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No insurance required at Junction City health clinic

Patients pay a monthly fee for Direct Primary Care at UnityPoint Health-Junction Medical

PEORIA — A new model of primary healthcare which skips the insurance company and provides unlimited doctor’s visits for a monthly fee is now available in Peoria.

Dr. Anton Grasch has been providing Direct Primary Care at UnityPoint Health – Junction Medical in the Junction City Shopping Center for about a year and a half. Also at the clinic is Dr. Mike Jongerius, who is in the process of transitioning his patients into the model.

Grasch, who first learned about Direct Primary Care in 2013 while doing his residency with UnityPoint Health, is enjoying the freedom the new model brings to patient interactions. He can now talk to patients about anything without having to figure out how to code it for the insurance company.

“It was always a problem, how to code and bill for a conversation about diet,” said Grasch. The new model also allows him to come up with innovative ways to improve his patients’ health.

“I’m hoping to eventually do things like cooking classes and yoga with patients,” he said.

Direct Primary Care also allows Grasch to talk for as long as necessary — appointment times are not limited — and even consult with patients over the phone or video chat on the computer.

“I can call and talk straight to my doctor and I don’t have to come into the office,” said Rachel Amsbaugh, 32, of Washington, one of Grasch’s patients. “For some things, like a twisted ankle, I can describe fairly well what hurts and where it hurts, and I can get advice without having to go in. Having that relationship with my doctor is very beneficial.”

Patients can even call the doctor in the middle of the night, though Grasch said that doesn’t happen much. Just knowing they can leave a message and then see the doctor first thing in the morning is enough for most non-emergency situations, he said. Being able to reach the doctor at any time helps reduce expensive emergency room visits.

“My five-year-old jumped off a diving board and landed on my sternum, and I thought I broke my sternum,” said Amsbaugh. “It was on the weekend, so I called the office and left a message. The next morning Dr. Garsch ordered an x-ray for me, and it turned out I was fine.”

A growing trend across the country, Direct Primary Care was started by independent physicians frustrated by the limitations of working with the traditional insurance billing system. UnityPoint Health might be the first healthcare corporation to offer the model, said Blake Long, UnityPoint’s Marketing Communications Manager.

“We’ve done some research and haven’t found any others doing it,” he said.

Participants in the UnityPoint plan pay according to their age, ranging from $59 a month for patients 17 years and younger, to $89 a month for patients over 65. The monthly fee includes an array of routine tests and procedures, including EKG, urinalysis, joint injections, and rapid strep screening. While insurance is not required for patients to sign up for the program, it is encouraged to pay for things not covered under the plan, including hospitalizations and visits to a specialist.

UnityPoint Health is currently talking to several area employers interested in including Direct Primary Care in their health insurance program, said Long.

“There are some studies which suggest that Direct Primary Care leads to healthier employees,” he said. Healthy employees are more productive and cost less. Another plus is that employees miss less work if they can consult with their doctor over the phone.

Amsbaugh has been seeing Dr. Grasch for about a year and she is very happy with the Direct Primary Care plan.

“It’s just nice to be able to have someone there when you need it. If something does go down in the middle of the night and and you need your doctor, you will be able to get your doctor, not someone who doesn’t know you. That continuity of care is something other types of health plans don’t give you.”

Leslie Renken can be reached at 686-3250 or lrenken@pjstar.com. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.

 

 

Will Congress Keep Children’s Health Insurance Program Afloat …

4c201_chip.art_wide-efff10e9c070df1927e4bdbb2776fda8a193e149-s1100-c15 Will Congress Keep Children's Health Insurance Program Afloat ...

It’s a beautiful morning in Pittsburgh, but Ariel Haughton is stressed out. She’s worried her young children’s health insurance coverage will soon lapse.

“So, we’re like a low-middle-class family, right?” she says. “I’m studying. My husband’s working, and our insurance right now is 12 percent of our income — just for my husband and I. And it’s not very good insurance either.”

4c201_chip.art_wide-efff10e9c070df1927e4bdbb2776fda8a193e149-s1100-c15 Will Congress Keep Children's Health Insurance Program Afloat ...

The policy that covers the couple requires high fees to even see a doctor, and it has a high deductible for further treatment.

In contrast, her young children — 2-year-old Nonnie and his big sister, Rose — are covered right now through the Children’s Health Insurance Program, or CHIP, a federal-state program that was created two decades ago to ensure that kids whose parents don’t have a lot of money, yet make too much money to qualify for Medicaid, can still get health care.

Right now, that coverage for the children doesn’t cost the family anything.

But Pennsylvania’s CHIP program is forecast to run out of money in February.

Though 9 million kids across the U.S. get their health insurance through CHIP, Congress let the program expire Sept. 30.

Since then, states have been burning through the cash that remains in their CHIP accounts, and parents, doctors and state officials are wondering whether Congress will save what has traditionally been a popular program with strong bipartisan support.

“CHIP is probably one of the most successful government programs we’ve enacted in the last couple of decades,” says Timothy McBride, a professor of health economics at Washington University in St. Louis and chairman of that state’s Medicaid oversight committee, which also oversees CHIP.

Keeping kids insured doesn’t cost much, he says, and it sure pays off.

It’s extremely important,” he says, “because it’s developmental — it’s vaccines. You know it can reduce the likelihood that a person has a lifelong chronic disease.”

The experience of Ariel Haughton’s daughter, Rose, bears that out.

Haughton says her own insurance policy charges $150 for each of her doctor visits, but her kids’ policy doesn’t. That allows her to take Rose and Nonnie for care when they need it.

“That’s not a small deal to a family like mine,” Haughton says. “A hundred and fifty dollars. If you have to pay that, you kind of ask yourself, like, ‘Are they sick enough? Does this merit a doctor visit?’ “

A few years ago, Rose came down with a fever and a rash on her face. It didn’t seem severe, but Haughton took Rose to the pediatrician anyway, just to check.

“The doctor looked at her and she said, ‘She has Lyme disease,’ ” Haughton recalls. “And she found a little tick!”

The doctor put Rose on antibiotics immediately and the little girl’s symptoms went away. If left untreated, Lyme can turn into chronic arthritis or other chronic problems.

“I know that if I had had to pay $150, I would have thought, ‘You know, let’s wait,’ ” Haughton says.

Dr. Todd Wolynn is the Haughtons’ pediatrician. He says families all over Pittsburgh are worried about the lapse in the federal insurance program’s funding.

“Parents are literally telling us they don’t know what to do,” Wolynn says. “They make too much to get Medicaid and they don’t have jobs or earn enough to get the commercial insurance. I don’t know what to tell them to do.”

Doctors and patients around the country are worried as CHIP money runs out in one state after another.

Utah announced it will end CHIP at the end of January if Congress doesn’t come up with money for the program. West Virginia’s CHIP board voted to end the program Feb. 28. And Colorado sent letters to its CHIP families saying that without new money the program will be cut off at the end of January.

Oregon has already run out of federal money and is borrowing from its Medicaid budget to ensure that its 80,000 CHIP kids keep their coverage through April.

“I’m absolutely opposed to kicking these vulnerable families off of access to health care,” says Oregon Gov. Kate Brown. “It’s appalling to me that Congress is not taking action and is not doing their jobs on this issue.”

Measures to fund the program passed in their relevant committees in the House and Senate in October, but then hit a snag when lawmakers couldn’t agree on other budget cuts to pay for CHIP.

Ariel Haughton says lawmakers should have gotten ahead of the problem.

“They could have worked on something in August or July, and passed it in September,” she says, “instead of just letting funding lapse and playing this game of chicken with our children’s health insurance.”

Lawmakers and staffers in Congress say CHIP funding will likely be included in an end-of-year spending bill. But as of now, there is no CHIP funding bill scheduled for consideration.

Deadline Is Friday For Most ACA Insurance Sign-Ups, With Important Exceptions

e2580_flooding-texas-1-560b6601465e9d181d8a1d08b8efa38a5c75e733-s1100-c15 Deadline Is Friday For Most ACA Insurance Sign-Ups, With Important Exceptions

A week after Hurricane Harvey swept through southern Texas in August, the streets of Katy, Texas were still flooded. People in the Puerto Rico and the Southeastern U.S. who were affected by the hurricanes are among those who may have extra time to enroll for 2018 health plans.

Justin Sullivan/Getty Images


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A week after Hurricane Harvey swept through southern Texas in August, the streets of Katy, Texas were still flooded. People in the Puerto Rico and the Southeastern U.S. who were affected by the hurricanes are among those who may have extra time to enroll for 2018 health plans.

Justin Sullivan/Getty Images

Open enrollment on the federal health law’s marketplace — HealthCare.gov — ends Friday, and most people who want a plan for next year need to meet the deadline.

But some consumers who miss the cutoff could be surprised to learn they have the opportunity to enroll later.

“While a lot of people will be eligible … I am still worried that a lot of consumers won’t know it,” says Shelby Gonzales, a senior policy analyst at the Center on Budget and Policy Priorities.

Under the health law, people are entitled to a special enrollment period when they have specific changes in their lives — such as losing other health insurance, getting married or having a child, or when they have a change in income that affects their eligibility for premium tax credits or cost-sharing reduction subsidies.

e2580_flooding-texas-1-560b6601465e9d181d8a1d08b8efa38a5c75e733-s1100-c15 Deadline Is Friday For Most ACA Insurance Sign-Ups, With Important Exceptions

Those special enrollment periods generally last at least 60 days.

Other circumstances can also qualify customers for a special enrollment period. But this year, consumer advocates are focused on two that could affect a substantial number of people: consumers whose 2017 marketplace policies are being discontinued in 2018 and people affected by the hurricanes that ravaged Texas, parts of the Southeastern United States and Puerto Rico.

It’s not clear how many consumers this will affect. In past years, people who signed up during a special enrollment period made up a tiny fraction of overall marketplace enrollment.

In the spring of 2016, 11.1 million people had a marketplace plan. Meanwhile, roughly 1.6 million signed up through a special enrollment period during 2015, according to the federal Centers for Medicare Medicaid Services.

The majority of people who use a special enrollment period do so because they’ve lost coverage under another plan. This applies to people who lose their job-based coverage as well as those with marketplace plans whose insurer discontinues their plan for the upcoming year.

Between 2014 and 2018 the average number of issuers per state declined from 5 to 3.5. Several leading insurance companies, including Anthem, Aetna and Humana, dramatically pulled back in their 2018 offerings.

e2580_flooding-texas-1-560b6601465e9d181d8a1d08b8efa38a5c75e733-s1100-c15 Deadline Is Friday For Most ACA Insurance Sign-Ups, With Important Exceptions

A growing proportion of people will likely qualify for special enrollment periods now, insurance analysts say, because of a loss of marketplace coverage.

People who are eligible have up to 60 days after their coverage ends on Dec. 31 to sign up for a new marketplace plan. Meeting the regular Dec. 15 sign-up deadline is preferable because it allows coverage to start Jan 1. But eligible people who miss that date can apply through the marketplace for a special enrollment period that will allow them to sign up until the end of February.

Even if the marketplace automatically re-enrolls customers in a plan that’s similar to the one that ended, they’re entitled to a special enrollment period to pick a new policy.

Gonzales fears consumers may not immediately realize that.

“The bottom line here is many consumers experienced a discontinuation of their plan this year,” she says. “Notices are complicated, and these consumers in particular are going to get several notices which may result in more confusion, and it will not be easily understood by many what an S.E.P. [special enrollment period] is, or how and/or when to activate it.”

This year, there are also special enrollment periods for people who were affected by the hurricanes that moved across all or parts of Texas, Florida, Georgia, Puerto Rico and elsewhere last fall.

The special enrollment period for 2018 applies to people who live in or move from counties designated by the Federal Emergency Management Agency as hurricane disaster areas. It gives them an extra two weeks — from Dec. 16 to Dec. 31 — to sign up for January coverage. Officials say they’ll consider extending the timeframe if necessary.

To take advantage of the special enrollment period, people must request it through the HealthCare.gov call center. They’ll be asked to attest that they resided in an affected area, but they won’t have to provide proof.

Consumer advocates who work on outreach for enrollment and help people sign up for coverage aren’t yet talking up the special enrollment periods, says Gonzales.

“They want one clear message for everyone: Open enrollment ends Dec. 15,” she says. Starting Dec. 16, these groups will start getting the word out for people who have missed the deadline and don’t realize they may still have other options.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Follow Michelle Andrews on Twitter: @mandrews110.

Parents Worry Congress Won’t Fund The Children’s Health Insurance Program

f6c2d_chip.art_wide-efff10e9c070df1927e4bdbb2776fda8a193e149-s1100-c15 Parents Worry Congress Won't Fund The Children's Health Insurance Program

It’s a beautiful morning in Pittsburgh, but Ariel Haughton is stressed out. She’s worried her young children’s health insurance coverage will soon lapse.

“So, we’re like a low-middle-class family, right?” she says. “I’m studying. My husband’s working, and our insurance right now is 12 percent of our income — just for my husband and I. And it’s not very good insurance either.”

f6c2d_chip.art_wide-efff10e9c070df1927e4bdbb2776fda8a193e149-s1100-c15 Parents Worry Congress Won't Fund The Children's Health Insurance Program

The policy that covers the couple requires high fees to even see a doctor, and has a high deductible for further treatment.

In contrast, her young children — 2-year-old Nonnie and his big sister Rose — are covered right now through the Children’s Health Insurance Program, or CHIP, a federal-state program that was created two decades ago to ensure that kids whose parents don’t have a lot of money, yet make too much money to qualify for Medicaid, can still get health care.

Right now, that coverage for the children doesn’t cost the family anything.

But Pennsylvania’s CHIP program is forecast to run out of money in February.

Though nine million kids across the U.S. get their health insurance through CHIP, Congress let the program expire on September 30.

Since then, states have been burning through the cash that remains in their CHIP accounts, and parents, doctors and state officials are wondering if Congress will save what has traditionally been a very popular program, with bipartisan support.

“CHIP is probably one of the most successful government programs we’ve enacted in the last couple of decades,” says Timothy McBride, a professor of health economics at Washington University in St. Louis and chairman of that state’s Medicaid oversight committee, which also oversees CHIP.

Keeping kids insured doesn’t cost much, he says, and it sure pays off.

It’s extremely important,” he says, “because it’s developmental — it’s vaccines. You know it can reduce the likelihood that a person has a lifelong chronic disease.”

The experience of Ariel Haughton’s daughter Rose bears that out.

Haughton says her own insurance policy charges $150 for each of her doctor visits, but her kids’ policy doesn’t. That allows her to take Rose and Nonnie for care when they need it.

“That’s not a small deal to a family like mine,” Haughton says. “A hundred and fifty dollars. If you have to pay that, you kind of ask yourself, like, ‘Are they sick enough? Does this merit a doctor visit?’ “

A few years ago her daughter Rose came down with a fever and a rash on her face. It didn’t seem severe, but Haughton took Rose to the pediatrician anyway, just to check.

“The doctor looked at her and she said, ‘She has Lyme disease,’ ” Haughton recalls. “And she found a little tick!”

The doctor put Rose on antibiotics immediately and the little girl’s symptoms went away. But if left untreated, Lyme can turn into chronic arthritis or other chronic problems.

“I know that if I had had to pay $150, I would have thought, ‘You know, let’s wait,’ ” Haughton says.

Dr. Todd Wolynn is the Haughton’s pediatrician. He says families all over Pittsburgh are worried about the lapse in the federal insurance program’s funding.

“Parents are literally telling us they don’t know what to do,” Wolynn says. “They make too much to get Medicaid and they don’t have jobs or earn enough to get the commercial insurance. I don’t know what to tell them to do.”

Doctors and patients around the country are worried as CHIP money runs out in one state after another.

Utah announced it will end CHIP at the end of January if Congress doesn’t come up with money for the program. West Virginia’s CHIP board voted to end the program February 28. And Colorado sent letters to its CHIP families saying that without new money the program will be cut off at the end of January.

Oregon has already run out of federal money, and is borrowing from its Medicaid budget to ensure its 80,000 CHIP kids keep their coverage through April.

“I’m absolutely opposed to kicking these vulnerable families off of access to health care,” says Oregon Gov. Kate Brown. “It’s appalling to me that Congress is not taking action and is not doing their jobs on this issue.”

Measures to fund the program passed in their relevant committees in the House and Senate in October, but then hit a snag when lawmakers couldn’t agree on other budget cuts to pay for CHIP.

Ariel Haughton says lawmakers should have gotten ahead of the problem.

“They could have worked on something in August or July, and passed it in September,” she says, “instead of just letting funding lapse and playing this game of chicken with our children’s health insurance.”

Lawmakers and staffers in Congress say CHIP funding will likely be included in an end-of-year spending bill. But as of now, there is no CHIP funding bill scheduled for consideration.

Deadline is Friday to purchase individual health insurance coverage

Friday is the last day for people to purchase individual health insurance coverage for 2018 through the government’s Marketplace Exchange.

“Demand is always higher near deadlines. It’s crunch time now,” said Jill Hanken, director of Enroll Virginia, in a news release. Enroll Virginia provides certified navigators to help people compare and select a policy.

Hanken said enrollment has been robust, and from Nov. 1 through Dec. 2, people living in 156,195 Virginia households had selected health plans. That figure does not show if more than one person in a household enrolled, nor does it count people who chose to automatically renew their 2017 policy.

This year, more than 364,600 Virginian had purchased individual coverage through the Marketplace. The window to do so for 2018 was narrowed when President Donald Trump’s administration shortened enrollment by a month, and cut the budget for navigators to help people select plans.

In much of Virginia, only one insurer is offering plans and those may not include someone’s health care providers. In Bedford County, for example, the lone insurer considers Carilion Clinic and LewisGale providers to be out of network.

And for people who earn too much to qualify for tax credits, 2018 premiums are substantially higher than this year’s.

A bipartisan coalition of Virginia’s senators and several House members last week asked the administration to extend the deadline. As of Monday the deadline remained midnight Dec. 15. 

Marketplace plans can be found at healthcare.gov or by calling 1-800-318-2596. The call center operates 24 hours a day.

Hanken said Enroll Virginia navigators can still offer one-on-one assistance, but appointment slots are filling fast. Call 1-888-392-5132 or find a local office at www.enrollva.org/get-help/.

Open enrollment for health insurance exchanges ends Friday

Time is running out for those still looking to sign up for health insurance through the marketplace exchanges created by the Affordable Care Act.

Friday marks the end of the open enrollment period.

“It’s definitely been a steady demand,” said Julie Grasson, assistant director of Toledo/Lucas County CareNet, one of several area organizations to offer enrollment assistance. Events on Tuesday and Thursday are booked solid, she said, and organizers have added an extra date Friday. 

Ohioans selected 80,498 plans from the exchange from Nov. 1 to Dec. 2, according to numbers released last week by the Centers for Medicare and Medicaid Services. Americans selected more than 3.6 million plans in that time period. 

Until this summer, several rural northwest Ohio counties faced the prospect of zero insurers offering plans on the exchange.

Paulding County, which at one time was the lone county in the country to be without any options, will be covered by CareSource in 2018, the Ohio Department of Insurance announced in August. Every county in the state now has at least one insurer offering plans on the exchange. 

Open enrollment will end Friday after six weeks, a period half as long as the open enrollment time frame in previous years. Additionally, significant federal cuts to funding for programs that offer enrollment guidance prompted the shut down of navigator services in Ohio this year.

But those looking for help in choosing a plan do have other options in northwest Ohio. 

“For individuals who have not signed up ever in the past, the process is a lot easier than it was in the beginning,” Ms. Grasson said. “It’s been streamlined.”

Toledo/Lucas County CareNet and Neighborhood Health Association will have certified application counselors from 9 a.m. to 5 p.m. Friday at the Toledo Lucas County Public Library’s Main Library, 325 Michigan St.

Call 419-842-0800 to make an appointment with CareNet or 419-214-5700  to make an appointment with Neighborhood Health Association. 

The Toledo-Lucas County Health Department also has walk-in hours and appointments with certified application counselors Monday through Friday at its downtown location, 635 N. Erie St. Call 419-213-4307 for an appointment.

At the department’s Western Lucas County Clinic, walk-ins and appointments are available Thursday from 9 a.m.to noon at the clinic, 330 Oak Terrace Blvd., Holland. Call 419-213-4536 for an appointment.

To compare available plans and estimate associated costs, visit healthcare.gov or call 1-800-318-2596. To find other assistance options outside of Lucas County, click on “Find Local Help” on the site’s homepage.

Contact Lauren Lindstrom at llindstrom@theblade.com, 419-724-6154, or on Twitter @lelindstrom.


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Funding at risk for children’s health insurance, clinics

U.S. Sen. Debbie Stabenow and others are sounding the alarm over the expiration of federal funding that provides health insurance to 116,000 lower-income children in Michigan, saying cancellation notices may be sent to families as early as next month despite bipartisan support for continuing the program.

The Children’s Health Insurance Program was not reauthorized by the Republican-led Congress in September, and lawmakers are at odds over how to pay for a five-year extension. CHIP funds programs such as MIChild, which provides health and dental coverage for children from working families that make more than double the federal poverty level — $43,290 for a family of three.

And in the wake of Flint’s water crisis, Michigan also is allowed to spend some of the federal money to remove lead hazards from the homes of low-income residents in Flint and other communities.

Stabenow, a Democrat, said there will be “very serious” consequences if Congress does not extend funding for CHIP and community health centers that serve the poor and uninsured.

“This is unacceptable. This is something that is bipartisan, strongly bipartisan,” she told The Associated Press in a phone interview.

On Friday, President Donald Trump signed a two-week spending bill to prevent — for now — a government shutdown, which also makes money available to several states that are in danger of running out of CHIP funds this month. Michigan’s allotment has been expected to last until April or May, state spokeswoman Angela Minicuci said. But cancellation notices must be sent 90 days in advance in case the funds are not replenished.

More imminent are funding cuts to the community health centers, which are located at more than 260 underserved urban and rural sites across the state and served more than 680,000 people last year. They will lose 70 percent of their funding starting next month, with more exhausting their federal funds each month through June.

Centers whose grant cycles begin in January — and are at risk first — include Advantage Health Centers in Detroit, Community Health Social Services Center in Detroit, Covenant Community Care in Detroit, Western Wayne Family Health Centers in Wayne County, Mid Michigan Community Health Services in the Houghton Lake and Bay Mills Health Center in Bay Mills Township.

Among those in the Michigan delegation pushing to renew the funding is Republican Rep. Tim Walberg of Tipton. He said last month that CHIP is a “successful federal-state partnership” and called the health centers a “key component of the health care safety net.”

Legislation won approval in the House in November, and a Senate committee that Stabenow sits on OK’d a funding bill in October. But the popular programs have been caught up in talks over several end-of-year agenda items, including the budget, hurricane aid and protections for immigrants brought to the country illegally as children.

Families in MIChild pay a $10 monthly premium for coverage, and there are no co-pays.

“It literally is saving lives of children in Michigan,” Stabenow said.

The insurance, she said, lets parents who make too much to qualify for Medicaid take their kids to a doctor, avoiding expensive and potentially unnecessary trips to the emergency room.

The Flint Water Interagency Coordinating Committee, which Republican Gov. Rick Snyder created to help address the Flint crisis, is expected to soon send a letter to Congress warning that lead pipe replacement funding will be compromised if CHIP is not extended.

If the funding is not reauthorized, the state may try to keep MIChild and other programs going with additional state money.

“We need to discuss that with the Legislature to see if the funding would be available,” Minicuci said.

More Texans may be left without health insurance after end of open enrollment

Open enrollment for health care under former President Barack Obama’s health care law ends Dec. 15, and while current Texas enrollment numbers are up from this time last year, new restrictions under the Trump administration may mean more uninsured Texans.

Under the Affordable Care Act, individuals who are not insured through an employer can buy plans through the federal government during the open enrollment period. In 2016, that period ran from Nov. 1 to Jan. 31 — but this year, it’s been cut in half to end Friday, Dec. 15. 

While several states opted to extend the enrollment period, Texas, which runs its services through the federal healthcare.gov webpage, did not.

Texas has seen 437,919 enrollees for the 2018 plan year as of Dec. 2, according to the Centers for Medicare and Medicaid Services — a 38.8 percent increase in enrollment when compared to this time last year. But that’s not much of a comfort to organizations trying to get more people enrolled.

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“We only have half as much time to enroll people,” said Melissa McChesney, an outreach coordinator at the Center for Public Policy Priorities, a left-leaning think tank. “So we would have to be doing significantly better than we are right now in order to avoid a dip enrollment numbers overall.”

“There is concern that we will see fewer Texans enroll in the marketplace, and that’s primarily because of the shortened enrollment period, and that does mean we are likely to see a higher number of uninsured Texans for 2018,” McChesney added.  

Last year, a total of 1.2 million Texans bought insurance during the enrollment period, about one-sixth of whom were automatically enrolled after not changing their coverage from the previous year, McChesney said.

Karen Pollitz,a senior fellow at the Kaiser Family Foundation, a health care nonprofit, said in previous years, enrollment has surged just before Dec. 15.

“Most people last year, in all the states, signed up by Dec. 15 even though open enrollment went all the way until the end of January because if you want coverage to begin on Jan. 1, that was the deadline,” Pollitz said.

However, shortening the window to enroll is not the only cut made by the Trump administration affecting Texans trying to buy health insurance.

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The administration cut the budget for outreach and advertising by 90 percent and slashed funding to the navigator program, in which someone walks potential buyers through the process, by 60 percent. Supporters of the Affordable Care Act said these cuts have led to a decrease in awareness about the enrollment period. 

Drew White, a health care policy expert at the conservative Texas Public Policy Foundation, said these restrictions were the administration’s attempts to roll back aspects of the law within their power.

“We don’t believe there is a whole lot they can do,” While said referring to the president’s executive powers. “Congress is going to have to be one to repeal the statues when it comes to the regulations or to roll back the Medicaid expansion, that’s just going to be out of their purview.”

“Congress should have made good on its promise and repealed Obamacare this year as they have been promising for seven, eight years prior to that,” White said. “It’s just unfortunate because consumers are going to see their premiums and deductibles go up with fewer and fewer options as long as federal insurance regulations remain in statute.”

While it hasn’t been heavily publicized, Pollitz said there will be a special enrollment period through the end of December for people who are living in or have moved out of hurricane-affected areas. People wishing to enroll during this period will have to do so over the phone, she added.

“I think everybody, CMS [Centers for Medicare and Medicaid Services], the navigators, the other people who help folks sign up really, really want the message to be, ‘Sign up by Dec. 15. That is the best way to do it,’” Pollitz said. “Some people will need more time, or miss it, and will have this opportunity.” 

In Congress, Republicans are promising to pass a new tax code by Christmas, and the current U.S. Senate plan includes a repeal of the portion of the ACA that requires all individuals to have health insurance.

The Congressional Budget Office, a nonpartisan congressional analysis organization, estimates that if the individual mandate is repealed, 13 million Americans will lose their health insurance in the next 10 years and that plans will have higher premiums as younger, healthier individuals opt to go without coverage.

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McChesney said even if it’s repealed, the individual mandate would still be in effect until 2019. 

“It’s important that people understand, who are considering purchasing ACA insurance right now, that they are still subject to the mandate and could potentially face a tax penalty if they go uninsured in 2018,” she said.

Disclosure: The Center for Public Policy Priorities, Kaiser Family Foundation and Texas Public Policy Foundation have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.

Read related Tribune coverage:

  • Texas is pushing the federal government for temporary funding for the Children’s Health Insurance Program while Congress fights over a permanent solution. [Full story]

  • Open enrollment for health insurance, which begins Nov. 1, will be shorter this year, and President Donald Trump has slashed funding for subsidies and outreach. [Full story]

  • Watch the video of our event in Houston on the health care landscape following Hurricane Harvey. Or check out our recap below. [Full story]

Funding for children’s health insurance at risk

A Children’s Health Insurance Program, or CHIP, was created in 1997 to give insurance to children whose guardians make too much money for Medicaid, but not enough to afford it on their own. Last year, nearly 9 million were enrolled, but this year Congress let CHIP’s federal funding expire. Diane Rowland, of the Kaiser Family Foundation, joins Hari Sreenivasan with more.

Iowa city provides health insurance to slain officer’s family

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School board members defends health insurance benefit – Fairbanks Daily News

FAIRBANKS — The Fairbanks region has only one local legislative entity offering health insurance to its elected officials — the school board.

Other local legislative bodies long ago eliminated health insurance compensation for their members, many of whom work day jobs and serve part-time in public office. However, the school board has maintained its health insurance benefit. 

Most members of the Fairbanks school board said they collect health insurance benefits from the school district in exchange for their public service. 

The cost to the Fairbanks North Star Borough School District to provide school board members with health benefits is $65,653 for the current fiscal year, according to the district’s chief financial officer. 

Other large school districts in Alaska also offer health insurance benefits to school board members. Members of school boards in Anchorage, the Matanuska-Susitna Borough and the Kenai Peninsula Borough are offered health benefits, according to officials with those districts. 

Juneau school board members do not receive health insurance, according to Kristin Bartlett, chief of staff at the Juneau School District.

Timi Tullis, director of board development and field services for the Association of Alaska School Boards, said board compensation is a local control decision and that it varies from district to district.

There was a time when health insurance was widely offered to local leaders in the Fairbanks North Star Borough. 

Members of the Fairbanks City Council did away with their health benefits in the late 1980s, according to City Councilman Jerry Cleworth, a long-time city leader. He said the council voted to eliminate council member health coverage as a cost-cutting measure.

Members of the Borough Assembly were allowed heath insurance as a benefit until a narrow vote in 2003 ended the practice, with proponents arguing that it is inappropriate to provide health insurance for part-time public service.

Members of the North Pole City Council also do not get health insurance from the city. Jeff Jacobson, former North Pole mayor and councilman, said in an email that he does not recall health insurance ever being offered to council members.

So why do Fairbanks school board members get health insurance? 

The News-Miner contacted school board members to ask why they should receive health care benefits. Their answers varied.

Tim Doran, a new member of the school board, said he declined the health insurance because he has other coverage but that he thinks it’s a valuable benefit that helps attract candidates to run for school board.

“It broadens the pool, especially people who might be more economically challenged,” he said. “You want a broad spectrum of people to run and be part of municipal government. There are some people who would find it very difficult to do for economic reasons.”

Board member Wendy Dominique said she accepted the health care benefit from the school district for herself and her husband but that her primary health care coverage is through her job on Fort Wainwright.

Dominique pointed out that compensation of local leaders varies from institution to institution. The school board stipend of $400 a month is substantially less than the Borough Assembly stipend of $900 a month, she said. 

“We do just as many hours as they do,” she said. 

Heidi Haas, president of the school board, did not disclose whether she accepts the health care benefit. 

“I can’t speak to why the other bodies compensate their members differently but believe that each body has the right to make that decision, as is the same across the state,” Haas said in an email. “Some school boards in the state offer retirement and some pay nearly $40,000 a year for board service, so there doesn’t appear to be a standard.”

Sean Rice, another Fairbanks school board member, said he rarely uses the coverage provided by the district. He said he has other health insurance that is his primary coverage. 

“I just did a bunch of signing,” Rice said. “They didn’t give me the offer to decline.” 

Board member Thomas Bartels said he didn’t know that the school district offered health insurance to its board members until after he was elected. He accepted coverage for himself and his family, he said.

“This is something that has been a part of the policy since probably 30-35 years ago,” he said. “I don’t have an answer as to why … Every institution is allowed to make their own judgment as to what they feel and deem necessary.”

Allyson Lambert said she accepted health insurance coverage for herself and her family. She also did not know the history of how health insurance became a benefit for serving on the school board.

Board member Sharon McConnell could not be reached for comment.  

Contact staff writer Amanda Bohman at 459-7587. Follow her on Twitter: @FDNMborough.

Price hikes push health insurance shoppers into hard choices

Margaret Leatherwood has eight choices for health insurance next year but no good options.

The cheapest individual coverage available in her market would eat up nearly a quarter of the income her husband brings home from the oilfields.

The Bryson, Texas, couple makes too much to qualify for Affordable Care Act tax credits that help people buy coverage. But they don’t make enough to comfortably afford insurance on their own, even though Paul Leatherwood works seven days a week.

“I hate to put it like this, but it sucks,” said Margaret Leatherwood, who stays at home and takes care of her grandchildren.

This largely middle-class crowd of shoppers is struggling to stay insured. They’ve weathered years of price hikes and shrinking insurance choices with no help. Faced with more price increases for next year, they’re mulling options outside insurance or skipping coverage entirely — a decision that could lead to a fine for remaining uninsured and huge bills if an emergency hits.

The sign-up period for 2018 coverage closes on Friday in most states, meaning shoppers have only a few more days to find something that squeezes into their budgets.

“I kind of cringe when I am meeting with those clients because I don’t have a solution for them,” said Kelly Rector, a Missouri-based insurance agent.

The ACA helped chop the U.S. uninsured population 41 percent to 28.8 million people earlier this year from 48.6 million in 2010, when it became law, according to the latest government figures.

The law expanded Medicaid coverage for the poor and created health insurance marketplaces where people can use income-based tax credits to buy a single or family individual insurance plan if they don’t get coverage through work. Those subsidies cover part or all of the bill, capping insurance costs at a percentage of income for those who are eligible. That shields recipients from price hikes of 20 percent or more that have hit many markets.

But that help stops abruptly for people making four times the federal poverty level or more — around $48,000 for an individual and more than $98,000 for a family of four.

Of the roughly 15 million people who bought ACA-compliant individual insurance for this year, nearly 7 million had no tax credit help, according to the Kaiser Family Foundation.

Meanwhile, the uninsured rate among adults who make too much to qualify for help buying coverage jumped to 5 percent this year from 2 percent in 2016, according to The Commonwealth Fund.

Brokers and health care researchers expect that to climb again, especially for people with income levels close to the cutoff for federal help.

“It’s not going to be like an on-off switch where prices get too high and nobody buys coverage,” said Sherry Glied of New York University. “It’s more like a drip, drip, drip.”

The vulnerable population includes the self-employed, small business owners and those close to qualifying for the Medicare program that covers people age 65 and over.

These customers can face monthly bills that climb past $2,000 for a family plan and then a big deductible before most coverage starts. Plus fewer markets this year have insurance that comes with a health savings account, which lets people save for medical expenses before taxes. Those accounts are popular with individual insurance shoppers who don’t get tax credit help, said St. Louis broker Emily Bremer.

Leslie Glogau said some of her customers in the Orlando, Florida area are considering short-term, limited-benefits plans that are cheaper than ACA-compliant coverage but can leave them vulnerable to big medical bills. Such plans also won’t stave off the uninsured penalty, which can amount to a few thousand dollars depending on income.

“People just don’t know which way to turn,” Glogau said.

Insurance shoppers won’t be fined if they can’t find an affordable option in their market. But going uninsured would still leave them exposed to huge medical bills.

Margaret and Paul Leatherwood wound up with a limited-benefits plan this year, but they want better protection in case of a big bill. She’s 58 and he just turned 60. They’re weighing joining a medical cost-sharing ministry for next year.

These ministries are not insurance, but they allow people to band together to share expenses, often by making monthly payments. They can be cheaper than regular coverage, and belonging to one allows customers to escape the ACA penalty for remaining uninsured.

Such arrangements usually come with restrictions or qualifications. For instance, participants may not be allowed to use tobacco, and there might be limits on help for medical conditions that existed before the customer signed up.

“That’s really the only option we have that’s going to cover anything,” Margaret Leatherwood said.

Lance and Stephanie Schmidt bought family coverage in the individual insurance market for years because they don’t get employer-sponsored coverage through Lance’s dental practice. But the Oklahoma City couple opted for a cost-sharing ministry this year after they realized the monthly insurance bill for their family of five would have more than doubled to over $1,200 and stuck them with a deductible that topped $7,000.

They now pay $450 a month for a plan through Liberty HealthShare, and they are leaning toward returning next year.

“There’s still some risk there, but so far it has proven to be just fine,” said Stephanie Schmidt.

Cost-sharing ministries and short-term plans aren’t the only alternatives to individual insurance. Tom Morrill, a broker from Kansas City, Missouri, has helped many of his customers set up group coverage through their businesses.

He said that gives them better options than what they would find on the individual market, where coverage prices from the dominant insurer, Cigna, are climbing an average of 42 percent. Four insurers have left that market. The 10 remaining plans all have narrow networks of providers and don’t pay for care outside those networks.

“It’s nuts,” Morrill said. “Rates have jumped dramatically. It’s not good coverage.”

NH enrollment for health insurance appears similar to last year as deadline nears

With one week left to sign up for health insurance through the federal marketplace, the number of people enrolling in New Hampshire is roughly equal to last year, although it is unclear what the final tally will be because the enrollment period has been shortened.

Most New Hampshire residents have until Friday to buy health insurance through the Health Insurance Marketplace. That deadline comes much earlier than in past years when open enrollment continued through the start of January.

Through Dec. 2, the end of the fifth week of the open enrollment period, nearly 19,500 New Hampshire residents had signed up through the Health Care Marketplace for health insurance to begin Jan. 1, according to Covering New Hampshire, a central source for information and assistance about the marketplace.

Last year, 21,500 people signed up through the end of the sixth week of the enrollment period. Data for the first five weeks last year were not available.

Insurance does not have to be purchased through the marketplace. However, only insurance bought through the marketplace is eligible for subsidies and tax breaks that can sharply reduce the cost of premiums.

As well as shortening the enrollment period for the Affordable Care Act, the Trump administration cut by 90 percent the amount of money spent on advertising and informing people about it this year. It also cut the amount spent on hiring navigators – people who are trained to assist the public to find insurance – by about 45 percent.

Advocates and nonprofits have been scrambling to get the word out and ensure that people aren’t caught off guard by the shorter enrollment period.

In past years, sign-ups spiked in the last couple of weeks of the open enrollment period as procrastinators scrambled to meet the deadline.

Last year, approximately 60,000 people signed up for health care through the federal marketplace in New Hampshire, not including those who signed up through Medicaid expansion.

This year’s premiums are much higher, and just three companies are participating through the New Hampshire Marketplace next year: Anthem, Ambetter from NH Healthy Families, and Harvard Pilgrim Health Care. The total number of plans being offered has fallen from 44 to 15.

Under the ACA, also known as Obamacare, you must buy health insurance or face a fine. This year the fine was up to $695 per adult, or $2,085 per family, and will probably rise next year, although details haven’t been released.

It is not necessary to buy insurance through the federal marketplace. You can get private insurance from an agent or an insurance company, although in that case you aren’t eligible for subsidies and tax breaks.

Not everybody in New Hampshire is facing the Friday deadline. About 20,000 who have insurance under Minuteman Health qualify for a special enrollment period that would give them until March 1 to select a new plan. The extension was allowed because Minuteman Health, a Massachusetts-based health insurance co-op, withdrew entirely from the New Hampshire marketplace, stranding its customers as of the end of this year.

For more information about the program, check CoveringNewHampshire.org.

(David Brooks can be reached at 369-3313, dbrooks@cmonitor.com or on Twitter @GraniteGeek.)

Funding at risk for children’s health insurance, clinics

  • 3f549_920x920 Funding at risk for children's health insurance, clinics

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LANSING, Mich. (AP) — U.S. Sen. Debbie Stabenow and others are sounding the alarm over the expiration of federal funding that provides health insurance to 116,000 lower-income children in Michigan, saying cancellation notices may be sent to families as early as next month despite bipartisan support for continuing the program.

The Children’s Health Insurance Program was not reauthorized by the Republican-led Congress in September, and lawmakers are at odds over how to pay for a five-year extension. CHIP funds programs such as MIChild, which provides health and dental coverage for children from working families that make more than double the federal poverty level — $43,290 for a family of three.

And in the wake of Flint’s water crisis, Michigan also is allowed to spend some of the federal money to remove lead hazards from the homes of low-income residents in Flint and other communities.

Stabenow, a Democrat, said there will be “very serious” consequences if Congress does not extend funding for CHIP and community health centers that serve the poor and uninsured.

“This is unacceptable. This is something that is bipartisan, strongly bipartisan,” she told The Associated Press in a phone interview.

On Friday, President Donald Trump signed a two-week spending bill to prevent — for now — a government shutdown, which also makes money available to several states that are in danger of running out of CHIP funds this month. Michigan’s allotment has been expected to last until April or May, said state spokeswoman Angela Minicuci. But cancellation notices must be sent 90 days in advance in case the funds are not replenished.

More imminent are funding cuts to the community health centers, which are located at more than 260 underserved urban and rural sites across the state and served more than 680,000 people last year. They will lose 70 percent of their funding starting next month, with more exhausting their federal funds each month through June.

Centers whose grant cycles begin in January — and are at risk first — include Advantage Health Centers in Detroit, Bay Mills Health Center in the eastern Upper Peninsula, Community Health Social Services Center in Detroit, Covenant Community Care in Detroit, MidMichigan Community Health Services in the northern Lower Peninsula and Western Wayne Family Health Centers outside Detroit.

Among those in the Michigan delegation pushing to renew the funding is Republican Rep. Tim Walberg of Tipton. He said last month that CHIP is a “successful federal-state partnership” and called the health centers a “key component of the health care safety net.”

Legislation won approval in the House in November, and a Senate committee that Stabenow sits on OK’d a funding bill in October. But the popular programs have been caught up in talks over several end-of-year agenda items, including the budget, hurricane aid and protections for immigrants brought to the country illegally as children.

Families in MIChild pay a $10 monthly premium for coverage, and there are no co-pays.

“It literally is saving lives of children in Michigan,” Stabenow said.

The insurance, she said, lets parents who make too much to qualify for Medicaid take their kids to a doctor, avoiding expensive and potentially unnecessary trips to the emergency room.

The Flint Water Interagency Coordinating Committee, which Republican Gov. Rick Snyder created to help address the Flint crisis, is expected to soon send a letter to Congress warning that lead pipe replacement funding will be compromised if CHIP is not extended.

If the funding is not reauthorized, the state may try to keep MIChild and other programs going with additional state money.

“We need to discuss that with the Legislature to see if the funding would be available,” Minicuci said.

___

Follow David Eggert on Twitter at https://twitter.com/DavidEggert00 . His work can be found at https://apnews.com/search/David%20Eggert

Health insurance enrollment window still open

It’s been about five weeks since the start of the open enrollment period for Montanans who get their health insurance through the individual exchange created by the federal Affordable Care Act. So far, state regulators and insurers agree: The number of people signing up for coverage on the exchange is close to what was expected.

“We’ve seen a lot of activity since day one, a lot of interest in our customer service lines and our agent offices, looking at the benefit designs for this year, looking at the costs for this year,” said John Doran, Blue Cross Blue Shield of Montana’s vice president of external affairs.

One week remains in the enrollment period, which opened on Nov. 1 and will continue through Dec. 15. Three companies are offering individual health plans this year – Blue Cross Blue Shield, PacificSource and the Montana Health Co-Op.

This year, the open enrollment period was roughly half as long as in previous years, after a change in a federal government rule. But State Auditor Matt Rosendale, Montana’s insurance and securities commissioner, said it doesn’t appear the shorter window will affect the number of people who sign up.

“The insurers have told me that everything is going smooth; the numbers are coming in where they anticipated them to be,” Rosendale said.

As of Dec. 2, the federal Centers for Medicare and Medicaid Services reported 18,428 Montanans had signed up for plans through the HealthCare.gov website. But that number doesn’t include others who extended policies by working directly with insurance companies.

“Typically we’ve had upwards of 50,000 to 60,000 Montana members who’ve enrolled in the ACA exchanges,” said Doran. “A lot of times it’s difficult to tell the official numbers until folks have finalized their applications and they’ve actually paid their premiums for January.”

In addition, anyone who already has a health plan from the individual market will be automatically re-enrolled in their current plan – or the closest available option – if they don’t make a selection during the open enrollment period.

“The most important thing for folks to remember is that you still have an opportunity to shop,” Rosendale said.

Rosendale pointed people to montanahealthanswers.com, which includes details about the available plans, including premiums and benefits.

Montana insurers have made a number of changes to their plans this year. Each company also raised its average rates between 13 and 20 percent, after the Trump administration decided to end federal subsidies for many policies on the individual exchange.

Rosendale, a Republican and an opponent of the Affordable Care Act, said he wants the federal government to loosen its requirements for health care coverage. He said that could eventually lead to less expensive options for consumers in Montana.

In the meantime, though, Rosendale said the best thing for Montanans to do is thoroughly research the options they have today.

“Make sure that you’re comparing apples to apples, so that you get the health care that addresses your needs,” he said. “Then find the plan that best accommodates your budget.”

Doran echoed that advice, and also encouraged people not to wait until Dec. 15 to make their decisions.

“We’ve seen in previous years, the last couple of days of open enrollment, the website can really get a crush of activity, which tends to slow things down,” he said. “You want to make sure that you don’t miss the deadline opportunity to enroll.”

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Sale of Premier Health’s insurance line falls apart

The insurance division, Premier Health Plan, sold Medicare Advantage plans and commercial insurance plans.

Sale of Premier Health’s insurance line falls apart

The insurance division, Premier Health Plan, sold Medicare Advantage plans and commercial insurance plans.

Doubts Rise About Sen. Collins’ Strategy To Shore Up Insurance Market

b814c_collins-3_wide-94fa4d94f8c92bcd9bec40082df257f03897b65f-s1100-c15 Doubts Rise About Sen. Collins' Strategy To Shore Up Insurance Market

Sen. Susan Collins, a Republican from Maine, walks through the Capitol with colleagues in early December.

Aaron P. Bernstein/Bloomberg via Getty Images


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Aaron P. Bernstein/Bloomberg via Getty Images

Sen. Susan Collins, a Republican from Maine, walks through the Capitol with colleagues in early December.

Aaron P. Bernstein/Bloomberg via Getty Images

Sen. Susan Collins, the Maine Republican whose vote was pivotal in pushing the GOP tax bill forward last week, thought she had a deal to bolster health care protections in exchange for her support.

But it’s now unclear wether her strategy to shore up part of the Affordable Care Act will prevail or that it would produce the results she anticipates.

The tax bill repeals the ACA’s fines for the individual mandate, which requires most people to have health insurance or pay a fine. Collins says she would vote for it if Senate Republicans promised to allow a vote on two other health bills.

One would reinstate payments to insurers in order to cover discounts that the ACA requires those insurers to provide to their lowest-income enrollees for out-of-pocket costs. President Trump ended those “cost-sharing reduction” payments in October. The bill that Collins supports would extend the payments for two years.

The other bill she supports would provide temporary funding for reinsurance pools, which help insurers pay claims for the sickest — and most expensive — customers. Reinsurance would help bring down premium costs for everyone else.

b814c_collins-3_wide-94fa4d94f8c92bcd9bec40082df257f03897b65f-s1100-c15 Doubts Rise About Sen. Collins' Strategy To Shore Up Insurance Market

Before the tax vote, Collins said in a statement she was “deeply concerned that the repeal of the individual mandate would almost certainly lead to further increases in the cost of health insurance premiums – premiums that are already too expensive under the ACA.” Senate Majority Leader Mitch McConnell, R-Ky., said on the floor that he would support Collins’ demands.

McConnell added that he would seek to restore the cost-sharing subsidies, “ideally prior to the adoption of any final tax reform conference agreement and certainly before the end of the year.” He also said he would “support passage of your bill” to create the reinsurance program, with the same timing.

But it’s nowhere near that easy.

The tax bill is now the subject of final negotiations between the House and the Senate. First, even if the bills pass the Senate, there is little to suggest that the House Republicans would go along. On Tuesday, House Speaker Paul Ryan, R-Wis., reportedly told other House leaders he was not a party to Collins’ health care deal with McConnell. Ryan had previously expressed opposition to restoring the cost-sharing payments.

In response to Ryan, Collins on Thursday signaled that she might not vote for the tax bill’s final passage.

But would Collins’ changes offset the elimination of the mandate? Some analysts question whether the bill restoring the federal cost-sharing subsidy payments could actually do more harm than good.

“It’s a mess,” says insurance industry consultant Robert Laszewski. Many states allowed insurers to raise premiums to make up for the loss of the federal cost-sharing reduction payments. So passing the law now, at least for 2018, would require insurers to make refunds to individuals and the federal government for those overpayments.

“It’s certainly too late to affect premiums for 2018,” agreed Aviva Aron-Dine, a former Obama administration health official at the Center on Budget and Policy Priorities, a progressive think tank. “It’s also too late to help with market disruption for 2018.”

Open enrollment for 2018 coverage on the federal marketplace ends Dec. 15, although some state-run exchanges have later deadlines.

One irony, Aron-Dine noted, is that state regulators have dealt with the loss of the federal payments in such a way that many customers can get unexpectedly large discounts on premiums, including bronze-level plans for no monthly premium or gold-level plans cheaper than the mid-level silver ones.

Going back to the original payment system, she says, would result in “a whole group of people who would actually see higher premiums.”

In addition, the tax bill’s elimination of the federal health law’s individual mandate penalty would also raise premium costs – beyond the expected yearly increases – by an average of 10 percent, according to the Congressional Budget Office. That’s because the CBO estimates that about 13 million people would give up their coverage by 2027. Fewer people buying insurance means that the insurance pools would have larger numbers of sicker enrollees and would be more expensive for insurers, who would likely raise premiums.

b814c_collins-3_wide-94fa4d94f8c92bcd9bec40082df257f03897b65f-s1100-c15 Doubts Rise About Sen. Collins' Strategy To Shore Up Insurance Market

Industry analysts also predict that the loss of the mandate could disrupt the marketplace enough to drive out some insurers.

The elimination of the mandate penalties is permanent, but Collins’ bill would fund the cost-sharing and reinsurance programs for only two years. Because of that, says Timothy Jost, a former law professor and expert on the health law, “I don’t think it’s going to be much of a carrot” to encourage insurers to stay in the individual market.

Analysts were more upbeat about the potential impact of the reinsurance program. The program would be similar to one that existed in the first years of the health law, “and it did in fact reduce premiums by about 10 percent,” Jost says.

But in order to set up such reinsurance programs and be eligible for funding, states would have to apply for special waivers under the health law. Federal officials have been slow about approving those. “States would have to get their act together politically,” says Jost. “And the money might run out before [the federal government] gets to your state.”

At least one organization thinks Collins is onto something.

The consulting firm Avalere Health estimated this week that the combination of funding the cost-sharing reductions and funding a new reinsurance program would offset the impact of the mandate repeal – at least temporarily.

“Funding CSRs and funding reinsurance is expected to decrease average premiums in the market by more than the 10 percent [increase] CBO is projecting” for getting rid of the mandate fines, says Chris Sloan, a co-author of the study.

But he warned that when the funding runs out, “we’re back where we started.”

Kaiser Health News, a nonprofit health newsroom, is an editorially independent part of the Kaiser Family Foundation.

Doubts Rise About Sen. Collins’ Strategy To Shore Up Insurance Market

b814c_collins-3_wide-94fa4d94f8c92bcd9bec40082df257f03897b65f-s1100-c15 Doubts Rise About Sen. Collins' Strategy To Shore Up Insurance Market

Sen. Susan Collins, a Republican from Maine, walks through the Capitol with colleagues in early December.

Aaron P. Bernstein/Bloomberg via Getty Images


hide caption

toggle caption

Aaron P. Bernstein/Bloomberg via Getty Images

Sen. Susan Collins, a Republican from Maine, walks through the Capitol with colleagues in early December.

Aaron P. Bernstein/Bloomberg via Getty Images

Sen. Susan Collins, the Maine Republican whose vote was pivotal in pushing the GOP tax bill forward last week, thought she had a deal to bolster health care protections in exchange for her support.

But it’s now unclear wether her strategy to shore up part of the Affordable Care Act will prevail or that it would produce the results she anticipates.

The tax bill repeals the ACA’s fines for the individual mandate, which requires most people to have health insurance or pay a fine. Collins says she would vote for it if Senate Republicans promised to allow a vote on two other health bills.

One would reinstate payments to insurers in order to cover discounts that the ACA requires those insurers to provide to their lowest-income enrollees for out-of-pocket costs. President Trump ended those “cost-sharing reduction” payments in October. The bill that Collins supports would extend the payments for two years.

The other bill she supports would provide temporary funding for reinsurance pools, which help insurers pay claims for the sickest — and most expensive — customers. Reinsurance would help bring down premium costs for everyone else.

b814c_collins-3_wide-94fa4d94f8c92bcd9bec40082df257f03897b65f-s1100-c15 Doubts Rise About Sen. Collins' Strategy To Shore Up Insurance Market

Before the tax vote, Collins said in a statement she was “deeply concerned that the repeal of the individual mandate would almost certainly lead to further increases in the cost of health insurance premiums – premiums that are already too expensive under the ACA.” Senate Majority Leader Mitch McConnell, R-Ky., said on the floor that he would support Collins’ demands.

McConnell added that he would seek to restore the cost-sharing subsidies, “ideally prior to the adoption of any final tax reform conference agreement and certainly before the end of the year.” He also said he would “support passage of your bill” to create the reinsurance program, with the same timing.

But it’s nowhere near that easy.

The tax bill is now the subject of final negotiations between the House and the Senate. First, even if the bills pass the Senate, there is little to suggest that the House Republicans would go along. On Tuesday, House Speaker Paul Ryan, R-Wis., reportedly told other House leaders he was not a party to Collins’ health care deal with McConnell. Ryan had previously expressed opposition to restoring the cost-sharing payments.

In response to Ryan, Collins on Thursday signaled that she might not vote for the tax bill’s final passage.

But would Collins’ changes offset the elimination of the mandate? Some analysts question whether the bill restoring the federal cost-sharing subsidy payments could actually do more harm than good.

“It’s a mess,” says insurance industry consultant Robert Laszewski. Many states allowed insurers to raise premiums to make up for the loss of the federal cost-sharing reduction payments. So passing the law now, at least for 2018, would require insurers to make refunds to individuals and the federal government for those overpayments.

“It’s certainly too late to affect premiums for 2018,” agreed Aviva Aron-Dine, a former Obama administration health official at the Center on Budget and Policy Priorities, a progressive think tank. “It’s also too late to help with market disruption for 2018.”

Open enrollment for 2018 coverage on the federal marketplace ends Dec. 15, although some state-run exchanges have later deadlines.

One irony, Aron-Dine noted, is that state regulators have dealt with the loss of the federal payments in such a way that many customers can get unexpectedly large discounts on premiums, including bronze-level plans for no monthly premium or gold-level plans cheaper than the mid-level silver ones.

Going back to the original payment system, she says, would result in “a whole group of people who would actually see higher premiums.”

In addition, the tax bill’s elimination of the federal health law’s individual mandate penalty would also raise premium costs – beyond the expected yearly increases – by an average of 10 percent, according to the Congressional Budget Office. That’s because the CBO estimates that about 13 million people would give up their coverage by 2027. Fewer people buying insurance means that the insurance pools would have larger numbers of sicker enrollees and would be more expensive for insurers, who would likely raise premiums.

b814c_collins-3_wide-94fa4d94f8c92bcd9bec40082df257f03897b65f-s1100-c15 Doubts Rise About Sen. Collins' Strategy To Shore Up Insurance Market

Industry analysts also predict that the loss of the mandate could disrupt the marketplace enough to drive out some insurers.

The elimination of the mandate penalties is permanent, but Collins’ bill would fund the cost-sharing and reinsurance programs for only two years. Because of that, says Timothy Jost, a former law professor and expert on the health law, “I don’t think it’s going to be much of a carrot” to encourage insurers to stay in the individual market.

Analysts were more upbeat about the potential impact of the reinsurance program. The program would be similar to one that existed in the first years of the health law, “and it did in fact reduce premiums by about 10 percent,” Jost says.

But in order to set up such reinsurance programs and be eligible for funding, states would have to apply for special waivers under the health law. Federal officials have been slow about approving those. “States would have to get their act together politically,” says Jost. “And the money might run out before [the federal government] gets to your state.”

At least one organization thinks Collins is onto something.

The consulting firm Avalere Health estimated this week that the combination of funding the cost-sharing reductions and funding a new reinsurance program would offset the impact of the mandate repeal – at least temporarily.

“Funding CSRs and funding reinsurance is expected to decrease average premiums in the market by more than the 10 percent [increase] CBO is projecting” for getting rid of the mandate fines, says Chris Sloan, a co-author of the study.

But he warned that when the funding runs out, “we’re back where we started.”

Kaiser Health News, a nonprofit health newsroom, is an editorially independent part of the Kaiser Family Foundation.

Maine Compass: Deadline for federal health insurance enrollment is just days away

As we all prepare for the holidays, it is important to remember that it’s open enrollment time. If you need health coverage, you should know that this year, individuals have a shorter period of time to enroll and select their plans — and fewer options to choose from. The open enrollment period this year is only six weeks — half as long as last year. The enrollment deadline is Dec. 15 for coverage that takes effect Jan. 1. Maine residents who want individual health insurance must go online soon and shop for the plan that best fits their needs and the needs of their family.

It has been widely reported that premiums are going up around the country, and unfortunately, this is also true of Maine. The cost of health care services continues to rise, and recent administrative and legislative decisions made in Washington have directly led to increasing insurance premiums.

Fortunately, most Maine residents purchasing on the exchange will be protected from these increases. While premiums are going up, many Mainers will also see their premium subsidy increase. These subsidies, known as the advanced premium tax credit, offset the cost of health insurance and will allow some residents to purchase health insurance with either very low or zero monthly premiums, depending on their income.

Additionally, certain eligible individuals will also find that another federal subsidy, called cost-sharing reduction subsidies, will dramatically reduce their deductibles, co-pays and other out-of-pocket expenses. These cost-sharing reduction subsidies, however, are available only for so-called “Silver” plans, which may have slightly higher monthly premiums. While you may have read that funding for this subsidy has been ended by actions in Washington, these affordable and attractive plans are still offered on the exchange.

Therefore, this year more than ever, it is extremely important that consumers carefully consider all the costs associated with a health insurance plan, including the premium, deductibles, co-payments, coinsurance and any other out-of-pocket expenses. If individuals have questions about the health plans available on Healthcare.gov, they should know that there are health navigators and certified assisters throughout the state of Maine who can help them with their concerns. These trained professionals have an extensive background in health care and can be reached online at enroll207.com or toll-free by phone at 800-965-7476. Consumers can also contact a licensed broker or even call a health plan directly.

Lastly, consumers will also notice that this year there will be fewer health insurers participating on the exchange through Healthcare.gov, so individuals will find fewer choices than in previous years. Health insurer participation rates around the country have declined, but in Maine, consumers will still find options from two quality health insurers, including Harvard Pilgrim, and be able to choose from several health insurance plans.

In Maine, much credit for the survival of the public health exchange is due to the leadership of the Maine Bureau of Insurance. Amid indecision from Washington about whether or not the cost-sharing reduction payments would be funded, Maine Insurance Superintendent Eric Cioppa was fair and decisive in his approach to regulating the marketplace for 2018. His foresight ensured that residents both had the opportunity to voice their concerns during the process and that Mainers would have a choice in health plans for 2018.

Harvard Pilgrim is proud to have participated in the Maine health insurance exchange for the past three years. As a company celebrating our 50th anniversary, and with over 20 years of serving Maine residents, our commitment to the state of Maine goes well beyond our role as an insurance provider – we hope to be a strong corporate citizen, in line with our not-for-profit mission and our core values.

So, before you get too caught up in the hustle and bustle of the holiday season, please take the time to review your individual health insurance options for 2018 at Healthcare.gov. Dec. 15 and the end of open enrollment are right around the corner.

Edward Kane is Maine vice president for Harvard Pilgrim Health Care.


92de4_article-fb-icon Maine Compass: Deadline for federal health insurance enrollment is just days away


92de4_article-fb-icon Maine Compass: Deadline for federal health insurance enrollment is just days away


92de4_article-fb-icon Maine Compass: Deadline for federal health insurance enrollment is just days away


92de4_article-fb-icon Maine Compass: Deadline for federal health insurance enrollment is just days away


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