Thursday, October 31, 2013

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

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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.

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Wednesday, October 30, 2013

Why 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

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Monday, October 28, 2013

Some Health Screenings May Harm More Than Help

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Some 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.

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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.

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Tuesday, October 22, 2013

How 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

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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

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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

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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.

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More From The Affordable Care Act, Explained

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Thursday, October 10, 2013

Employers Trim Health Costs By Cutting Coverage For Spouses

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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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Medicaid Looks Good To A Former Young Invincible

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How A Tax On Medical Devices United Political Rivals

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Monday, October 7, 2013

First Step In Health Exchange Enrollment: Train The Helpers

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House Ties Government Funding To One-Year Obamacare Delay

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One Key Thing No One Knows About Obamacare

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