Original Story: latimes.com
California's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall.
Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage.
Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said.
The exchange said the private insurance should remain in place until coverage kicks in under Medi-Cal, the state's Medicaid program for lower-income residents.
"There have been some cases of individuals where the wires got crossed and people were removed from Covered California before Medi-Cal was live," said Peter Lee, executive director of Covered California. "It's been a limited number of cases, but it's still a concern."
At the same time, Covered California has been contacting nearly 100,000 households that risked losing coverage if they didn't provide proof of citizenship or legal residency.
Covered California said it has cleared half of that list and about 50,000 households must still provide verification. Their coverage under the Affordable Care Act will be canceled Oct. 31 if they fail to provide the proper documentation.
That verification effort, in particular, has taken a toll on the state's customer service, according to the exchange.
Less than 1% of callers reached the exchange within 30 seconds last month; the state's goal is an 80% response rate in half a minute.
Sixty-four percent of people abandoned their call entirely.
Lee attributed the poor performance to shifting call-center workers to citizenship and residency issues.
"We have taken a lot of people off the phone in the past month," Lee said. "Unfortunately, we haven't been answering the phone as quickly as we would like."
Robert Ross, a Covered California board member, asked at last week's board meeting whether there was a plan to reduce wait times before calls ramp up when open enrollment begins Nov. 15.
Also, about 1.2 million enrollees will be looking to renew their coverage or shop for a new policy prior to January.
Lee said the exchange is close to hiring an outside vendor to supply extra call-center support during peak times.
He also noted that upgrades to the state website should decrease the number of consumer questions and calls.
For instance, applicants will be able to pay their initial premium online at sign-up rather than wait for their insurer to bill them. That two-step process confused many consumers who were unsure about the status of their coverage, and it triggered a high volume of calls.
Showing posts with label obamacare. Show all posts
Showing posts with label obamacare. Show all posts
23 July 2014
INVESTIGATORS OBTAIN OBAMACARE COVERAGE, SUBSIDIES USING FAKE IDENTITIES
Story first appeared: FoxNews.com
Undercover government investigators were able to obtain thousands of dollars in taxpayer subsidies under ObamaCare using fake identities, according to findings being presented to Congress on Wednesday.
The probe by the Government Accountability Office has raised fresh concerns about the ability of the sprawling health care program to prevent or intercept costly fraud schemes. In the case of the GAO investigation, 11 out of 12 applications submitted using "fictitious identities" were accepted, resulting in subsidized health coverage.
"For each of our 11 approved applications, we paid the required premiums to put policies into force, and are continuing to pay the premiums. For the 11 applications that were approved for coverage, we obtained the advance premium tax credit in all cases," the report said.
According to the GAO, the total amount for these credits was $2,500 monthly, adding up to $30,000 a year.
GAO officials were to testify about the findings before a House Ways and Means subcommittee Wednesday.
"We are seeing a trend with ObamaCare information systems: under every rock, there is incompetence, waste, and the potential for fraud," Rep. Dave Camp, R-Mich., chairman of the committee, said in a statement. "This law is already hitting Americans where it hurts the most - their pocketbooks. Now, this administration is forcing the American taxpayer to foot the bill for ObamaCare's waste and fraud."
Sen. Orrin Hatch, R-Utah, added: "Ironically, the GAO has found ObamaCare is working really well -- for those who don't exist."
The inquiries were carried out in several different states.
The administration pointed out that six of the GAO's fake online applications were blocked by eligibility checks built into computer systems at HealthCare.gov. Still, the GAO says its undercover agents found a way around that by phoning the call centers and were able to enroll anyway.
In six other applications, GAO investigators also tried to sign up fake applicants with in-person representatives. But in five of those cases, GAO was "unable to obtain in-person assistance" for various reasons, including one representative saying they could not help because HealthCare.gov was down.
"We are examining this report carefully and will work with GAO to identify additional strategies to strengthen our verification processes," administration spokesman Aaron Albright said. At least on paper, fraudsters risk prosecution and heavy fines.
The GAO said its investigators concocted fake identities using invalid Social Security numbers and falsely claiming citizenship or legal residence. In other cases, they made up income figures that would disqualify them from getting subsidies.
Among the findings:
--Contractors processing applications for the government told the GAO their role was not to ferret out potential fraud.
--Five of six bogus phone applications went through successfully. The one exception involved an applicant who refused to provide a Social Security number.
--Six online applications were snagged by an identity checking system. But investigators just dialed a call center and all six were approved. That seemed to be an open pathway to coverage.
Undercover government investigators were able to obtain thousands of dollars in taxpayer subsidies under ObamaCare using fake identities, according to findings being presented to Congress on Wednesday.
The probe by the Government Accountability Office has raised fresh concerns about the ability of the sprawling health care program to prevent or intercept costly fraud schemes. In the case of the GAO investigation, 11 out of 12 applications submitted using "fictitious identities" were accepted, resulting in subsidized health coverage.
"For each of our 11 approved applications, we paid the required premiums to put policies into force, and are continuing to pay the premiums. For the 11 applications that were approved for coverage, we obtained the advance premium tax credit in all cases," the report said.
According to the GAO, the total amount for these credits was $2,500 monthly, adding up to $30,000 a year.
GAO officials were to testify about the findings before a House Ways and Means subcommittee Wednesday.
"We are seeing a trend with ObamaCare information systems: under every rock, there is incompetence, waste, and the potential for fraud," Rep. Dave Camp, R-Mich., chairman of the committee, said in a statement. "This law is already hitting Americans where it hurts the most - their pocketbooks. Now, this administration is forcing the American taxpayer to foot the bill for ObamaCare's waste and fraud."
Sen. Orrin Hatch, R-Utah, added: "Ironically, the GAO has found ObamaCare is working really well -- for those who don't exist."
The inquiries were carried out in several different states.
The administration pointed out that six of the GAO's fake online applications were blocked by eligibility checks built into computer systems at HealthCare.gov. Still, the GAO says its undercover agents found a way around that by phoning the call centers and were able to enroll anyway.
In six other applications, GAO investigators also tried to sign up fake applicants with in-person representatives. But in five of those cases, GAO was "unable to obtain in-person assistance" for various reasons, including one representative saying they could not help because HealthCare.gov was down.
"We are examining this report carefully and will work with GAO to identify additional strategies to strengthen our verification processes," administration spokesman Aaron Albright said. At least on paper, fraudsters risk prosecution and heavy fines.
The GAO said its investigators concocted fake identities using invalid Social Security numbers and falsely claiming citizenship or legal residence. In other cases, they made up income figures that would disqualify them from getting subsidies.
Among the findings:
--Contractors processing applications for the government told the GAO their role was not to ferret out potential fraud.
--Five of six bogus phone applications went through successfully. The one exception involved an applicant who refused to provide a Social Security number.
--Six online applications were snagged by an identity checking system. But investigators just dialed a call center and all six were approved. That seemed to be an open pathway to coverage.
21 May 2014
INSURANCE QUIRK CONCERNS DOCTORS
Original Story: DetroitNews.com
A quirk in Obamacare has doctors throughout Michigan worried they’re going to be stuck with unpaid bills or forced to become bill collectors when treating patients.
The Affordable Care Act, in a rule published by Centers for Medicare & Medicaid Services, dictates that patients enrolled in government-subsidized health plans — individuals who have purchased a plan from the marketplace and receive a tax credit for it — have their medical bills covered by insurers for 30 days.
But during the following 60-day grace period, insurers may “pend” or hold off paying the claims and, ultimately, deny payments if the patient doesn’t catch up on his or her premiums.
That means doctors will get paid only if they collect directly from the patient long after an appointment, a move that the American Medical Association says “could pose a significant financial risk for medical practices.”
The AMA is so concerned about this rule that it’s created a step-by-step guide for its physician members to minimize their risks, and it includes a “Dear Patient” notice to mail. And some doctors have been reluctant to treat patients with plans they purchased from the marketplace — resulting in less access to health care for consumers.
“Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers,” said AMA President Ardis Dee Hoven in a statement.
Previously, insurers generally would cancel a policy if a subscriber fell behind more than 30 days, rather than the ACA’s 90 days. The insurer, rather than the doctor, would be responsible for bills incurred before that cancellation.
With the new grace period, the burden is shifted to the doctors and their billing departments to collect money that a patient owes. Doctors’ offices are likely to to hire bill collectors if initial efforts to collect for unpaid services are unsuccessful. Doctors’ offices have financial counselors to help uninsured patients come with payment plans.
“We’ve been talking about this rule for more than a year,” said Dr. Randall Bickle, a family practitioner in Northville and the chief executive and medical director of Olympia Medical Services, a Livonia-based physicians group.
“The issue for doctors is, how aggressive are you willing to be to go after that payment and are you going to be available to send that money back if they pay the premium in full?” Bickle said, describing some of the questions that have popped up since this quirk was discovered.
The Michigan State Medical Society, which represents 15,000 doctors, has been educating its members about the rule as well, said Rebecca Black, the society’s senior director of health care delivery and education.
“Physicians are so overwhelmed right now because there are so many mandates that they are supposed to be a part of or they will start to get penalized,” Black said. “Because they have so much going on, it’s a good time to remind our membership to check insurance eligibility with every office visit.”
One of those overwhelmed is Dr. Annemarie Poleck, who practices family medicine solo in the office her father, Dr. Stanley Poleck, founded in Detroit. While her staff checks the eligibility prior to each appointment, often an insurance company fails to have the most current information, giving her a green light to treat, rather than a red.
Poleck is already seeing signs of the impact of this 90-day grace period. Recently, she referred a patient to a podiatrist for a broken ankle. Two podiatrists, leery of the patient’s marketplace health care, refused to see her unless she paid in advance for their service that she would receive in the future. A third podiatrist finally agreed without the upfront payment stipulation.
“I expect a lot of doctors will refuse to see patients in the future because they are worried about payment, and that goes against our training,” Poleck said.
Dr. Robert Frank, chief executive and chief medical officer of Wayne State University Physician Group in Detroit, doesn’t expect that to happen with the 2,000 doctors in his physician group, the second-largest in southeast Michigan.
“The physician-patient relationship is a very different relationship than repossessing someone’s car,” Frank said.
“It’s always been treated with reverence, so I think people are somewhat reluctant to collect from a patient, but it has become a factor of everyday business. With a group like ours, which has a good technology backstop, I expect we will be able to check patients’ insurance in real time, so I don’t believe it will be a significant problem.”
Wayne State University Physician Group, long a presence in the Detroit Medical Center, is undergoing a suburban expansion. It’s opening two floors of clinical and physician offices in June at the former Saturn headquarters in Troy, where its “back office” crew is already located, including the billing department.
Despite the extra offices, Frank believes current billing staffing will easily handle all of the new rules, so there are no plans to increase its staff.
“I don’t foresee in the short run this rule impacting us on any level,” said Frank, whose group provides more than $9 million annually in charity care.
The charity question is one that Henry Ford Health System is exploring, said Sharifa Alcendor, director of patient care management and assistance for Henry Ford. “It would actually cost us a lot less money if we just pay a person’s $125 insurance premium for them rather than foot the $125,000 care they’ve needed, so we’re busy researching and looking for guidance if its legal and appropriate to help patients” by paying their premiums when they encounter this quirk, she said.
Beaumont Health System will follow the CMS rule but remains unsure of its impact.
“We have no way of predicting how many such patients will come to Beaumont (or Beaumont doctors), and whether or not they will keep up on their premiums,” said Doug Darland, vice president, contracting and payer strategy for Beaumont. “The impact could be very small or very large, based on the types of services provided.”
Blue Cross Blue Shield of Michigan has put several programs in place to minimize the impact of this government mandate, which may be avoided by a patient if he or she pays the insurance premium on time, said Terry Burke, Blue Cross vice president for individual business.
Blue Cross extended its initial deadline for a first payment to 30 days rather than the marketplace’s 10 days and later pushed it back another 30 days, Burke said. New members received a welcome call from a new team of representatives who remind them that coverage begins when they receive payment.
Then Burke followed up with an automated telephone reminder and a letter to reinforce the message.
The results of this forethought helped Blue Cross achieve a 97 percent premium payment rate.
“We are all trying to do the right thing” in helping prevent billing surprises, Burke said.
From The Detroit News: http://www.detroitnews.com/article/20140517/BIZ/305170024#ixzz32M2CNmwC
A quirk in Obamacare has doctors throughout Michigan worried they’re going to be stuck with unpaid bills or forced to become bill collectors when treating patients.
The Affordable Care Act, in a rule published by Centers for Medicare & Medicaid Services, dictates that patients enrolled in government-subsidized health plans — individuals who have purchased a plan from the marketplace and receive a tax credit for it — have their medical bills covered by insurers for 30 days.
But during the following 60-day grace period, insurers may “pend” or hold off paying the claims and, ultimately, deny payments if the patient doesn’t catch up on his or her premiums.
That means doctors will get paid only if they collect directly from the patient long after an appointment, a move that the American Medical Association says “could pose a significant financial risk for medical practices.”
The AMA is so concerned about this rule that it’s created a step-by-step guide for its physician members to minimize their risks, and it includes a “Dear Patient” notice to mail. And some doctors have been reluctant to treat patients with plans they purchased from the marketplace — resulting in less access to health care for consumers.
“Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers,” said AMA President Ardis Dee Hoven in a statement.
Previously, insurers generally would cancel a policy if a subscriber fell behind more than 30 days, rather than the ACA’s 90 days. The insurer, rather than the doctor, would be responsible for bills incurred before that cancellation.
With the new grace period, the burden is shifted to the doctors and their billing departments to collect money that a patient owes. Doctors’ offices are likely to to hire bill collectors if initial efforts to collect for unpaid services are unsuccessful. Doctors’ offices have financial counselors to help uninsured patients come with payment plans.
“We’ve been talking about this rule for more than a year,” said Dr. Randall Bickle, a family practitioner in Northville and the chief executive and medical director of Olympia Medical Services, a Livonia-based physicians group.
“The issue for doctors is, how aggressive are you willing to be to go after that payment and are you going to be available to send that money back if they pay the premium in full?” Bickle said, describing some of the questions that have popped up since this quirk was discovered.
The Michigan State Medical Society, which represents 15,000 doctors, has been educating its members about the rule as well, said Rebecca Black, the society’s senior director of health care delivery and education.
“Physicians are so overwhelmed right now because there are so many mandates that they are supposed to be a part of or they will start to get penalized,” Black said. “Because they have so much going on, it’s a good time to remind our membership to check insurance eligibility with every office visit.”
One of those overwhelmed is Dr. Annemarie Poleck, who practices family medicine solo in the office her father, Dr. Stanley Poleck, founded in Detroit. While her staff checks the eligibility prior to each appointment, often an insurance company fails to have the most current information, giving her a green light to treat, rather than a red.
Poleck is already seeing signs of the impact of this 90-day grace period. Recently, she referred a patient to a podiatrist for a broken ankle. Two podiatrists, leery of the patient’s marketplace health care, refused to see her unless she paid in advance for their service that she would receive in the future. A third podiatrist finally agreed without the upfront payment stipulation.
“I expect a lot of doctors will refuse to see patients in the future because they are worried about payment, and that goes against our training,” Poleck said.
Dr. Robert Frank, chief executive and chief medical officer of Wayne State University Physician Group in Detroit, doesn’t expect that to happen with the 2,000 doctors in his physician group, the second-largest in southeast Michigan.
“The physician-patient relationship is a very different relationship than repossessing someone’s car,” Frank said.
“It’s always been treated with reverence, so I think people are somewhat reluctant to collect from a patient, but it has become a factor of everyday business. With a group like ours, which has a good technology backstop, I expect we will be able to check patients’ insurance in real time, so I don’t believe it will be a significant problem.”
Wayne State University Physician Group, long a presence in the Detroit Medical Center, is undergoing a suburban expansion. It’s opening two floors of clinical and physician offices in June at the former Saturn headquarters in Troy, where its “back office” crew is already located, including the billing department.
Despite the extra offices, Frank believes current billing staffing will easily handle all of the new rules, so there are no plans to increase its staff.
“I don’t foresee in the short run this rule impacting us on any level,” said Frank, whose group provides more than $9 million annually in charity care.
The charity question is one that Henry Ford Health System is exploring, said Sharifa Alcendor, director of patient care management and assistance for Henry Ford. “It would actually cost us a lot less money if we just pay a person’s $125 insurance premium for them rather than foot the $125,000 care they’ve needed, so we’re busy researching and looking for guidance if its legal and appropriate to help patients” by paying their premiums when they encounter this quirk, she said.
Beaumont Health System will follow the CMS rule but remains unsure of its impact.
“We have no way of predicting how many such patients will come to Beaumont (or Beaumont doctors), and whether or not they will keep up on their premiums,” said Doug Darland, vice president, contracting and payer strategy for Beaumont. “The impact could be very small or very large, based on the types of services provided.”
Blue Cross Blue Shield of Michigan has put several programs in place to minimize the impact of this government mandate, which may be avoided by a patient if he or she pays the insurance premium on time, said Terry Burke, Blue Cross vice president for individual business.
Blue Cross extended its initial deadline for a first payment to 30 days rather than the marketplace’s 10 days and later pushed it back another 30 days, Burke said. New members received a welcome call from a new team of representatives who remind them that coverage begins when they receive payment.
Then Burke followed up with an automated telephone reminder and a letter to reinforce the message.
The results of this forethought helped Blue Cross achieve a 97 percent premium payment rate.
“We are all trying to do the right thing” in helping prevent billing surprises, Burke said.
From The Detroit News: http://www.detroitnews.com/article/20140517/BIZ/305170024#ixzz32M2CNmwC
13 January 2014
ACCENTURE WINS U.S. CONTRACT FOR OBAMACARE ENROLLMENT WEBSITE
Original Article by: Bloomberg News
Accenture Plc (ACN), the second-biggest technology-consulting company, will take over construction of healthcare.gov, the Obamacare enrollment website that debuted with crippling computer problems in October.
The U.S. government has awarded Accenture’s Federal Services unit a one-year contract, with an initial payment of $45 million, the Dublin-based company said in a statement yesterday. Accenture will succeed Montreal-based CGI Group Inc. (GIB/A), which drew criticism for the website’s early stumbles.
While the site has improved, healthcare.gov’s first two months were marred by delays, error messages and garbled data that bogged down insurance sign-ups in the 36 U.S. states served by the federal system. Accenture led construction of California’s better-performing state exchange.
“Accenture will bring deep healthcare industry insight as well as proven experience building large-scale, public-facing websites to continue improving healthcare.gov,” David Moskovitz, chief executive officer at Accenture Federal Services, said in the statement.
The government-run insurance exchanges offer health plans and access to subsidies created by the 2010 Patient Protection and Affordable Care Act. CGI’s role in managing healthcare.gov had been reduced following the botched rollout, with a unit of UnitedHealth Group Inc. (UNH) brought in to oversee emergency repairs. Most Americans have until March 31 to select a health plan for 2014 coverage.
Contract Value
Accenture rose less than 1 percent to $83.20 in New York trading on Jan. 10, the day The Washington Post reported the company would replace CGI. Its shares have gained 19 percent for the 12 months through last week. CGI fell 2.9 percent, to $31.58 on Jan. 10.
The Centers for Medicare and Medicaid Services chose Accenture from more than a dozen firms, according to the company’s statement. The contract’s final value will be based on “mutually agreed-upon work plans,” the company said.
Accenture will help the federal system prepare for its second open enrollment period in October 2014, including “24/7 support of the marketplace application, eligibility and enrollment functions, generation and transmission of enrollment forms, and features related to special enrollment periods,” according to the statement. Accenture also will develop new features for future phases of the program.
Accenture Plc (ACN), the second-biggest technology-consulting company, will take over construction of healthcare.gov, the Obamacare enrollment website that debuted with crippling computer problems in October.
The U.S. government has awarded Accenture’s Federal Services unit a one-year contract, with an initial payment of $45 million, the Dublin-based company said in a statement yesterday. Accenture will succeed Montreal-based CGI Group Inc. (GIB/A), which drew criticism for the website’s early stumbles.
While the site has improved, healthcare.gov’s first two months were marred by delays, error messages and garbled data that bogged down insurance sign-ups in the 36 U.S. states served by the federal system. Accenture led construction of California’s better-performing state exchange.
“Accenture will bring deep healthcare industry insight as well as proven experience building large-scale, public-facing websites to continue improving healthcare.gov,” David Moskovitz, chief executive officer at Accenture Federal Services, said in the statement.
The government-run insurance exchanges offer health plans and access to subsidies created by the 2010 Patient Protection and Affordable Care Act. CGI’s role in managing healthcare.gov had been reduced following the botched rollout, with a unit of UnitedHealth Group Inc. (UNH) brought in to oversee emergency repairs. Most Americans have until March 31 to select a health plan for 2014 coverage.
Contract Value
Accenture rose less than 1 percent to $83.20 in New York trading on Jan. 10, the day The Washington Post reported the company would replace CGI. Its shares have gained 19 percent for the 12 months through last week. CGI fell 2.9 percent, to $31.58 on Jan. 10.
The Centers for Medicare and Medicaid Services chose Accenture from more than a dozen firms, according to the company’s statement. The contract’s final value will be based on “mutually agreed-upon work plans,” the company said.
Accenture will help the federal system prepare for its second open enrollment period in October 2014, including “24/7 support of the marketplace application, eligibility and enrollment functions, generation and transmission of enrollment forms, and features related to special enrollment periods,” according to the statement. Accenture also will develop new features for future phases of the program.
28 November 2012
Requirements of Health Care Reform Affirmed
story first appeared in Los Angeles Times
The Obama administration reaffirmed key requirements of the new healthcare law Tuesday, setting out how insurance companies will cover nearly all Americans, even if they are already ill, and provide plans with minimum benefits.
Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law's requirements as the federal government races to implement the legislation by the end of next year.
But the proposed rules issued Tuesday hew closely to the Affordable Care Act that President Obama signed in 2010. At the same time, administration officials restated their commitment to move rapidly ahead, despite continued resistance from some Republican governors.
Health and Human Services Secretary Kathleen Sebelius said this means that beginning in October next year, families and small-business owners everywhere will be able to shop for affordable, quality health coverage and entrepreneurs won't have to give up their chance at affordable health coverage to start a new business.
Under the law, Americans who are not covered through work will be able to comparison shop for health insurance in online markets, also known as exchanges, designed to mimic the shopping experience of popular travel sites.
These exchanges will be run by state governments, except in states that elect to leave the job to the federal government or to partner with Washington.
More than 15 states, mostly with GOP governors, have said they will not operate an exchange. Some governors have complained the federal government has put too many requirements on the exchanges.
In state and federally run exchanges, insurance companies will be prohibited from denying coverage to sick Americans. Insurers will no longer be able to charge more from women or customers with medical conditions.
And for the first time, insurers will have to cover 10 basic benefits, including hospitalizations, emergency care, newborn and maternity care, and prescription drugs.
The Obama administration has allowed each state to detail this set of benefits, allowing for some variations of drugs that might be covered, for example.
That worries many consumer advocates who would like to see a national standard for health insurance. Carl Schmid, deputy executive director of the AIDS Institute fears that leaving the decision up to the states of which drugs insurance plans must cover, many patients, particularly those with complex medical conditions, may not have the coverage they need.
But several leading consumer groups, including AARP, which represents older residents, and the American Cancer Society's Cancer Action Network, applauded the administration for retaining key protections in the law, including a requirement that insurers charge elderly consumers no more than three times as much as they charge young customers.
Insurers had pushed for more leeway to vary rates based on age, arguing that this was necessary to keep premiums affordable for younger, healthier customers.
Gary Cohen, who oversees insurance regulations at the Department of Health and Human Services, said the administration did not believe this was necessary to attract younger consumers, who will have access to a lower-priced health plan to cover catastrophic illness and also may qualify for new subsidies to offset their premiums.
The administration adjusted several rules to accommodate industry concerns, including allowing insurance companies to institute higher deductibles in plans they sell to small businesses and setting enrollment periods to prevent consumers from signing up for insurance only when they get sick.
The proposed new rules drew cautious praise from several leading industry representatives. Karen Ignagni, head of America's Health Insurance Plans, reiterated concerns that requirements still may force consumers to purchase coverage that is more costly than they have today.
The Obama administration reaffirmed key requirements of the new healthcare law Tuesday, setting out how insurance companies will cover nearly all Americans, even if they are already ill, and provide plans with minimum benefits.
Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law's requirements as the federal government races to implement the legislation by the end of next year.
But the proposed rules issued Tuesday hew closely to the Affordable Care Act that President Obama signed in 2010. At the same time, administration officials restated their commitment to move rapidly ahead, despite continued resistance from some Republican governors.
Health and Human Services Secretary Kathleen Sebelius said this means that beginning in October next year, families and small-business owners everywhere will be able to shop for affordable, quality health coverage and entrepreneurs won't have to give up their chance at affordable health coverage to start a new business.
Under the law, Americans who are not covered through work will be able to comparison shop for health insurance in online markets, also known as exchanges, designed to mimic the shopping experience of popular travel sites.
These exchanges will be run by state governments, except in states that elect to leave the job to the federal government or to partner with Washington.
More than 15 states, mostly with GOP governors, have said they will not operate an exchange. Some governors have complained the federal government has put too many requirements on the exchanges.
In state and federally run exchanges, insurance companies will be prohibited from denying coverage to sick Americans. Insurers will no longer be able to charge more from women or customers with medical conditions.
And for the first time, insurers will have to cover 10 basic benefits, including hospitalizations, emergency care, newborn and maternity care, and prescription drugs.
The Obama administration has allowed each state to detail this set of benefits, allowing for some variations of drugs that might be covered, for example.
That worries many consumer advocates who would like to see a national standard for health insurance. Carl Schmid, deputy executive director of the AIDS Institute fears that leaving the decision up to the states of which drugs insurance plans must cover, many patients, particularly those with complex medical conditions, may not have the coverage they need.
But several leading consumer groups, including AARP, which represents older residents, and the American Cancer Society's Cancer Action Network, applauded the administration for retaining key protections in the law, including a requirement that insurers charge elderly consumers no more than three times as much as they charge young customers.
Insurers had pushed for more leeway to vary rates based on age, arguing that this was necessary to keep premiums affordable for younger, healthier customers.
Gary Cohen, who oversees insurance regulations at the Department of Health and Human Services, said the administration did not believe this was necessary to attract younger consumers, who will have access to a lower-priced health plan to cover catastrophic illness and also may qualify for new subsidies to offset their premiums.
The administration adjusted several rules to accommodate industry concerns, including allowing insurance companies to institute higher deductibles in plans they sell to small businesses and setting enrollment periods to prevent consumers from signing up for insurance only when they get sick.
The proposed new rules drew cautious praise from several leading industry representatives. Karen Ignagni, head of America's Health Insurance Plans, reiterated concerns that requirements still may force consumers to purchase coverage that is more costly than they have today.
19 November 2012
Republican States Delaying Health Care Law Deadine
story first appeared on nytimes.com
The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama’s health care law.
State Senator Jack Hatch, a Democrat who vented his frustration at a news conference here this week, said there had been a total blackout of information, and they they are behind schedule and at a disadvantage.
States are supposed to tell the Obama administration by Friday whether they want to create their own health insurance exchange — a deadline that many had bet might never come to pass, choosing to sit on their hands for months in the hope that Mitt Romney would win the presidency and the health care law would be repealed.
On Wednesday, they dug in their heels a little more. Leaders of the Republican Governors Association, gathering in Las Vegas for their annual meeting, wrote a letter to Mr. Obama requesting more time, more guidance and a meeting where the president and governors could talk.
Insurance exchanges — basically online markets where the uninsured can shop for private health insurance, often with federal subsidies to help pay — are considered critical to making the health care law work. So far, 17 states, most led by Democrats, and the District of Columbia have indicated they will create their own state-run exchanges.
The other options are setting up an exchange in partnership with the federal government, or simply letting the federal government do it.
Every state is supposed to have an exchange by Jan. 1, 2014, when the health care law will require most Americans to have insurance. The exchanges are supposed to be ready to start enrolling people in October 2013.
Despite the unhappiness, there are indications that some Republican governors may be softening their opposition to the law. Gov. Rick Scott of Florida, a Republican who had been one of its toughest critics, signaled this week that he would be open to compromising.
And Governor McDonnell of Virginia — like Florida, a state Mr. Obama carried — noted that while his state had been the first to file suit seeking to block the law, it would comply with it.
But he said that the complexity of the law, and the lack of details from Washington, meant that “my best experts in Virginia, my doctors and others that are advising me on what to do, say they still can’t make a prudent call between a state or federal exchange because we don’t have all the answers.”
Others are facing intense, sometimes conflicting pressures from state legislators and interest groups. In Wisconsin, health care providers and business groups are lobbying Gov. Scott Walker to create a state exchange, while Tea Party groups are warning him not to.
At the Republican governors meeting in Las Vegas, Mr. Walker said in an interview that he would prefer a state-based program, but that he doubted that the federal government would allow him to shape it as he saw fit.
He said that he would not disclose his decision until Friday, but added, “Why do I want to take on the potential risk to my taxpayers if I don’t really have any true authority about what’s going to happen?”
Republicans who support state-run exchanges say they are embracing a fundamental conservative belief: that states should make their own decisions rather than cede control to the federal government. But others argue that deferring to the federal government is a shrewder move; that way, they say, it will not be their fault if anything goes wrong.
The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama’s health care law.
State Senator Jack Hatch, a Democrat who vented his frustration at a news conference here this week, said there had been a total blackout of information, and they they are behind schedule and at a disadvantage.
States are supposed to tell the Obama administration by Friday whether they want to create their own health insurance exchange — a deadline that many had bet might never come to pass, choosing to sit on their hands for months in the hope that Mitt Romney would win the presidency and the health care law would be repealed.
On Wednesday, they dug in their heels a little more. Leaders of the Republican Governors Association, gathering in Las Vegas for their annual meeting, wrote a letter to Mr. Obama requesting more time, more guidance and a meeting where the president and governors could talk.
Insurance exchanges — basically online markets where the uninsured can shop for private health insurance, often with federal subsidies to help pay — are considered critical to making the health care law work. So far, 17 states, most led by Democrats, and the District of Columbia have indicated they will create their own state-run exchanges.
The other options are setting up an exchange in partnership with the federal government, or simply letting the federal government do it.
Every state is supposed to have an exchange by Jan. 1, 2014, when the health care law will require most Americans to have insurance. The exchanges are supposed to be ready to start enrolling people in October 2013.
Despite the unhappiness, there are indications that some Republican governors may be softening their opposition to the law. Gov. Rick Scott of Florida, a Republican who had been one of its toughest critics, signaled this week that he would be open to compromising.
And Governor McDonnell of Virginia — like Florida, a state Mr. Obama carried — noted that while his state had been the first to file suit seeking to block the law, it would comply with it.
But he said that the complexity of the law, and the lack of details from Washington, meant that “my best experts in Virginia, my doctors and others that are advising me on what to do, say they still can’t make a prudent call between a state or federal exchange because we don’t have all the answers.”
Others are facing intense, sometimes conflicting pressures from state legislators and interest groups. In Wisconsin, health care providers and business groups are lobbying Gov. Scott Walker to create a state exchange, while Tea Party groups are warning him not to.
At the Republican governors meeting in Las Vegas, Mr. Walker said in an interview that he would prefer a state-based program, but that he doubted that the federal government would allow him to shape it as he saw fit.
He said that he would not disclose his decision until Friday, but added, “Why do I want to take on the potential risk to my taxpayers if I don’t really have any true authority about what’s going to happen?”
Republicans who support state-run exchanges say they are embracing a fundamental conservative belief: that states should make their own decisions rather than cede control to the federal government. But others argue that deferring to the federal government is a shrewder move; that way, they say, it will not be their fault if anything goes wrong.
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