begun making doctor’s appointments.
“With coverage,” she said, “I can be my best self. Health insurance won’t control my job choices.”
A series of last-minute changes in rules and deadlines for people to sign up and pay premiums have left less time for insurers to activate coverage and issue identification cards, adding to the uncertainty caused by the troubled rollout of the health exchange.
“There will be a lot of confusion,” said Brian D. Caswell, a former president of the Kansas Pharmacists Association, who owns a drugstore in rural Baxter Springs. “Many people will get insurance cards, but will not have a clue what’s covered, what’s not covered and what they are supposed to pay.”
Others may find their insurance companies have no record of their enrollment because the information was not sent by the online marketplaces where they signed up for coverage. Some of the newly insured may have trouble finding doctors who accept their health plans, many of which are restricting the number of providers in their networks to hold down premium costs.
I Had My DNA Picture Taken, With Varying Results
By KIRA PEIKOFF
I like to plan ahead; that much I knew about myself before I plunged into exploring my genetic code. I’m a healthy 28-year-old woman, but some nasty diseases run in my family: coronary heart disease, rheumatoid arthritis, Alzheimer’s and breast cancer.
So I decided to read the tea leaves of my DNA. I reasoned that it was worth learning painful information if it might help me avert future illness.
Like others, I turned to genetic testing, but I wondered if I could trust the nascent field to give me reliable results. In recent years, a handful of studies have found substantial variations in the risks for common diseases predicted by direct-to-consumer companies.
I set out to test the tests: Could three of them agree on me?
The answers were eye-opening — and I received them just as one of the companies, 23andMe, received a stern warning from the Food and Drug Administration over concerns about the accuracy of its product. At a time when the future of such companies hangs in the balance, their ability to deliver standardized results remains dubious, with far-reaching implications for consumers.
My experiment ran into hurdles from the start. After I ordered 23andMe’s saliva test kit, which for $99 promised a report on more than 240 health conditions and traits, it turned out that I could not legally send it in; the New York State Health Department forbids any labs that lack a state permit to accept specimens from a health-related test. Luckily, my in-laws mailed it from their home in New Jersey.
Then I learned that the other two companies I planned to approach were no longer offering genetic testing. Additional research led me to two more: Genetic Testing Laboratories and Pathway Genomics. G.T.L. charged $285 for a report on 25 disease risks, and required a professional sample collector to draw blood; Pathway charged $399 for a report on 24 disease risks. (In 2010, Pathway planned to sell its saliva test kit at Walgreens, but abandoned the idea after the F.D.A. challenged the sales. Now Pathway requires a doctor to order a kit on a patient’s behalf.)
After my tests had been sent, I braced myself for the revelations about my DNA. It took about two months to receive all the results, and when I did, the discrepancies were striking.
Roughed Up by an Orca? There’s a Code for That
By ANDREW POLLACK
Know someone who drowned from jumping off burning water skis? Well, there’s a new medical billing code for that.
Been injured in a spacecraft? There’s a new code for that, too.
Roughed up by an Orca whale? It’s on the list.
Next fall, a transformation is coming to the arcane world of medical billing. Overnight, virtually the entire health care system — Medicare, Medicaid, private insurers, hospitals, doctors and various middlemen — will switch to a new set of computerized codes used for determining what ailments patients have and how much they and their insurers should pay for a specific treatment.
The changes are unrelated to the Obama administration’s new health care law. But given the lurching start of the federal health insurance website, HealthCare.gov, some doctors and health care information technology specialists fear major disruptions to health care delivery if the new coding system — also heavily computer-reliant — isn’t put in place properly.
They are pushing for a delay of the scheduled start date of Oct. 1 — or at least more testing beforehand. “If you don’t code properly, you don’t get paid,” said Dr. W. Jeff Terry, a urologist in Mobile, Ala., who is one of those who thinks staffs and computer systems, particularly in small medical practices, will not be ready in time. “It’s going to put a lot of doctors out of business.”
The new set of codes, known as I.C.D.-10, allows for much greater detail than the existing code, I.C.D.-9, in describing illnesses, injuries and treatment procedures. That could allow for improved tracking of public health threats and trends, and better analysis of the effectiveness of various treatments.
Officials at the Centers for Medicare and Medicaid Services declined to be interviewed about the new codes. But a spokeswoman said that the agency was “committed to implementing I.C.D.-10 on Oct. 1, 2014, and that will not change.”
In a letter in November, Kathleen Sebelius, the secretary of health and human services, told Senator Jeff Sessions, Republican of Alabama, that the Medicare and Medicaid officials were working diligently to help doctors get ready. “I.C.D.-10 is foundational for building a modernized health care system that will facilitate broader access to high quality care,” she wrote.
Still, the troubles with HealthCare.gov have given new ammunition to those urging a go-slow approach on I.C.D.-10 and have made it harder for the government to stand behind assurances that the transition will go smoothly.
Despite Health Law, Many People May Be Left Underinsured
People with chronic conditions will be better protected from crippling medical bills starting in January, as the health law's coverage requirements and spending limits take effect.
But a recent analysis by Avalere Health found that many people may still find themselves underinsured, spending more than 10 percent of their income on medical care, not including premiums, even if they qualify for cost-sharing subsidies on the health insurance marketplaces.
"You have some great protections in place, but these out-of-pocket costs and how plans are structured are going to create some serious problems," says Marc Boutin, executive vice president at the National Health Council, an advocacy group for people with chronic health conditions.
The Obamacare We Deserve
By MICHAEL MOORE
TODAY marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.
That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.
I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.
What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.
By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.
The Obamacare Obama gets
Posted Dec. 31, 2013, at 10:13 a.m.
Who says government health care doesn’t work? There is a government health plan that is available to a small number of individuals. The risk pool consists of a few dozen people, all of whom work in one building in downtown Washington. If they need a check-up, the doctor comes up to their office for a house call. If they need a prescription, the medicine is delivered to their desks. If they need to see a specialist, they are taken by government transport to one of the best hospitals in the world. If they need surgery, a special suite is available.
And it is all free of charge.
This is not Obamacare. But it is the care President Barack Obama gets. Obama, his family and members of the White House senior staff are all taken care of by the doctors of the White House Medical Unit. It’s the best health plan in the world. I know. For a brief time, I was on it.
The president should have this kind of health care. And to the extent that he depends on having his top aides healthy and available to him, they should, too.
But with this kind of health coverage, why on earth did the president make such a show of “signing up” for Obamacare? He admittedly has no intention of using it. The White House says he signed up as a “symbolic” show of solidarity, so he could lead by example. Really? That would be like Obama signing up his kids to attend D.C. public schools as a sign of solidarity with the poor kids trapped in failing schools — but then saying it was just “symbolic” and sending his kids to their tony private school instead.
But since he was showing solidarity with the rest of America, did the president actually get on his computer like the rest of America and try to navigate the disastrous Obamacare website he created? Nope. While most people had to plug their personal information into a website that ABC News reports still has “serious security vulnerabilities,” the White House decided that for “security reasons” sharing the president’s personal information on government websites was unwise. So, an administration official said, “Like some Americans, the complicated nature of the president’s case required an in-person sign-up.”
Unreported robot surgery injuries open new questions for FDA
Posted Dec. 31, 2013, at 9:28 a.m.
NEW YORK — When Sheena Wilson, 45, underwent robotic surgery for a hysterectomy in May, she didn’t know the Intuitive Surgical Inc. system used by her doctor was previously tied to a variety of injuries for the same procedure.
Her rectum was badly burned in the operation, said Wilson, a mother of two from Parlin, N.J. Now, she is on long- term disability, fearful of losing her job and facing a third corrective surgery, she said in a telephone interview.
“If I had known there were other people who had injuries, I would never have done this surgery,” said Wilson, who has filed suit against Intuitive and her doctor. “Whatever they have in place is not working.”
The use of complex medical devices is exploding. Last year, Intuitive’s da Vinci robotic surgery system alone helped doctors perform more than 350,000 surgeries in U.S. hospitals. Yet patients like Wilson, whose lives depend on the proper use of increasingly complex high-tech medical equipment, often can’t get a complete picture of potential problems.
While a U.S. database lists reports of deaths and injuries sent to the Food and Drug Administration, the agency has no authority to force doctors to contribute. And while hospitals are supposed to report, they often don’t, critics say.
Indeed, a Bloomberg review of reports for operations with Intuitive’s robotic system found dozens of injuries that went unreported for years. Meanwhile, details of other patient problems involving use of the company’s product, cited in legal papers or in interviews with patients, were missing entirely.
“The adverse event reporting system is a disaster,” said David Challoner, vice president emeritus for health affairs at the University of Florida, who co-authored an Institute of Medicine report urging an overhaul of the FDA’s system for regulating and monitoring devices. “Every link in the chain has a reason not to report.”
The FDA, meanwhile, says it is “well aware of under- reporting of adverse events” and is working to improve the system, said William Maisel, chief scientist at the agency’s unit that oversees devices. “Even if there is under-reporting, it doesn’t mean you can’t draw conclusions from the data,” Maisel said in an interview.
Angela Wonson, an Intuitive spokeswoman, said that information about the safety of the company’s products is available through multiple data sources, including national surgery databases and clinical research. All of these sources, taken together, provide “a clear picture,” she said in an e- mailed response to questions.
While Wonson acknowledged there was a time gap for many injury reports, she said that’s because the company often isn’t aware of what happened until legal claims are made. In most cases, “there was no complaint at the time of the surgery or in the weeks thereafter by the patient, surgeon or hospital,” Wonson wrote.
Posted Dec. 31, 2013, at 9:39 a.m.
Adam Peterson’s life is about to change. For the first time in years, he is planning to do things he could not have imagined. He intends to have surgery to remove his gallbladder, an operation he needs to avoid another trip to the emergency room. And he’s looking forward to running a marathon in mid-January along the California coast without constant anxiety about what might happen if he gets injured.
These plans are possible, says Peterson, who turned 50 this year and co-manages a financial services firm in Champaign, Ill., because of a piece of plastic the size of a credit card that arrived in the mail the other day: A health insurance card.
Peterson is among the millions of uninsured Americans who are benefiting from the Affordable Care Act, the 2010 law that launched far-reaching changes to the U.S. health-care system and is President Barack Obama’s premiere domestic achievement.
These beneficiaries have not been oblivious to the problems of the new insurance exchanges, including a rollout so botched that Obama called it his biggest mistake of the year. Many, including Peterson, had first-hand encounters with the error-prone federal website, HealthCare.gov, that tested their patience and resolve. Some called help lines that couldn’t help them. Others drove long distances to meet with trained enrollment workers who couldn’t get them enrolled. Yet they persisted.
And as New Year’s Day approaches, and with it, health insurance, their frustration is trumped by gratitude. “I get these messages from acquaintances on Facebook saying, ‘Let me keep my doctor,’ ” Peterson said. “Well, what about those of us who didn’t have health insurance before? . . . I have been walking a tightrope and have had some twists and falls off of it. To not have to worry about this anymore is a tremendous relief.”
Getting Americans health insurance is at the heart of the health law, the most significant change in health-care policy since the 1965 creation of Medicare, the federal program for the elderly, and Medicaid, the federal-state program for the poor and disabled. Such a dramatic expansion in coverage had eluded presidents, including Republican Richard Nixon and Democrat Bill Clinton, for decades.
This core mission has sometimes been obscured by the political and legal disputes that have dogged and, in important ways, altered the law. Strong research links having health insurance and being healthy. Having a health plan does not guarantee that a good doctor is within reach when a patient needs one. But insurance matters.
Consumers Start Using Coverage Under Health Law
By ROBERT PEAR and ABBY GOODNOUGH
WASHINGTON — Kathy Hornbach of Tucson is not wasting any time before using her new health insurance coverage, which took effect on New Year’s Day. Ms. Hornbach, 57, has an appointment with a cardiologist on Thursday for a stress test.
“I’ve had some heart palpitations, and my mom’s side has a history of heart problems starting early,” she said Wednesday in a telephone interview. “So it’s mostly just to double-check that everything is O.K.”
Ms. Hornbach, who has had breast cancer and retired early from the technology industry, said that insurance companies in Arizona had refused to cover her until about two years ago, when she got a policy with monthly premiums of $285 and a deductible of $5,500 a year. Last month, using the federal insurance exchange, she bought a midlevel silver plan with lower premiums and deductible.
“It’s a better policy — lower out-of-pocket, more choice of doctors,” she said. “This is a very happy day.”
Consumers around the country began using coverage provided by the new health care law on Wednesday, the same day that Medicaid expanded to hundreds of thousands of people in about half the states. Many provisions of the 2010 health care law offering new benefits and protections to consumers, including those with pre-existing conditions, also took effect.
Hospitals said they were getting ready for an influx of newly insured patients, but many health care providers said the pace was slower than usual because of the New Year’s holiday. In a typical report, Clay Holtzman, a spokesman for Swedish Medical Center in Seattle, said the system’s hospitals were not seeing an immediate surge.
“We might at some point down the road, since we have spent a lot of time informing uninsured patients of their options under the exchange and expanded Medicaid,” Mr. Holtzman said in an email. “But it depends on if those patients chose plans that include us.”
Swedish is one of the largest hospital systems in the region, but Mr. Holtzman said it had been excluded from the networks of providers used by the two largest health plans on the state’s insurance exchange.
Some people using their new insurance discovered that they could be responsible for substantial co-payments and other out-of-pocket costs.
Access to Health Care May Increase ER Visits, Study Suggests
By SABRINA TAVERNISE
Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits as people sought care from primary care doctors. But a rigorous new study conducted in Oregon has flipped that assumption on its head, finding that the newly insured actually went to the emergency room more often.
The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts. The pattern was so strong that it held true across most demographic groups, times of day, and types of visits, including for conditions that were treatable in primary care settings.
The finding casts doubt on the hope that expanded insurance coverage will help rein in rising emergency room costs just as more than two million people are gaining coverage under the Affordable Care Act.
Instead, the study suggests that the surge in the numbers of insured people may put even greater pressure on emergency rooms and increase costs. Nearly 30 million uninsured Americans could gain coverage under the law, about half of them through Medicaid. The first policies took effect on Wednesday.
“I suspect that the finding will be surprising to many in the policy debate,” said Katherine Baicker, an economist at Harvard University’s School of Public Health and one of the authors of the study.
But Dr. Baicker and other economists who worked on the study said the increased use of emergency rooms is driven by a basic economic principle: When things or services get cheaper, people buy and use more of them. Previous studies have found that uninsured people face substantial out of pocket costs that can put them in debt when they go to the emergency room, and that Medicaid reduces those costs.
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The smooth and inexpensive rollout of Medicare on July 1, 1966 provides a sharp contrast to the costly chaos of Obamacare.
We won’t rehearse the chaos part here, just the costs.
As of March, 2013, federal grants for Obamacare’s state exchanges totaled $3.8 billion. Spending for the federal exchange is harder to pin down because funding has come from multiple accounts, including: the $1 billion Health Insurance Implementation Fund; DHHS’ General Departmental Management Account and General Departmental Management Account; CMS’s Program Management Account and the Prevention and Public Health Fund. CMS estimates fiscal 2014 spending for the federally-operated exchanges at $2 billion. So it’s safe to say that the costs of getting the exchanges up and running, and (hopefully) enrolling 7 million people in the program’s first year will exceed $6 billion.
Bear in mind that the exchanges won’t actually pay any medical bills, just sign people up for coverage. So billions more in overhead costs will show up on the books of the private insurers and state Medicaid programs that will actually process medical claims.
Back in 1966, Medicare started paying bills for 18.9 million seniors (99 percent of those eligible for coverage) just 11 months after Pres. Johnson signed it into law. Overhead costs for the first year totaled $120 million (equivalent to $867 million in 2013 – all subsequent figures are given in 2013 dollars). But that figure includes the cost of processing medical bills, not just the enrollment costs.
Moreover, Medicare and Medicaid (which was passed at the same time) displaced several smaller federal health assistance programs, saving about $376 million on their overhead costs.
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