If Supreme Court rules against insurance subsidies, most want them restored

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U.S. Supreme CourtBy Julie Rovner
KHN

A new poll finds that most people think Congress or states should act to restore health insurance subsidies if the Supreme Court decides later this year they are not permitted in states where the federal government is running the marketplace.

The court in March is set to hear King v. Burwell, a lawsuit arguing that the wording of the Affordable Care Act means that financial assistance with premiums is available only in the 13 states that created and are running their own online insurance exchanges.

If the court were to invalidate subsidies in the federally run states, 64 % said Congress should restore them, and 59% said states should create their own exchanges.

If the court sides with those challenging the law, millions of people in the 37 states that use the federal Healthcare.gov site would lose the help they have been getting. A decision in the case is expected in late June.

Less than half the respondents in the monthly tracking poll by the Kaiser Family Foundation said they had heard about the case. (Kaiser Health News is an editorially independent project of the foundation.)

But if the court were to invalidate subsidies in the federally run states, 64 percent said Congress should restore them, and 59 percent said states should create their own exchanges. Continue reading

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More states lean toward Medicaid expansion

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Indiana state flagBy Christine Vestal
Stateline

The federal government yesterday approved Indiana’s plan to expand Medicaid under the Affordable Care Act, increasing the number of expansion states to 28, plus the District of Columbia.

With enrollment starting Feb. 1, Indiana’s plan could add an estimated 350,000 low-income adults to the nearly 5 million expected to enroll in the 27 states that expanded Medicaid last year.

In accepting Indiana’s plan, the Obama administration demonstrated its determination to increase the number of expansion states, even if it means waiving traditional Medicaid rules.

For example, under Indiana’s plan, people with incomes above the federal poverty level ($11,670 for an individual) must contribute to a health savings account or be locked out of coverage for six months.

The penalty for not paying into a health savings account, which has never before been approved by the U.S. Department of Health and Human Services, reflects an important GOP health care tenet: People who receive Medicaid benefits should take personal responsibility for their care. Republican Gov. Mike Pence called his plan “the first-ever consumer-driven health care plan for a low-income population.”

FamiliesUSA

FamiliesUSA

Judith Solomon, health policy director at the Center on Budget and Policy Priorities, which advocates for low-income people, noted that Indiana’s plan is derived from a successful demonstration project that has been in effect since 2007, so its green light doesn’t necessarily apply to other states.

Under the Medicaid expansion that is part of the Affordable Care Act (ACA), the federal government pays the full price for covering newly eligible adults with incomes up to 138 percent of the federal poverty level ($16,105) through 2016 and then gradually lowers its share to 90 percent in 2020 and beyond. Continue reading

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Global health news – January 28, 2015

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Many African-Americans fall into a health ‘coverage gap’

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By Teresa Wiltz
Stateline

Thanks to the Affordable Care Act, the percentage of people of color who do not have health insurance is projected to fall dramatically by 2016, greatly narrowing the historic disparities in coverage between whites and nonwhites.

Many low-income African-Americans are caught in a “coverage gap”: They make too much to qualify for Medicaid, but not enough to qualify for subsidized insurance an exchanges.

But one minority group is likely to benefit less than others: African-Americans.

Fifty-five percent of all African-Americans reside in the 23 states that have not expanded Medicaid eligibility under the ACA. By comparison, 42 percent of whites, 38 percent of Latinos and 23 percent of Asians live in nonexpansion states, according to the Urban Institute.

In those nonexpansion states, a disproportionate number of blacks don’t qualify for the narrower Medicaid program in place now. Medicaid typically covers pregnant women, young children, and disabled and elderly adults.

Relatively few able-bodied adults with children qualify in those states, and only at incomes well below the federal poverty level. (Childless adults do not qualify.)

FamiliesUSA

FamiliesUSA

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Obamacare cost to be 20% less than forecast, budget office says – LA Times

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Twenty-dollar bill in a pill bottlePresident Obama’s healthcare law will cost about 20% less over the next decade than originally projected, the Congressional Budget Office reported Monday, in part because lower-than-expected healthcare inflation has led to smaller premiums.

So far, the number of uninsured Americans has dropped by about 12 million. By the end of 2016, 24 million fewer Americans will lack insurance, the nonpartisan budget office forecast.

Excluding immigrants in the country illegally, who are not eligible for coverage under the law, only about 8% of Americans under age 65 will lack insurance by the time Obama leaves office, the budget office’s latest report on the law estimates.

via Obamacare cost to be 20% less than forecast, budget office says – LA Times.

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Health news headlines – January 27, 2015

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Global health news – January 27, 2015

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Adminstration to quicken pace towards quality-based Medicare payments

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cms-logo-200pxBy Jordan Rau
KHN

HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments

The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

The announcement by Health and Human Services Secretary Sylvia Burwell is intended to spur efforts to supplant Medicare’s traditional fee-for-service medicine, in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares.

Within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

Since the passage of the federal health law in 2010, the administration has been designing new programs and underwriting experiments to come up with alternate payment models.

Last year, 20 percent of traditional Medicare spending, about $72 billion, went to models such as accountable care organizations, or ACOs, where doctors and others band together to care for patients with the promise of getting a piece of any savings they bring to Medicare, administration officials said.

There are now 424 ACOs, and 105 hospitals and other health care groups that accept bundled payments, where Medicare gives them a fixed sum for each patient, which is supposed to cover not only their initial treatment for a specific ailment but also all the follow-up care.

Other Medicare-funded pilot projects give doctors extra money to coordinate patient care among specialists and seek to get Medicare to work more in harmony with Medicaid, the state-federal health insurer for low-income people.

Burwell’s targets are for 30 percent, or about $113 billion, of Medicare’s traditional spending to go to these kind of endeavors by the end of President Barack Obama’s term in 2016, and 50 percent — about $215 billion — to be spent by the end of 2018. Continue reading

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Credit: Dan Shirly

Credit: Dan Shirly

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Uninsured? Beware of the health law’s tax penalty

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The penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent.

By April Dembosky, KQED and Jeff Cohen, WNPR

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is.

“This year taxes and health care intersect in a brand new way. ‘

IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form.

Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

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An H&R Block office in Hartford, Conn., is decorated with cardboard cutouts from a national ad campaign on the health law’s tax implications. (Photo by Jeff Cohen/WNPR)

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be much more complex for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges.

To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.” Continue reading

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Federal policy change may boost school-based health services

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school_nurse_clip_artBy Michael Ollove
Stateline

A recent federal policy reversal, long-sought by states and health care advocates, could enable schools to take a lead role in managing chronic childhood diseases and result in the hiring of many more school nurses.

The change, announced quietly and unexpectedly last month by the Centers for Medicare and Medicaid Services (CMS), will allow public schools to receive Medicaid money for health services they provide to eligible students for the first time since 1997.

“Children don’t park their chronic diseases outside the school doors,” – Donna Mazyck, exe. dir. National Association of School Nurses.

Once several financing and bureaucratic hurdles are cleared, advocates believe the new policy will improve the coordination of care provided to children with conditions such as asthma, diabetes and mental illness. It will be especially important, they say, for low-income kids who are less likely to have comprehensive medical coverage.

The policy change had been sought for at least 10 years by states and advocacy groups working in the area of children’s health. CMS declined to comment, beyond the letter it sent to state Medicaid directors announcing the decision.

“It’s still so early, a month into the rule changes, but this represents a tremendous opportunity to address children’s health needs,” said Mary-Beth Malcarney, an assistant research professor at the George Washington University School of Public Health, whose work was used by the coalition of advocacy groups that pushed CMS for the change. Continue reading

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Health news headlines – January 23, 2015

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Global health news – January 23, 2015

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