Wednesday, December 18, 2013

Central Labor Council Breakfast Builds Support for Single Payer, HR 676

From UnionsForSinglePayer.org –

U.S. Congressman John Conyers (D MI), chief sponsor of HR 676, was honored at a December 6th Labor Breakfast co-hosted by the New York City Central Labor Council and the Progressive Democrats of America in celebration of the endorsement by the 1.3 million member NYC CLC of HR 676, Expanded and Improved Medicare for All.

Congressman Conyers told of the energy that the endorsement of HR 676 by the NYC CLC brings to the movement of healthcare for all, reports Robert Score, Recording-Corresponding Secretary of IATSE Local One. Score has played a leadership role in advancing HR 676 within New York labor and in union locals across the country.

NYC CLC President Vincent Alvarez, a member of IBEW Local 3, delivered the opening remarks. He said that the forces within the industrial-insurance complex, although powerful, must be confronted before the working class families of our country are completely decimated by the ever increasing costs of health care. He spoke of the necessity for all working people, union and non-union, to have proper healthcare.

Stephen Shaff spoke on behalf of PDA, and special guest television broadcaster Phil Donohue, introduced Congressman John Conyers who has sponsored HR 676 in every Congress since 2003. The legislation currently has a total of 54 co-sponsors, the most recent being Rep. Betty McCollum of Minnesota who has signed on for the first time even though she is in her 4th term.

Conyers noted that four days after Dr. Martin Luther King Jr. was assassinated in 1968, he introduced a bill to make King�s birthday a national holiday.

�It took 15 years before Congress joined with me to make Dr. King�s birthday a national legal holiday. So I�m in this for the long run,� said Congressman Conyers.

Wednesday, December 11, 2013

Health Exchange Enrollment By State, In 2 Charts

More From Shots - Health News HealthSome Young Athletes May Be More Vulnerable To Hits To The HeadHealthGlobal Malaria Deaths Hit A New LowHealthStaph Germs Hide Out In The Hidden Recesses Of Your NoseHealthHealth Exchange Enrollment By State, In 2 Charts

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Monday, December 9, 2013

Will Obamacare Play Big In 2014? Keep An Eye On N.H. Senate Race

Listen to the Story 5 min 9 sec Playlist Download Transcript   Enlarge image i

Sen. Jeanne Shaheen, D-N.H., on Capitol Hill earlier this year.

J. Scott Applewhite/AP

Sen. Jeanne Shaheen, D-N.H., on Capitol Hill earlier this year.

J. Scott Applewhite/AP

With a new White House push to promote the Affordable Care Act well underway, the question is whether an improved HealthCare.gov site and onslaught of positive talking points will be enough to bolster Senate Democrats facing tough races in 2014.

One re-election fight to watch is Democratic Sen. Jeanne Shaheen's in New Hampshire, where she's been taking heat for supporting the new health care law.

Step inside a small diner called Chez Vachon in a working-class section of Manchester, N.H., and you'd never guess the White House is actually regaining its footing on the health care rollout. The president is reporting promising enrollment numbers and a faster website, but John Hill couldn't care less. He says the price of his insurance has skyrocketed.

"We asked why the price of the insurance was so high," says Hill. "They said, 'Well, the new Obamacare law. That's the reason why.' "

That law had some pretty severe repercussions in New Hampshire. A strong Tea Party faction in the state legislature voted down a state health insurance exchange, so everyone in the state applying for insurance under the Affordable Care Act has to sign up on the federal government website.

But that federal exchange has drawn only one insurance provider for New Hampshire: Anthem Blue Cross and Blue Shield. And Anthem shut out 10 of the state's 26 hospitals from its health plans on the exchange, which means traveling in a car for an hour or more for many people in northern New Hampshire who need to see a doctor.

Hill says he's absolutely not voting for Shaheen next year.

"She voted for this. She knew what she was getting into," says Hill. "Now she realizes, 'Oh, this is a big mistake.' "

Shaheen was one of most vocal Democrats to criticize the launch of HealthCare.gov. She's demanded an extension of the enrollment period, and asked President Obama to appoint someone to oversee website fixes into next year.

Theresa Avard says Shaheen's just trying to have it both ways by distancing herself from a law that so many people in New Hampshire hate.

"You can't be a yo-yo," says Avard. "I'm sorry, you know. That's what I call my grandchildren when they don't do right. They yo-yo, up and down."

But Shaheen rejects the suggestion that she's just protecting herself for the next election cycle.

"This should not be about politics. This should be about good policy," says Shaheen. "I've been working on health care issues since I first was elected to the state senate from the seacoast of New Hampshire over 20 years ago."

On this day, she's touring the National Visa Center in Portsmouth to draw attention to a program granting visas for Iraqis and Afghans who risked their lives working for the U.S. Since the rollout of the new health care law, Shaheen hasn't hosted any town hall meetings. But she says her office has been inundated with angry complaints from people upset about the launch.

Still, Shaheen says: "It's a long time from now to [November of] 2014. And I think we're going to get the problems fixed with the health care law.

"I think there will probably be other things that come up, just as there are when we're making that significant of policy change," says Shaheen. "But the way to deal with it [is] to find those fixes."

Toppling Shaheen in 2014 is going to take a formidable force. She was a popular three-term governor who's still enjoying pretty solid poll numbers.

"For Shaheen, right now, Obamacare is the only cloud in the sky in New Hampshire," says Dante Scala, a political scientist at the University of New Hampshire. "So what she needs to do is just keep guard and not become complacent with what is clearly a winning position at this point."

Former Sen. Scott Brown of Massachusetts keeps flirting with the idea of running against her, and he has the star power, but he still won't commit.

Bob Smith, a former U.S. senator, has announced his candidacy, but he still needs to move back to New Hampshire from Florida, where he failed twice to win a Senate seat. And the other Republican candidates just don't have much name recognition.

As split as New Hampshire is over the health care law, it's a big question whether people are going to be focusing on other things by next fall.

Back at Chez Vachon, Bob Garon says Republicans need to give up on their obsession with the Affordable Care Act.

"I really don't think that we are going to elect a politician because of Obamacare," says Garon. "I think what's going to sink in is it's the law � whether you like it or not. You can bounce it around and play tennis with it all you want, but it's the damn law."

But the New Hampshire state Republican Party says it plans to make Obamacare a central issue next fall.

"There's no question that what voters care about right now is the collapse of Obamacare � the failed rollout, the increased costs, the decreased access to quality health insurance," says Jennifer Horn, chair of the New Hampshire Republican Party. "So absolutely that is something we will be talking about."

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Saturday, December 7, 2013

Canceled In California: People Eye Health Plans Off Exchange

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Thursday, December 5, 2013

White House Cites Pre-Existing Condition Case From Its Own Ranks

More From Shots - Health News HealthMedical Journal Goes To The DogsHealth CareWhite House Cites Pre-Existing Condition Case From Its Own RanksHealthFDA Expected To Approve New, Gentler Cure For Hepatitis CHealthHealthCare.gov Now Allows Window Shopping, And A Do-Over

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White House Cites Pre-Existing Condition Case From Its Own Ranks

More From Shots - Health News HealthMedical Journal Goes To The DogsHealth CareWhite House Cites Pre-Existing Condition Case From Its Own RanksHealthFDA Expected To Approve New, Gentler Cure For Hepatitis CHealthHealthCare.gov Now Allows Window Shopping, And A Do-Over

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Wednesday, December 4, 2013

Administration Says You Can Now Escape HealthCare.Gov 'Prison'

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Administration Says You Can Now Escape HealthCare.Gov 'Prison'

More From Shots - Health News HealthFertility Drugs, Not IVF, Are Top Cause Of Multiple BirthsHealthSecond Meningitis Outbreak Erupts In Southern CaliforniaHealthAdministration Says You Can Now Escape HealthCare.Gov 'Prison'HealthRule Spells Out How Insurers Must Cover Mental Health Care

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Monday, December 2, 2013

Could A Tech Giant Build A Better Health Exchange? Maybe Not

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The Real Fix for Obamacare’s Flaws: Medicare for All

Lost amidst the well-chronicled travails of the Affordable Care Act rollout are the long term effects of people struggling to get the health coverage they need without going bankrupt.

If that sounds familiar, it’s because that’s been the main story line of the US healthcare system for several decades. Sadly, little has changed.

Still, with all the ACA’s highly publicized snafus, and less discussed systemic flaws, there’s no reason to welcome the cynical efforts to repeal or defund the law by politicians whose only alternative is more of the same callous, existing market-based healthcare system.

US nurses oppose the rollback and appreciate that several million Americans who are now uninsured may finally get coverage, principally through the expansion of Medicaid, or access to private insurance they’ve been denied because of their prior health status.

At the same time, nurses will never stop campaigning for a fundamental transformation to a more humane single-payer, expanded Medicare for all system not based on ability to pay and obeisance to the policy confines of insurance claims adjustors.

Website delays � the most unwelcome news for computer acolytes since the tech boom crashed � are not the biggest problem with the ACA, as will become increasingly apparent long after the signup headaches are a distant memory.

What prompted the ACA was a rapidly escalating healthcare nightmare, seen in 50 million uninsured, medical bills plunging millions into un-payable debt or bankruptcy, long delays in access to care, and record numbers skipping needed treatment due to cost.

The main culprit was our profit-focused system, with rising profiteering by a massive health care industry, and an increasing number of employers dropping coverage or just dumping more costs onto workers.

The ACA tackles some of the most egregious inequities: lack of access for many of the working poor who will now be eligible for Medicaid or subsidies to offset some of their costs for buying private insurance through the exchanges, a crackdown on several especially notorious insurance abuses, and encouragement of preventive care.

But the law actually further entrenches the insurance-based system through the requirement that uncovered individuals buy private insurance. It’s also chock full of loopholes.

Some consumers who have made it through the website labyrinth have found confusing choices among plans which vary widely in both premium and out of pocket costs even with the subsidies, a pass through of public funds to the private insurers.

The minimum benefits are also somewhat illusory. Insurance companies have decades of experience at gaming the system and warehouses full of experts to design ways to limit coverage options.

The ACA allows insurers to cherry pick healthier enrollees by the way benefit packages are designed, and as a Washington Post article noted on 21 November, consumers are discovering insurers are restricting their choice of doctors and excluding many top ranked hospitals from their approved “network”.

The wide disparity between the healthcare you need, what your policy will cover, and what the insurer will actually pay for remains.

Far less reported is what registered nurses increasingly see � financial incentives within the ACA for hospitals to prematurely push patients out of hospitals to cheaper, less regulated settings or back to their homes. It also encourages shifting more care delivery from nurses and doctors to robots and other technology that undermines individual patient care, and that may work no better than the dysfunctional ACA websites.

Is there an alternative? Most other developed nations have discovered it, a single-payer or national healthcare system.

Without the imperative of prioritizing profits over care, Medicare for all streamlines the administrative waste and complex insurance billing operations endemic to private insurance. That waste is a major reason why the US has more than double the per capita cost of healthcare of other developed nations, yet lower life expectancies than many.

Medicare for all eliminates the multi-tiered health plans that plague both the individual and group insurance markets that are tied to the girth of your wallet not your need for care. Class, gender, and racial disparities in access and quality of care vanish under Medicare for all.

It’s beyond time that we stop vilifying government and perpetuating a corporatized healthcare system that has abandoned so many. We can, with a system of Medicare for all, we can cut healthcare costs and promote a much more humane society.

Thursday, November 28, 2013

Breaking Up With HealthCare.gov Is Hard To Do

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Wednesday, November 27, 2013

Small-Business Access To Online Health Exchanges Delayed Again

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Tuesday, November 26, 2013

Supreme Court Will Hear New Challenge To Health Law

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Monday, November 25, 2013

Inequality Is (Literally) Killing America

Only a few miles separate the Baltimore neighborhoods of Roland Park and Upton Druid Heights. But residents of the two areas can measure the distance between them in years�twenty years, to be exact. That�s the difference in life expectancy between Roland Park, where people live to be 83 on average, and Upton Druid Heights, where they can expect to die at 63.

Underlying these gaps in life expectancy are vast economic disparities. Roland Park is an affluent neighborhood with an unemployment rate of 3.4 percent, and a median household income above $90,000. More than 17 percent of people in Upton Druid Heights are unemployed, and the median household income is just $13,388.

It�s no secret that this sort of economic inequality is increasing nationwide; the disparity between America�s richest and poorest is the widest it�s been since the Roaring Twenties. Less discussed are the gaps in life expectancy that have widened over the past twenty-five years between America�s counties, cities and neighborhoods. While the country as a whole has gotten richer and healthier, the poor have gotten poorer, the middle class has shrunk and Americans without high school diplomas have seen their life expectancy slide back to what it was in the 1950s. Economic inequalities manifest not in numbers, but in sick and dying bodies.

On Wednesday, Senator Bernie Sanders convened a hearing before the Primary Health and Aging subcommittee to examine the connections between material and physiological well-being, and the policy implications. With Congress fixed on historic reforms to the healthcare delivery system, the doctors and public health professionals who testified this morning made it clear that policies outside of the healthcare domain are equally vital for keeping people healthy�namely, those that target poverty and inequality.

�The lower people�s income, the earlier they die and the sicker they live,� testified Dr. Steven Woolf, who directs the Center on Society and Health at Virginia Commonwealth University. In America, people in the top 5 percent of the income gradient live about nine years longer than those in the bottom 10 percent. It isn�t just access to care that poor Americans lack: first, they are more likely to get sick. Poor Americans are at greater risk for virtually every major cause of death, including cancer, heart disease and diabetes. As Woolf put it, �Economic policy is not just economic policy�it�s health policy.�

Tracing health disparities back to their socioeconomic roots adds context to growing calls for pro-worker policies like raising the minimum wage and providing paid sick leave. Lisa Berkman, director of Harvard�s Center for Population and Development Studies, presented a range of evidence indicating that policies supporting men and women in the labor force�particularly low-wage and female workers�lead to better health for themselves and their families.

Continue reading…

Thursday, November 21, 2013

The U.S. Lags in Life Expectancy Gains

From Bloomberg Businessweek –

Life expectancy in the U.S. has been growing more slowly than in other developed countries and is now more than a year below the developed-country average, according to a new report (PDF) from the Organisation for Economic Co-operation and Development.

Even though Americans, on average, live to be almost 80, this is not good news. Life expectancy at birth is affected by trends in everything from infant mortality, accident rates, and violence to chronic diseases and care for the elderly, which makes it a highly sensitive indicator of a nation�s economic development.

U.S. life expectancy in 2011 was 78.7 years. That was an increase of a little less than eight years since 1970. Impressive, but not as big as the 10-year gain for the OECD as a whole. �Life expectancy [in the U.S.] is now more than a year below the OECD average of 80.1,� the OECD said in a press statement, �compared to one year above the average in 1970.�

Why has the U.S. fallen off pace? The OECD report sums up some American studies by the National Research Council and the Institute of Medicine that suggest some causes. None of the theories reflect well on the U.S.:

1. The highly fragmented nature of the U.S. health system, with relatively few resources devoted to public health and primary care, and a large share of the population uninsured;

2. Health-related behaviors, including higher calorie consumption per capita and obesity rates, higher consumption of prescription and illegal drugs, higher deaths from road traffic accidents and higher homicide rates;

3. Adverse socioeconomic conditions affecting a large segment of the U.S. population, with higher rates of poverty and income inequality than in most other OECD countries.

Ouch.

Friday, November 15, 2013

Obama Moves To Delay Cancellations Of Insurance Plans

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Thursday, November 14, 2013

Oregon Shines On Medicaid, As Texas Stalls On Sign-Ups

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Oregon Shines On Medicaid, As Texas Stalls On Sign-Ups

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Wednesday, November 13, 2013

More Than 106,000 Chose Health Plans Under Affordable Care Act

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Monday, November 11, 2013

The First Estimate On Insurance Signups Is Pretty Darned Small

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Friday, November 8, 2013

In Massachusetts, Health Care Prices Remain Hard To Get

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In Massachusetts, Health Care Prices Remain Hard To Get

More From Shots - Health News Health CareWhite House Releases Long-Awaited Rules On Mental HealthHealthIn Massachusetts, Health Care Prices Remain Hard To GetHealthPolio In The Middle East And Africa Could Threaten EuropeHealthPersistence Pays Off For Uninsured Alaskan

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In Massachusetts, Health Care Prices Remain Hard To Get

More From Shots - Health News Health CareWhite House Releases Long-Awaited Rules On Mental HealthHealthIn Massachusetts, Health Care Prices Remain Hard To GetHealthPolio In The Middle East And Africa Could Threaten EuropeHealthPersistence Pays Off For Uninsured Alaskan

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Wednesday, November 6, 2013

Administration Looks To Give Labor Unions Health Tax Relief

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Administration Looks To Give Labor Unions Health Tax Relief

More From Shots - Health News HealthIVF Doesn't Raise Overall Risk For Childhood CancersHealthBabies' Immune Systems May Stand Down To Let Good Microbes GrowHealthA New Look At An Old Epilepsy Drug Yields Treatment ClueHealthHow Pictures Of Infant Boy's Eyes Helped Diagnose Cancer

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Tuesday, November 5, 2013

Call Centers Got Big Deals Under Health Law, But How Big?

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In Colorado, A Couple Finds Relief In Obamacare

More From Shots - Health News Health CareIn Colorado, A Couple Finds Relief In ObamacareHealthWondering If You Need A Strep Test? Crowdsourcing Might HelpHealthFor Many Workers, It's Time To Consider Insurance OptionsHealthInsurance Cancellations: The Price Of Mending A Broken System?

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Monday, November 4, 2013

Bariatric Surgery Can Keep Pounds Off For Years

More From Shots - Health News HealthBariatric Surgery Can Keep Pounds Off For YearsHealthChildhood Maltreatment Can Leave Scars In The BrainHealth CareOregon's State Exchange May Be Worse Than HealthCare.govHealthJohnson & Johnson To Pay $2.2 Billion In Marketing Settlement

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Saturday, November 2, 2013

So You Found An Exchange Plan. But Can You Find A Provider?

More From Shots - Health News Health CareAdding To Insurance Confusion, Outside Groups Try To Cash InHealth CareSo You Found An Exchange Plan. But Can You Find A Provider?HealthFeds To Ease Restrictions On Flexible Spending AccountsHealthSorry, Red Sox, Heavy Stubble Beats Beards For Attractiveness

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Friday, November 1, 2013

Which Plans Cover Abortion? No Answers On HealthCare.gov

More From Shots - Health News HealthFeds To Ease Restrictions On Flexible Spending AccountsHealthSorry, Red Sox, Heavy Stubble Beats Beards For AttractivenessHealthSeeing In The Pitch-Dark Is All In Your HeadHealth CareWhich Plans Cover Abortion? No Answers On HealthCare.gov

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Thursday, October 31, 2013

For The Young And Healthy, Health Insurance Is A Hard Sell

More From Shots - Health News HealthPolio Has Not Returned To South Sudan, After AllHealthToo Many Texts Can Hurt A Relationship, But <3 Always HelpsHealth CareFor The Young And Healthy, Health Insurance Is A Hard SellShots - Health NewsCongress Moves Closer To Changing Medicare Pay For Doctors

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Add Security To The List Of HealthCare.gov Tech Issues

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Rep. Mike Rogers, R-Mich., asks about website security questions Wednesday at a House Energy and Commerce Committee hearing on problems with HealthCare.gov.

Chip Somodevilla/Getty Images

Rep. Mike Rogers, R-Mich., asks about website security questions Wednesday at a House Energy and Commerce Committee hearing on problems with HealthCare.gov.

Chip Somodevilla/Getty Images

To the long list of problems plaguing HealthCare.gov, add data security. The enrollment site for the new health insurance exchanges had a security flaw that didn't get patched up when the exchange marketplace went live.

An internal government memo obtained by The Washington Post and Associated Press is dated Sept. 27 � four days before the HealthCare.gov website went live. It shows the government decided to go forward with launching the site even though there were "inherent security risks."

The memo says that from a security perspective, aspects of the system that were not tested due to the ongoing development "exposed a level of uncertainty that can be deemed as a high risk for FFM [Federally Facilitated Marketplace]."

Under federal government cybersecurity protocol, someone has to sign off on temporary certifications to operate despite security risks, and in testimony before the House Energy and Commerce panel Wednesday, Health and Human Services Secretary Kathleen Sebelius said that temporary authority was granted because a security risk "mitigation plan" was in place.

All Tech Considered What's A 'Glitch,' Anyway? A Brief Linguistic History All Tech Considered A Diagram Of HealthCare.gov, Based On The People Who Built It Sebelius: Hold Me Accountable For HealthCare.gov Debacle 4 min 15 sec Add to Playlist Download  

"You accepted a risk of every user of this computer that put their personal financial information at risk," said Rep. Mike Rogers, R-Mich., while questioning Sebelius.

The personal information going into HealthCare.gov includes birth date, Social Security number and an estimated income range. Sebelius emphasized that the additional security controls gave the agency confidence in going ahead with the launch, despite the audit showing a security gap.

"They get to make those decisions and those tradeoffs," says Waylon Krush, CEO of LunarLine, a cybersecurity firm that does work with dozens of federal government agencies, including HHS. "[Agency systems] process, store, manage, review a lot more sensitive data than what your general citizen is gonna put on HealthCare.gov, so I would say, from a risk perspective, it's pretty low, actually."

But the agency's technological credibility is dwindling, as programmers rush to fix ongoing issues with the error-riddled system. Now, programmers have to make sure they don't introduce new security risks with each patch.

"I know they're doing simultaneous testing as new code is loaded," Sebelius said Wednesday. Krush says this attention on security presents a good reminder for all of us.

"Everyone should always ask those questions, whether it's commercial or government, 'How are you protecting my data?' " he says.

Share Facebook Twitter Google+ Email Comment More From All Tech Considered TechnologyAdd Security To The List Of HealthCare.gov Tech IssuesDigital LifeTo Keep Your Attention, Airline Safety Videos Up Their GameTechnology(Don't) Pardon Me: One Man's Fight Against Distracted WalkingDigital LifeWeekly Innovation: A Light Bulb That's Also A Flashlight

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Wednesday, October 30, 2013

Why Insurers Cancel Policies, And What You Can Do About It

More From Shots - Health News HealthOnline Advice Can Hurt Teens At Risk For Suicide, Self-HarmHealthNotices Canceling Health Insurance Leave Many On EdgeHealthThe Long List Of Health Apps Features Few Clear WinnersHealthWhy Insurers Cancel Policies, And What You Can Do About It

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Tuesday, October 29, 2013

Short-Term Insurance Skirts Health Law To Cut Costs

More From Shots - Health News HealthFor A Longer Life, You Might Try Mowing The LawnHealth CareInsurance Cancellations Elbow Out Website Woes At Health HearingHealthShort-Term Insurance Skirts Health Law To Cut CostsHealthHow A Wandering Brain Can Help People Cope With Pain

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Monday, October 28, 2013

Some Health Screenings May Harm More Than Help

More From Shots - Health News HealthUnlikely Multiple Sclerosis Pill On Track To Become BlockbusterHealth CareMore Technical Issues For Obamacare, But Good News For MedicareResearch NewsEeek, Snake! Your Brain Has A Special Corner Just For ThemHealthSome Health Screenings May Harm More Than Help

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Some Health Screenings May Harm More Than Help

More From Shots - Health News HealthUnlikely Multiple Sclerosis Pill On Track To Become BlockbusterHealth CareMore Technical Issues For Obamacare, But Good News For MedicareResearch NewsEeek, Snake! Your Brain Has A Special Corner Just For ThemHealthSome Health Screenings May Harm More Than Help

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Saturday, October 26, 2013

'Loyal Soldier' Sebelius Vows To Stay Put, Fix HealthCare.gov

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Health and Human Services Secretary Kathleen Sebelius speaks Thursday in Phoenix.

Laura Segall/Getty Images

Health and Human Services Secretary Kathleen Sebelius speaks Thursday in Phoenix.

Laura Segall/Getty Images

This has not been an easy month for Health and Human Services Secretary Kathleen Sebelius.

Republican Sen. Pat Roberts of Kansas � who learned the political ropes working for Sebelius' father-in-law, then a Kansas congressman � called for her to step down over the debut of HealthCare.gov, the problem-plagued website where people are supposed to apply for coverage under the Affordable Care Act.

Invited on the usually friendly-to-Democrats The Daily Show, Sebelius was lampooned by host Jon Stewart, who challenged her to a race of sorts: "I'm going to try and download every movie ever made, and you're going to try to sign up for Obamacare, and we'll see which happens first."

And while she was able to laugh off Stewart's opening gag, Sebelius had trouble clearly explaining why, if businesses have been given an extra year to implement Obamacare, individuals shouldn't have the same delay.

Sebelius served six years as the Democratic governor of largely Republican Kansas. She is the daughter of the late Ohio Gov. John Gilligan. University of Kansas political science professor Burdett Loomis says she remains popular at home, despite the hits she's been taking in Washington:

"This hasn't been an easy time for her. The Obamacare rollout has clearly been problematic; she pretty much got roasted on Jon Stewart; but she's been a loyal soldier to Barack Obama and I think she truly believes that Obamacare is in the best interest of the country."

Seven years ago the Bush administration unveiled Medicare Part D, which provides seniors with prescription drug benefits. The website for that program had a similarly rocky debut. The HHS secretary then was former Utah Gov. Mike Leavitt, who notes Sebelius did not make many of the key decisions regarding the rollout of Obamacare. Leavitt says he empathizes with Sebelius:

"It's much like being the pilot of an airplane full of passengers sitting on the tarmac with a series of complications you don't entirely control. It's better to say to the passengers, 'This is where we are. This is how much time we expect it'll take. ... Here's what we're doing to remedy it and here's how it's going to affect you. We're doing our best.' "

Before being elected governor, Sebelius was Kansas insurance commissioner. The Republican occupant of the job now, Sandy Praeger, says the glitches in the rollout of Obamacare are not Sebelius' fault.

"The complexity of what she's having to deal with is massive and in an environment that's been pretty politically charged, to say the least. So I have a great deal of sympathy for what she's having to work through," says Praeger. "I know she's probably very frustrated."

Praeger says calls for Sebelius to resign are totally inappropriate. And in an appearance in Phoenix, Sebelius rejected Republican demands she step down.

'The majority of people calling for me to resign I would say are people who I don't work for and who do not want this program to work in the first place," Sebelius said Thursday. "I have had frequent conversations with the president and I have committed to him that my role is to get the program up and running, and we will do just that."

Sebelius is expected to testify before a House committee investigating the Affordable Care Act's implementation as soon as Wednesday.

Share Facebook Twitter Google+ Email Comment More From Health Care Health CarePR Experts: Obamacare Message (Not Just The Site) Needs FixPoliticsBipartisan Anger, Competing Interests Over HealthCare.govHealth Care'Loyal Soldier' Sebelius Vows To Stay Put, Fix HealthCare.govBusinessFor Obamacare To Work, It's Not Just About The Numbers

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Friday, October 25, 2013

Clinics Close As Texas Abortion Fight Continues

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In July, abortion rights advocates marched in Austin, Texas, to protest legislation that could shut down all but five abortion clinics and restrict abortion rights throughout the state.

Tamir Kalifa/AP

In July, abortion rights advocates marched in Austin, Texas, to protest legislation that could shut down all but five abortion clinics and restrict abortion rights throughout the state.

Tamir Kalifa/AP

The fight over abortion in Texas is being played out in federal court, where abortion rights activists are challenging a new state law.

The measure bans abortions at 20 weeks, adds building requirements for clinics and places more rules on doctors who perform abortions. Some clinics have shut down, saying they can't comply with the law set to go into effect Oct. 29.

Abortion rights activists call the new law a dramatic change that will affect all clinics across the state, including a huge Planned Parenthood facility in Fort Worth that opened in June.

It's a $6.5 million center with three surgical suites and 19,000 square feet of space, built specifically to meet the building standards that activists saw coming.

"You know, we did not think the laws would come as quickly as they did," says Ken Lambrecht, president and CEO of Planned Parenthood of Greater Texas.

He says three nurses are required to be in the clinic when abortions are performed. The law also mandates the size of operating rooms, the type of ventilation systems and the width of the hallways.

"You could fit at least two gurneys in this hallway, and it's the size of many hospital corridors," he says. "And it's certainly not necessary for the procedure."

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Lambrecht says there's no medical basis for the new law. He thinks the law is intended to increase costs and shut down clinics, most of which do not meet the new building codes.

Abortion rights groups are challenging the law. At a hearing this week, the state's attorney argued that Texas has the right to regulate clinics and has an interest in protecting the rights of the unborn.

"If the woman chooses to proceed with the abortion, she should have the best care and best environment possible," says state Rep. Jodie Laubenberg, who sponsored the measure.

She says the law is designed to make abortions safer.

"Why would anyone argue against making it a better place and a better environment?" she asks. "If a clinic closes, that is their choice. We're not forcing anyone to close."

Laws like the one in Texas have passed in more than a dozen states. As a result, clinics have closed in states from Virginia to Ohio, and in Texas.

Another provision threatening to close clinics requires doctors to have admitting privileges at a hospital within 30 miles of a facility.

But hospitals do not have to grant admitting privileges. Some say doctors must live in the local community. Others require them to admit a certain number of patients. Some don't approve of abortion.

The doctor in Fort Worth does have privileges, but the hospital is too far from the clinic. That means the brand new Planned Parenthood center there would also have to stop performing abortions.

Across the vast Texas plains, more than 300 miles from Fort Worth, is the city of Lubbock, in the northwest part of the state. It's just an hour from the New Mexico border, and it's home to a much smaller Planned Parenthood clinic. The facility recently stopped scheduling appointments.

Annie Jones recently had an abortion. She's a single mother working and going to school in Lubbock, and she has a 2-year-old daughter, Molly.

Jones, who is 28, says she decided to have an abortion because it was best for her family.

"I knew that if I decided to have the second child, I would be doing it a disservice," she says. "I'd be doing my daughter a disservice because I wouldn't be able to care for them in the way that they deserved."

At least three Texas clinics have closed since the law passed, and Jones is worried that this center could close, too.

"I think that the people who are passing the bills ... are trying to legislate morality, and they see abortion as wrong," she says.

For abortion opponents, passing the measure after a filibuster was a big victory. When Republican Gov. Rick Perry signed the bill, he said it would further what he called "the culture of life in Texas."

"It is our responsibility and duty to give voice to the unborn � the individuals whose survival is at stake," Perry said.

But abortion rights activists say the right to an abortion was decided 40 years ago.

Angela Martinez, director of the Lubbock clinic, says if her facility closes, women seeking abortions would have to travel more than 300 miles.

"We are the only clinic in West Texas who sees patients and performs abortions," Martinez says. "It's frustrating for me. It's frustrating for my staff, just because ... we want to be available."

Just outside the clinic on a recent crisp morning, a few protesters stand holding signs. Krysten Haga says she sees the law as a first step, not as the end of this debate.

"I'd like to see abortion completely banned in the United States," Haga says. "That's ideally what we're looking for � is for abortion to not be an option at all."

A federal judge is expected to rule soon whether part of the new Texas law will go into effect next week.

Share Facebook Twitter Google+ Email Comment More From Health Fitness & NutritionAging Well: Keeping Blood Sugar Low May Protect Memory BusinessFor Obamacare To Work, It's Not Just About The NumbersHealthPennsylvania Governor Talks Up Plan To Expand Medicaid His WayHealthWhat If Husbands Had A GPS To Help Wives With Breast Cancer?

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Tuesday, October 22, 2013

How Health Law Affects Fertility Treatment, Health Savings Accounts

More From Shots - Health News HealthWant Your Daughter To Be A Science Whiz? Soccer Might HelpHealth CareDoctors Enlist Therapists To Deliver Better, Cheaper CareHealthOnline Insurance Brokers Stymied Selling Obamacare PoliciesHealthHow Health Law Affects Fertility Treatment, Health Savings Accounts

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Doctors Enlist Therapists To Deliver Better, Cheaper Care

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Doctors Enlist Therapists To Deliver Better, Cheaper Care

More From Shots - Health News HealthWant Your Daughter To Be A Science Whiz? Soccer Might HelpHealth CareDoctors Enlist Therapists To Deliver Better, Cheaper CareHealthOnline Insurance Brokers Stymied Selling Obamacare PoliciesHealthHow Health Law Affects Fertility Treatment, Health Savings Accounts

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How Health Law Affects Fertility Treatment, Health Savings Accounts

More From Shots - Health News HealthWant Your Daughter To Be A Science Whiz? Soccer Might HelpHealth CareDoctors Enlist Therapists To Deliver Better, Cheaper CareHealthOnline Insurance Brokers Stymied Selling Obamacare PoliciesHealthHow Health Law Affects Fertility Treatment, Health Savings Accounts

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Monday, October 21, 2013

Enrollments For Health Care Exchanges Trickle In, Slowly

More From Shots - Health News Health CareHow Long Do They Really Have To Fix That Obamacare Website?HealthScientists Grow New Hair In A Lab, But Don't Rush To Buy A CombHealthFirst Polio Cases Since 1999 Suspected In SyriaHealthBreast Milk Bought Online Has High Levels Of Bacteria

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Thursday, October 17, 2013

If A Tech Company Had Built The Federal Health Care Website

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HealthCare.gov was meant to create a simple, easy way for millions of Americans to shop for subsidized health care.

Instead, in a little two more than weeks, it has become the poster child for the federal government's technical ineptitude.

A dysfunctional contracting system clearly bears some of the blame. But entrepreneurs in Silicon Valley likely would have approached the project differently from the start.

A week after the site launched, NPR spoke to Suzanne Cloud, a jazz musician based in Philadelphia. At that point, Cloud had spent hours on the site, trying to sign up for coverage. "Something went wrong, and it just went to a page with all kinds of html stuff," she said.

This week, Cloud says she gave up on the website and ended up registering by phone. The folks on the phone took all of her information � then asked if she'd like to pick out her plan online or receive information about her health care options via snail mail.

Cloud chose snail mail. "Once I signed up with the telephone, I didn't go back and try the site again," she said.

At 17 days old, HealthCare.gov has become a bit of a joke � even to folks like Cloud, who were eagerly awaiting its rollout.

So how could a roughly $400 million software project that had been in the works for years have so many problems at its launch? One bit of advice from Silicon Valley: Start small.

"It's not as if Facebook says, 'OK, here is our six-year plan for how we're going to make Facebook.com,' " says entrepreneur Ben Balter. "They build one feature at a time, and take a step back, look at how the feature is be used, before they go on to the next feature."

Balter says you build something small, you test it, and when it works for your users, then you take the next step. Right now, Balter works for GitHub.

"GitHub is a social code-sharing service," he says. "Think of it like Facebook for code. So instead of posting pictures of your kids or posting ... on Twitter what you had for lunch, you are showing what projects you're working on."

By sharing the code you are writing, lots of people can critique it, find the bugs, offer ideas and make sure it works. It's called open source, and Balter believes HealthCare.gov should have been written that way from the start.

"Why would you make that code private?" Balter asks.

But often when things don't work in government, the impulse is to duck and cover and clamp down on information.

"I think the key reason is the way projects get funded," says Michael Cockrill, who used to work in startups and is now the chief information officer for Washington state.

He says to get a software project funded in the public sector, typically you have say exactly what it is going to do, spell how much it will cost and when you will finish.

"As a result, you end up creating this culture that is all about doing what you said you were gonna do," Cockrill says.

It's a culture that is risk-adverse and terrified of public failure. You can't learn from little failures or adjust course midstream. And instead of taking big jobs, breaking them down into small tasks and testing for success at each step, a project like HealthCare.gov becomes a giant all-or-nothing gamble.

Cockrill says too often it's a gamble taxpayers loose.

"You've made all these commitments about what you are going to build. What is it going to look like upfront," Cockrill says. "And even if the market changes underneath you, and even if your customers need something different � which you know always happens � you made a commitment a big public commitment, and they've written it into budgets and law."

Cockrill and many others around the country are trying to help governments become more flexible and agile as they embark on software development projects.

"It's really hard to convince people to kind of trust you," he says. "Especially when you are saying, 'Look I don't know exactly what is going to look like � but we are going to do what matters most first.' "

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Wednesday, October 16, 2013

Hitches On Health Exchanges Hinder Launch Of Insurance Co-op

More From Shots - Health News HealthFamily Caregiving Can Be Stressful, Rewarding And Life-AffirmingHealth CareTo Reduce Patient Falls, Hospitals Try Alarms, More NursesHealthHitches On Health Exchanges Hinder Launch Of Insurance Co-opHealthBioethicists Give Hollywood's Films A Reality Check

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Tuesday, October 15, 2013

Why A Medical Device Tax Became Part Of The Fiscal Fight

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Among the bargaining chips in the budget crisis on Capitol Hill, there's the small but persistent issue of taxing medical device manufacturers.

The 2.3 percent sales tax covers everything from MRI machines to replacement hips and maybe even surgical gloves. The tax was imposed to help pay for the Affordable Care Act. It didn't attract much attention at first � at least, not outside the world of medical device manufacturers.

But they have waged a persistent campaign to undo the tax, and right now is the closest they have come to succeeding.

House Republicans have made repeated efforts to kill the tax, but Democrats had opposed any changes to the health care law.

Senate Finance Committee Chairman Max Baucus, D-Mont., last month dismissed changes in the medical devices tax. He told Politico that the industry had agreed to it when the bill was being written and "a deal's a deal."

But even Democrats have started softening that hard line.

Illinois Sen. Richard Durbin, the Senate's second-ranking Democrat, told CNN recently: "We can work out something, I believe, on the medical device tax � that was one of the proposals from the Republicans � as long as we replace the revenue."

Last week, a bipartisan compromise in the Senate included the idea of delaying the tax for two years.

Maine Republican Sen. Susan Collins spearheaded the proposal. She cited the lobbying campaign's work when she said the tax "will cause the loss of as many as 43,000 domestic jobs, according to industry estimates."

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Those estimates are crucial to the lobbying effort.

The CEO of one of the industry's giants, Medtronic, said last fall that the company likes to "focus on things we can control." Medtronic, which is based in Minnesota, did not respond to an interview request Tuesday.

But one of Minnesota's senators is a leader of the anti-tax campaign.

Democrat Amy Klobuchar gave industry advocates some advice this summer.

"I think that at the beginning of this battle, people didn't understand in Congress how many medical device manufacturers they had," she said. "I think just making the case at home and also back in Washington makes a difference."

And that is what the medical device industry has been doing, quietly but assiduously.

Cook Group, the largest privately owned maker of medical devices, boosted its lobbying outlays significantly in the past two years. It's also working with an industry consultant, Joe Hage, on a website called no2point3.com.

The website collects stories of anger and anguish from the small-business people who run a lot of the companies. It also has a petition to repeal with 11,000 signatures. It's all fueled by a LinkedIn group that Hage runs.

"The medical devices group is not in league with Washington lobbyists directly," Hage says, but he quickly adds: "We like to think that this effort complements their effort by giving them another bow in their quiver."

Still, it's hardly clear whether those efforts will move votes or whether the whole tax question will be just a pawn in the much larger debate over the budget and the debt limit.

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Friday, October 11, 2013

FAQ: How Obamacare Affects Employers And How They're Responding

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.

Do employers have to do anything different under the Affordable Care Act?

Not right away. The only thing required of employers at the start is that they notify workers that the new health insurance exchanges have opened. You may have received a letter from your employer to this effect � you probably don't need to do anything.

Starting in 2015, large employers with 50 or more workers have a responsibility � but no mandate � to offer employees health coverage. If they don't, they may face fines, but only if their workers go to health insurance exchanges and have earnings low enough to qualify for federal subsidies. Stores and restaurants � less likely to offer health insurance in the past � may be most affected. The coverage rule doesn't affect workers who put in less than 30 hours a week.

There are no responsibilities for small employers with fewer than 50 workers. If they want to buy coverage for their employees, the insurance exchanges represent a new option for them in terms of where to shop. Certain employers with fewer than 25 workers are eligible for federal tax credits. To qualify, the company has to cover at least half of the premium for all of its employees, and also have average wages of less than $50,000. For details on these tax credits, see this answer sheet from the IRS.

Will my employer cut back on my insurance coverage?

A number of employers have been overhauling the health benefits they offer employees, citing rising costs.

There are two themes to what they are doing. In trying to control their own spending, employers often are shifting health costs to employees. So the average annual deductible for an individual � what consumers pay before insurance kicks in � nearly doubled in the past seven years, from $584 in 2006 to $1,135 this year, according to the Kaiser Family Foundation.

But employers aren't just making workers pay more. They're trying to make them think more about health-related expenses and behavior.

Companies such as grocer Kroger Co. pay only a fixed amount for particular drugs or procedures, giving patients incentive to shop around for the best price. IBM started giving rebates to workers who adopt healthy lifestyles. Penalizing smokers with surcharges is one of the few discriminatory measures the health act allows.

What about part-time workers?

Nothing in the Affordable Care Act says that employers have to cover part-time workers. The law defines part time as someone who works less than 30 hours a week.

Some employers that have offered part-time workers minimal coverage, such as Trader Joe's and Home Depot, have dropped it on the grounds that those workers can now find coverage through the insurance exchanges. Most workers in this situation will be pleased with the outcome. They'll likely find better coverage than what they had for less money. Although depending on the situation, some people may see their premiums go up.

Are employers reducing their workforce as a result of the Affordable Care Act?

There have been reports of employers holding back on hiring in order to stay under the 50-employee threshold that triggers health insurance responsibilities. There also have been reports of employers cutting workers' hours to below 30 per week so that they don't count as full-time. While there is anecdotal evidence of both things happening, there's no evidence that those cases have added up to a broader drag on the economy as a whole.

Will my company stop offering coverage to my spouse and dependents?

Some companies, including UPS, have decided to stop covering working spouses if they have access to coverage at their own jobs. The health law does not require employers to cover spouses, but surveys show that only a minority of companies have implemented a "spousal exclusion."

However, employers increasingly offer incentives to get spouses off their plans. They may charge workers extra if a covered spouse has access to other insurance, or they may pay bonuses when spouses are not on the company policy.

The health law requires employers who offer coverage to employees to also offer coverage to dependent children, or pay a penalty.

See other Frequently Asked Questions on the Affordable Care Act:

Understanding The Health Insurance Mandate And Penalties For Going Uninsured All About Health Insurance Exchanges And How To Shop At Them A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act Where Medicaid's Reach Has Expanded � And Where It Hasn't


Additional coverage from NPR Member Stations:

California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

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FAQ: How Obamacare Affects Employers And How They're Responding

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.

Do employers have to do anything different under the Affordable Care Act?

Not right away. The only thing required of employers at the start is that they notify workers that the new health insurance exchanges have opened. You may have received a letter from your employer to this effect � you probably don't need to do anything.

Starting in 2015, large employers with 50 or more workers have a responsibility � but no mandate � to offer employees health coverage. If they don't, they may face fines, but only if their workers go to health insurance exchanges and have earnings low enough to qualify for federal subsidies. Stores and restaurants � less likely to offer health insurance in the past � may be most affected. The coverage rule doesn't affect workers who put in less than 30 hours a week.

There are no responsibilities for small employers with fewer than 50 workers. If they want to buy coverage for their employees, the insurance exchanges represent a new option for them in terms of where to shop. Certain employers with fewer than 25 workers are eligible for federal tax credits. To qualify, the company has to cover at least half of the premium for all of its employees, and also have average wages of less than $50,000. For details on these tax credits, see this answer sheet from the IRS.

Will my employer cut back on my insurance coverage?

A number of employers have been overhauling the health benefits they offer employees, citing rising costs.

There are two themes to what they are doing. In trying to control their own spending, employers often are shifting health costs to employees. So the average annual deductible for an individual � what consumers pay before insurance kicks in � nearly doubled in the past seven years, from $584 in 2006 to $1,135 this year, according to the Kaiser Family Foundation.

But employers aren't just making workers pay more. They're trying to make them think more about health-related expenses and behavior.

Companies such as grocer Kroger Co. pay only a fixed amount for particular drugs or procedures, giving patients incentive to shop around for the best price. IBM started giving rebates to workers who adopt healthy lifestyles. Penalizing smokers with surcharges is one of the few discriminatory measures the health act allows.

What about part-time workers?

Nothing in the Affordable Care Act says that employers have to cover part-time workers. The law defines part time as someone who works less than 30 hours a week.

Some employers that have offered part-time workers minimal coverage, such as Trader Joe's and Home Depot, have dropped it on the grounds that those workers can now find coverage through the insurance exchanges. Most workers in this situation will be pleased with the outcome. They'll likely find better coverage than what they had for less money. Although depending on the situation, some people may see their premiums go up.

Are employers reducing their workforce as a result of the Affordable Care Act?

There have been reports of employers holding back on hiring in order to stay under the 50-employee threshold that triggers health insurance responsibilities. There also have been reports of employers cutting workers' hours to below 30 per week so that they don't count as full-time. While there is anecdotal evidence of both things happening, there's no evidence that those cases have added up to a broader drag on the economy as a whole.

Will my company stop offering coverage to my spouse and dependents?

Some companies, including UPS, have decided to stop covering working spouses if they have access to coverage at their own jobs. The health law does not require employers to cover spouses, but surveys show that only a minority of companies have implemented a "spousal exclusion."

However, employers increasingly offer incentives to get spouses off their plans. They may charge workers extra if a covered spouse has access to other insurance, or they may pay bonuses when spouses are not on the company policy.

The health law requires employers who offer coverage to employees to also offer coverage to dependent children, or pay a penalty.

See other Frequently Asked Questions on the Affordable Care Act:

Understanding The Health Insurance Mandate And Penalties For Going Uninsured All About Health Insurance Exchanges And How To Shop At Them A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act Where Medicaid's Reach Has Expanded � And Where It Hasn't


Additional coverage from NPR Member Stations:

California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

Share Facebook Twitter Google+ Email Comment More From The Affordable Care Act, Explained HealthFAQ: Where Medicaid's Reach Has Expanded � And Where It Hasn'tHealthFAQ: How Obamacare Affects Employers And How They're RespondingHealthFAQ: What Retirees And Seniors Need To Know About The Affordable Care ActHealthFAQ: A Young Adult's Guide To New Health Insurance Choices

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Thursday, October 10, 2013

Employers Trim Health Costs By Cutting Coverage For Spouses

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Tuesday, October 8, 2013

The Religious Alternative To Obamacare's Individual Mandate

Listen to the Story 7 min 43 sec Playlist Download Transcript   Private Vs. Public Health Care Options

No matter what happens in Congress, the Affordable Care Act deadlines are still in effect. On Tuesday, public exchanges will open for business. Already, several companies are making changes to how they provide health care to their employees.

Host Arun Rath speaks with NPR's Julie Rovner about those changes and the difference between public and private options. You can hear their conversation � and the full story on the health care sharing ministries � at the audio at the top of the page.

The Affordable Care Act requires nearly every American to have health insurance or pay a penalty, beginning Jan. 1. The so-called "individual mandate" has been controversial ever since the law was passed.

But for people who fall into a few select categories, the mandate doesn't apply. Like Native Americans who get health coverage through the Indian Health Service, or people who are incarcerated.

Another exception is for members of "health care sharing ministries," a way for individuals with a "common set of ethical or religious beliefs" to share medical bills.

Sharing Health Burdens

The sharing ministries are not insurance: there's no guarantee that a given bill will be covered. Instead, it's like a co-op, where members decide what procedures to cover, and then all pitch in to cover the cost as group.

"It's a group of people, in this case Christians, who band together and agree that they want to share one another's burdens," says Andrea Miller, medical director for the largest Christian health-insurance alternative, Medi-Share.

She says members put aside a certain amount of money every month, which then goes to other Christians who need help paying their medical bills. Medi-Share's monthly fees vary, but its website advertises that family options "average less than $300 a month."

There are a few requirements to fulfill before participating, Miller says. The first is that you have to be Christian. "Second, you need to agree to living a Christian lifestyle, including no smoking, including not abusing alcohol or drugs," she says.

To constitute as a health care sharing ministry � and therefore be exempt from the Affordable Care Act requirements � the nonprofit has to have been in existence since 1999 (Medi-Share has existed since '93). The ministries also have an independent accounting firm conduct a publicly available annual audit.

Footing The Bill

Tens of thousands of Americans belong to Christian health sharing ministries, including Fred Bennett of Chattanooga, Tenn.

Bennett and his wife, Beth, have belonged to a health care sharing ministry for 19 years. They've always been healthy, but in the last few years, as they've entered their 60s, they started to have medical trouble.

"In '04, my wife was rushed to the hospital with E.coli in her kidneys and, actually, it spread to all of her body," he says.

She recovered, but the hospital bill was staggering. After six days in the hospital, most of which was spent in intensive care, the cost came to about $70,000.

Shots - Health News 'How Much Will Obamacare Cost Me?' Try Our Calculator

And that bill was just the beginning for the Bennetts.

"She hasn't had many claims, but unfortunately, I had a stretch of five or six years there that things were pretty rough," Bennett says, including multiple surgeries and a heart attack.

The medical bills reached tens of thousands of dollars, but for each incident, the Bennetts paid only their $250 deductible. The rest was paid by fellow Christians through Medi-Share.

Of course, the same would have been true if they had normal health insurance. But Bennett says he prefers the health sharing ministry because the ministry doesn't pay for procedures he thinks are immoral, like abortions.

"The part I liked about it was that I wouldn't have to be having some of my premiums spent to take care of someone who wasn't taking of themself, physically or spiritually, either one," he says.

What's Not Covered

While the federal health law includes an exemption for health sharing ministries, some states have sued to try to keep them out. The concern is that consumers shopping for insurance will be confused about what ministries really guarantee in the way of coverage.

"We do not share in every medical need that a person has," Miller of Medi-Share says. "Some of the things we don't share in are related to lifestyle issues, such as an abortion. But others of them are related to things that the members have agreed that they would rather pay for themselves."

For example, she says, members tend to pay for their own preventative care (with the exception of very young children). There are also some restrictions on pre-existing conditions.

At Medi-Share, Miller works with a steering committee of health share members who discuss what kind of care is covered by the guidelines. "Any significant change in the guidelines is something that has to be passed by all the members," she says.

In August, CNBC reported that members whose claims are rejected have the right to file an appeal. In the current fiscal year, 76 percent of the bills submitted to Medi-Share were considered eligible, and all of those were covered, Medi-Share told CNBC.

Spiritual Support

Bennett of Tennessee points out that because all the members decide what to share the cost of, health ministries often cover things insurance rarely does, like adoption fees and funeral costs. Plus, he says, his health sharing ministry gives him a service he could never get from an insurance company.

"The night before my surgery, the lady who'd helped me locate the right providers and everything called me back and said, 'Would it be OK if I prayed with you for your surgery tomorrow?'"

Three days later, she called back to ask how the surgery went.

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