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Postcard From The Hill: Senators Shelve Histrionics In Search Of Obamacare Fix

Kaiser Health News:HealthReform - September 12, 2017

After a summer of flame-throwing over the Affordable Care Act’s repeal, Republicans and Democrats are now engaged in a serious collaborative effort to find a legislative solution that would ward off predicted premium rate hikes this year.

Sen. Lamar Alexander, who chairs the Senate Health, Education, Labor and Pensions (HELP) Committee, and his colleagues are up against a tight deadline to craft a bill to steady premiums in the Affordable Care Act’s shaky markets. Insurers must nail down plans late this month for the coming enrollment season.

If that weren’t challenging enough, the Tennessee Republican and the committee’s ranking Democrat, Sen. Patty Murray of Washington, have insisted their bill also be simple, bipartisan and balanced.

Two much-discussed ideas so far are funding subsidies that help moderate-income consumers pay out-of-pocket costs for health care and giving states more leeway on insurance coverage and plans for their residents.

Use Our ContentThis KHN story can be republished for free (details).

Over three hearings in two weeks, senators solicited ideas and insights from bipartisan panels of governors, state insurance commissioners, government researchers and insurance company executives. Before the hearings, there were informal “coffee sessions” so that non-committee members from both parties could drop by to ask questions.

Noticeably absent: Democratic press conferences griping about the Republicans’ failure to permit hearings or seek input on their plans to repeal and replace the Affordable Care Act, also known as Obamacare. Such public airings were a fixture last summer when a Republican task force chosen by Senate Majority Leader Mitch McConnell drafted a replacement bill that was defeated in late July.

Civility has ruled the HELP committee’s hearings, kept them policy-focused — and mostly as dry as day-old toast. They are nearly incomprehensible to anyone but health policy experts.

On Tuesday, Alexander queried a witness about the nuances of segmenting invisible high-risk pools, and Sen. Sheldon Whitehouse (D-R.I.) asked about two types of reinsurance.

The committee’s members are a cross section of each party’s politics — from Sen. Rand Paul (R-Ky.) on the right to Sen Elizabeth Warren (D-Mass.) and Sen. Bernie Sanders (I-Vt.) on the far left.

But all 23 members get the same time to question witnesses — five minutes each. On occasion, Alexander is lenient with Democrats and Republicans alike, allowing them extra time to get detailed policy answers from witnesses.

There is no talk of death spirals, collapsing markets or sabotage — terms that colored past debates about Obamacare. Instead, HELP senators bat around the nuances of actuarial equivalence, budget neutrality and reinsurance programs.

“So far, we’ve had focused, substantive discussions in our first two hearings — and in our many conversations off the committee — on areas of significant common ground around these goals,” Murray said in her opening statement Tuesday.

This atmosphere is the antithesis of the rancor that hung over the “repeal and replace” debates. Sen. Al Franken (D-Minn.), a former comedian, has even had time to joke with Republicans.

Partisan posturing hasn’t been entirely missing at these hearings, though. Warren used some of her questioning time last week to denounce the Trump administration’s threats to end reimbursements to insurance companies for the “cost-sharing reduction” discounts they provide to enrollees with incomes under 250 percent of the federal poverty level.

Sen. Bill Cassidy (R-La.) used his time to advocate for reducing federal spending on Medicaid.

First HHS medical support team arrives in Florida Keys

HHS Gov News - September 12, 2017

A National Disaster Medical System team from the U.S. Department of Health and Human Services became part of the first wave of federal responders transported today into the Florida Keys as part of the Trump Administration's government-wide efforts to provide relief to those affected by Hurricane Irma. The team will establish a mobile medical unit and begin providing medical care to assist a local hospital.

National Disaster Medical System personnel from Hawaii loading a US Coast Guard aircraft with equipment and supplies to assist the state of Florida with public health and medical support in the Florida Keys.“The Florida Keys were particularly hard hit in this massive storm, and all current indicators are that the medical infrastructure is damaged and in some cases may be destroyed,” explained HHS Assistant Secretary for Preparedness and Response Robert Kadlec, M.D. “Our medical professionals are trained to provide care in austere conditions after disasters, and they’re arriving with the first wave of equipment and supplies they’ll need to help save lives.”

Additional medical personnel could follow at the state’s request. In other areas of Florida, HHS dispatched NDMS and the U.S. Public Health Service Commissioned Corps teams to assist local healthcare workers in caring for evacuees in six shelters. So far the teams have seen approximately 100 patients.

In addition, HHS medical teams are providing care at a shelter in Puerto Rico and at an overwhelmed hospital emergency department in St. Thomas, and triaging evacuees from multiple islands as they reach Puerto Rico. The teams also embedded with Urban Search and Rescue to find dialysis patients and aided the U.S. Virgin Islands in evacuating these patients to Puerto Rico.

These medical professionals are among the more than 675 personnel HHS deployed to support the emergency response in Florida, Puerto Rico, and the U.S. Virgin Islands. The remainder are providing response coordination, supporting emergency operations centers, or available for additional assignments from the states or U.S. territories.

To help the effected states and U.S. territories respond to the health impacts of the storm, HHS Secretary Tom Price, M.D., signed public health emergency declarations for Florida, Puerto Rico, the U.S. Virgin Islands, Georgia and South Carolina. The Centers for Medicare & Medicaid Services subsequently provided waivers to health care providers and facilities so that Americans who rely on Medicare, Medicaid or the Children Health Insurance Program (CHIP) could receive unimpeded care during the crisis. 

HHS’s Administration for Children and Families (ACF) employees continue to coordinate with the Department of State and Department of Defense to evacuate American citizens from the island of St. Martin.  The ACF Office of Refugee Resettlement initiated repatriation efforts to ensure that Americans were safely transported back to American soil and out of harm’s way beginning Saturday evening.  A total of 1,694 repatriates have safely touched ground in Puerto Rico and eventually back to the continental United States.

The Disaster Distress Helpline remains activated to aid people in coping with the behavioral health effects of the storm and help people in impacted areas connect with local behavioral health professionals. The helpline can be reached toll-free at 1-800-985-5990 or text TalkWithUs to 66746. Since Hurricane Irma made landfall, the helpline has assisted more than 170 callers from impacted areas.

HHS also provided data to public health authorities in Florida to assist them in reaching Medicare beneficiaries who rely on electrically powered medical equipment at home. Power outages become life-or-death situations for people with these medical conditions.

The Department remains committed to meeting the medical and public health needs of communities across the southeast impacted by Hurricane Irma. Health tips for clean up after the hurricane are available at www.phe.gov/irma.

Critical updates also are available at:

Uninsured Rate Falls To Record Low Of 8.8%

Kaiser Health News:Insurance - September 12, 2017

Three years after the Affordable Care Act’s coverage expansion took effect, the number of Americans without health insurance fell to 28.1 million in 2016, down from 29 million in 2015, according to a federal report released Tuesday.

The latest numbers from the U.S. Census Bureau showed the nation’s uninsured rate dropped to 8.8 percent. It had been 9.1 percent in 2015.

Both the overall number of uninsured and the percentage are record lows.

The latest figures from the Census Bureau effectively close the book on President Barack Obama’s record on lowering the number of uninsured. He made that a linchpin of his 2008 campaign, and his administration’s effort to overhaul the nation’s health system through the ACA focused on expanding coverage.

When Obama took office in 2009, during the worst economic recession since the Great Depression, more than 50 million Americans were uninsured, or nearly 17 percent of the population.

Use Our ContentThis KHN story can be republished for free (details).

The number of uninsured has fallen from 42 million in 2013 — before the ACA in 2014 allowed states to expand Medicaid, the federal-state program that provides coverage to low-income people, and provided federal subsidies to help lower- and middle-income Americans buy coverage on the insurance marketplaces. The decline also reflected the improving economy, which has put more Americans in jobs that offer health coverage.

The dramatic drop in the uninsured over the past few years played a major role in the congressional debate over the summer about whether to replace the 2010 health law. Advocates pleaded with the Republican-controlled Congress not to take steps to reverse the gains in coverage.

The Census numbers are considered the gold standard for tracking who has insurance because the survey samples are so large.

The uninsured rate has fallen in all 50 states and the District of Columbia since 2013, although the rate has been lower among the 31 states that expanded Medicaid as part of the health law. The lowest uninsured rate last year was 2.5 percent in Massachusetts and the highest was 16.6 percent in Texas, the Census Bureau said. States that expanded Medicaid had an average uninsured rate of 6.5 percent compared with an 11.7 percent average among states that did not expand, the Census Bureau reported.

More than half of Americans — 55.7 percent — get health insurance through their jobs. But government coverage is becoming more common. Medicaid now covers more than 19 percent of the population and Medicare nearly 17 percent.

Uninsured Rate Falls To A Record Low Of 8.8 Percent

Kaiser Health News:HealthReform - September 12, 2017

Three years after the Affordable Care Act’s coverage expansion took effect, the number of Americans without health insurance fell to 28.1 million in 2016, down from 29 million in 2015, according to a federal report released Tuesday.

The latest numbers from the U.S. Census Bureau showed the nation’s uninsured rate dropped to 8.8 percent. It had been 9.1 percent in 2015.

Both the overall number of uninsured and the percentage are record lows.

The latest figures from the Census Bureau effectively close the book on President Barack Obama’s record on lowering the number of uninsured. He made that a linchpin of his 2008 campaign, and his administration’s effort to overhaul the nation’s health system through the ACA focused on expanding coverage.

When Obama took office in 2009, during the worst economic recession since the Great Depression, more than 50 million Americans were uninsured, or nearly 17 percent of the population.

Use Our ContentThis KHN story can be republished for free (details).

The number of uninsured has fallen from 42 million in 2013 — before the ACA in 2014 allowed states to expand Medicaid, the federal-state program that provides coverage to low-income people, and provided federal subsidies to help lower- and middle-income Americans buy coverage on the insurance marketplaces. The decline also reflected the improving economy, which has put more Americans in jobs that offer health coverage.

The dramatic drop in the uninsured over the past few years played a major role in the congressional debate over the summer about whether to replace the 2010 health law. Advocates pleaded with the Republican-controlled Congress not to take steps to reverse the gains in coverage.

The Census numbers are considered the gold standard for tracking who has insurance because the survey samples are so large.

The uninsured rate has fallen in all 50 states and the District of Columbia since 2013, although the rate has been lower among the 31 states that expanded Medicaid as part of the health law. The lowest uninsured rate last year was 2.5 percent in Massachusetts and the highest was 16.6 percent in Texas, the Census Bureau said. States that expanded Medicaid had an average uninsured rate of 6.5 percent compared with an 11.7 percent average among states that did not expand, the Census Bureau reported.

More than half of Americans — 55.7 percent — get health insurance through their jobs. But government coverage is becoming more common. Medicaid now covers more than 19 percent of the population and Medicare nearly 17 percent.

If You’re Blindsided By Health Plan Changes, Learn The Root Causes — And Your Rights

Kaiser Health News:HealthReform - September 12, 2017

How much notice is required if benefits change? Do insurers have to give you a heads up if your plan doesn’t meet the minimum coverage standard under the Affordable Care Act?  Readers’ questions this month are centered around insurance notification requirements.

Q: My father’s health insurance coverage through his company was reduced without him being aware of the change. The insurance company continued to cover my parents’ bills until 10 months after the change. Now it’s trying to charge my parents for all of my mother’s doctor visits to manage her multiple sclerosis during that time. This will result in thousands of dollars in repayments. Can the insurer do that?

You may need to do some digging to figure out what’s going on here. Health plans can reduce the benefits that they offer or increase cost sharing during the plan year, but under the Affordable Care Act they generally have to notify enrollees 60 days before any changes become effective.

Insuring Your Health

KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.

To contact Michelle with a question or comment, click here.

This KHN story can be republished for free (details).

That doesn’t always happen, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms.

“It is very possible that something was done incorrectly, particularly if you have a self-funded employer that’s doing all the claims processing in-house,” said Palanker, who is a former health plan administrator.

Since the health plan continued to pay the claims for your mother’s multiple sclerosis for 10 months after the change, this may not be a notification problem, however.

“It suggests that the insurance company did a claims audit and determined that they should never have been paying these claims,” Palanker said. Such audits are common. “They do it routinely to try to identify fraud and abuse.”

Some states don’t allow insurers to retroactively adjust claims except in cases of fraud.

Your first step should be to contact the health plan to find out why the claims were denied retroactively. Then, regardless of the reason for the back charges, your parents “should absolutely complain, no matter what,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Depending on what you learn, your dad’s human resources department may be helpful in resolving the problem, said Pollitz. Or you may need to file an appeal with the health plan, complain to your state insurance regulator or to the federal Department of Labor.

Q: As a longtime self-employed businesswoman, I’ve bought coverage on the individual market for years. I was unaware that the short-term health insurance policy I’d been sold didn’t meet ACA requirements. The pricing was similar. Don’t people have to agree in writing that they understand the limitations of those policies? Is there anything I can do?

As of last January, short-term health plan enrollment applications and related materials were required to display prominently a warning that the plan doesn’t satisfy the health insurance coverage requirements under the ACA. There’s no requirement that people acknowledge in writing that they understand what they’re buying, however. Since these short-term plans aren’t considered adequate coverage,  you may have to pay a penalty just like people who don’t buy any insurance.

In your case, you may have purchased the plan before that requirement went into effect, said Timothy Jost, an emeritus professor at Washington and Lee law school who is an expert on health law.

As for remedies, fortunately the open enrollment period for 2018 starts Nov. 1. You can sign up for a more comprehensive plan at that time on your state marketplace for coverage that begins Jan. 1.

Q: I was hospitalized with a traumatic brain injury, had surgery and spent two months in the intensive care unit. Now my insurer is no longer covering some of my medical care. Does my insurer have to notify me of this change, or is it sufficient that the hospital insurance case manager verbally informed me? 

Health plans have to notify you in writing when they deny a claim. But in your case, there may not have been an actual denial, Palanker said.

Hospital staff are typically in constant communication with a patient’s insurer about what services are covered, whether a particular treatment requires prior authorization from the health plan, or similar issues.

It’s not uncommon for a doctor to want a patient to remain in the hospital, for example, while the insurer maintains that it’s not medically necessary, Palanker said. The insurer may want the patient moved to an inpatient rehabilitation center or discharged home instead.

In these cases, there’s not an actual adverse determination and thus no requirement that the insurer notify you. The hospital case manager would likely be the one to inform you of the change.

You still have a right to that information. “The patient should ask the case manager what was asked of the insurer and then ask the insurer what is the basis that something is not covered under the plan,” Palanker said. The hospital’s patient advocate or caseworker can work with the patient to put together the necessary paperwork to request a determination and file an appeal with the insurer, if necessary.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

HHS, DoD rescue dialysis patients from U.S. Virgin Islands after Hurricane Irma

HHS Gov News - September 11, 2017

As part of the Trump Administration's government-wide efforts to provide relief to those affected by Hurricane Irma, personnel from the U.S. Department of Health and Human Services and Department of Defense have begun evacuating dialysis patients from St. Thomas, U.S. Virgin Islands, to San Juan, Puerto Rico, due to the extensive damage to the health care infrastructure on St. Thomas. Disruptions in dialysis treatment can become life-threatening within two or three days.

Data from the Centers for Medicare & Medicaid Services (CMS) indicate that more than 130 American dialysis patients make their home on St. Thomas. For the first time in the department’s history, HHS medical personnel also have embedded with Urban Search and Rescue teams attempting to find patients who did not respond to local authorities’ message about evacuating. These rescue and evacuation operations are complicated by hurricane damage, which brought down telephone lines and cell towers and has made roads impassable.

“People who rely on dialysis are among the most medically vulnerable after natural disasters, and given the extent of the destruction on St. Thomas, we are very concerned about the health and safety of dialysis patients there right now,” said HHS Assistant Secretary for Preparedness and Response Robert Kadlec, M.D. “Our medical personnel and our agency partners are working as quickly as possible under grueling conditions to assist the territory in its life-saving efforts.”

HHS emergency managers also are working with territory agencies, dialysis facilities and other partners to arrange dialysis services and temporary shelter in San Juan for the evacuated patients. As patients arrive by plane, health care workers from the local dialysis network triage each patient and provide immediate dialysis or transport of the patient to the hospital if additional care is needed. Partners include Department of Defense, FEMA, CMS, the Quality Insights Renal Network 3 of CMS’ End-Stage Renal Disease (ESRD) Network Program, and the Kidney Community Emergency Response (KCER) Program.

Data to support the evacuation came from the HHS emPOWER initiative and CMS systems. To aid in planning, emPOWER provides public health authorities with the total number of Medicare beneficiaries in a zip code who rely on 14 types of life-maintaining and assistive equipment, ranging from oxygen concentrators to electric wheelchairs, as well as data on the number of people who rely on dialysis, oxygen, and home health services. Specific information can be provided for life-saving efforts in a disaster.

Approximately 100 HHS medical personnel are deployed to Puerto Rico and the U.S. Virgin Islands to aid in patient evacuation and to assist USVI doctors and nurses in providing medical care in a hospital emergency department in St. Thomas. Additional medical teams are positioned in Florida and prepared to provide medical care and public health support as needed by the state. As of Sunday morning, approximately 550 personnel were staged in Florida with additional teams and Federal Medical Stations on alert to deploy when and where requested.

National Disaster Medical System personnel from California and Oregon aid in evacuating a dialysis patient from St. Thomas, U.S. Virgin Islands, to Puerto Rico for medical care

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