California journalist Randy Dotinga has written several pieces about his own efforts to obtain health insurance. His “long-running tale of woe” features several twists and turns but it isn’t that unusual in the grim world of 21st-century health insurance in the United States.
Since 2000, I’ve been jilted by a grand total of seven insurance companies. The eighth — the one covering me now — comes courtesy of Obamacare and looks like it might actually stick around for a while. Expensive? Yes. A relief? Absolutely.
What is unusual is for a journalist who covers health and medicine to be so open about his own experiences. In an article for AHCJ, he offers journalists some tips on how to do the same.
We’re closing in on the start of the ACA’s second open enrollment season. Both Kevin Counihan, the new HealthCare.gov “CEO” within the Department of Health and Human Services, and HHS Secretary Sylvia Burwell have been speaking out a bit more about the upcoming season.
But there’s a lot they aren’t saying – or touting. Here are a few things we do – or don’t – know about what to expect by Nov. 15, the start of the three-month enrollment period: Continue reading
Photo: Margot Sanger-KatzJournalists at a Sept. 18 Washington, D.C., chapter meeting heard from Tom Scully, a former CMS administrator; Stephen Zuckerman, a senior fellow at the Urban Institute; and Marilyn Werber Serafini, a former journalist now with the Alliance for Health Reform.
Open enrollment is coming again. And with millions of new people signing up for health insurance and renewing their plans come opportunities for new stories about how the Affordable Care Act is working.
Stephen Zuckerman, a senior fellow at the Urban Institute and Tom Scully, a former administrator at the Centers for Medicare and Medicaid Services who now works as a private equity investor, spoke to an AHCJ chapter meeting in Washington, D.C. about the possible stories ahead.
We wrote earlier this month about the Sept. 5 deadline for people who had signed up for ACA coverage through the federal exchange but still had some inconsistencies in the record about their citizenship or legal residency. Here’s an update:
As of early September, the Department of Health and Human Services said 310,000 people still had status questions (down from close to a million “data-matching” cases in late May). Most did get the information in and the questions resolved. But about a third did not, and that means about 115,000 people will lose coverage at the end of this month. Continue reading
Remember all those stories about people being shifted into part-time work so their employers don’t have to provide health insurance?
According to a new Urban Institute report, funded by the Robert Wood Johnson Foundation, it hasn’t happened.
If, and when, the employer mandate fully kicks in (more on that below) things could change. But the anecdotes we’ve heard about employers cutting hours because of the Affordable Care Act are just that – scattered anecdotes. (And when it does occur, it might be a result of other business conditions, not the health law). Under the ACA the definition of “full-time” work is 30 hours; anyone working 30 hours a week or more would have to be covered. The fear was that employers would cut them to, say, 28 or 29 hours, to avoid that obligation. Continue reading
Friday is the deadline for some 350,000 people who have yet to document their citizenship/legal residency for their health insurance through the federal exchange to get the information submitted and verified or face losing insurance at the end of this month.
It would be a good time to check with health, enrollment and immigrant advocacy groups in your community to see what kind of obstacles they are facing (technical, language barriers, poor communication, confusion) and what steps they are taking to meet the deadline. The Centers for Medicare & Medicaid Services says it has been trying to reach the affected people by email, mail and telephone. Immigration advocacy groups say that the outreach has left a lot to be desired and people are having trouble getting problems sorted out. Continue reading
The percent of premium dollars allocated to administrative costs and profit dropped in all markets since the introduction of the 80/20 rule. (Click to enlarge image.)
A new report on how health insurers are complying with the medical loss ratio rules shows insurers spent more on care delivery and less on profit and overhead in 2013 than they did in the previous two years.
The report, “Consumers Benefited From 80/20 Rule in 2013,” from the federal Department of Health and Human Services (HHS) shows that the percentage of consumers insured by companies that met or exceeded the requirements under the MLR rules has risen each year since the rules became effective in 2011. Tables accompanying the report offer some great story ideas for journalists who want to dig deeper into why insurers in their states would pay rebates to consumers rather than put those funds into care delivery.
Also called the 80/20 rules, the MLR regulations in the Affordable Care Act require insurers to spend a minimum of 80 percent of premium income on delivering care (and not on profit and overhead) in the small group and individual markets and at least 85 percent of premium income on care delivery in the large group market.
Under the MLR rules, if insurers fail to spend at least at these levels, they have to rebate the difference to consumers. Those rebates are due by Aug. 1.
“In the first three years of the MLR program, individual and employer plan enrollees received or will receive over $1.9 billion in refunds,” the HHS report said. Continue reading
Even for those of us who cover the Affordable Care Act (ACA) more or less full time, July 22 was a pretty zany day. Here’s a recap and some resources to help you going forward.
First an appeals court in Washington, D.C., ruled, 2-1 that people can’t continue to get subsidies in the federal exchanges – just on the state exchanges. Only it didn’t move to enforce that ruling – which would cut off millions receiving subsidies – because the three judges on that panel knew they didn’t necessarily have the last word. There are more legal fights to come in the case, known as Halbig v. Burwell. (It was v. Sebelius but the name was updated.)
Then, less than three hours later, another appeals court – also a panel of three judges – in Richmond, Va., issued the exact opposite ruling. They said, 3-0, that the subsidies in the federal exchange were fine. Well, maybe not fine – they thought the law was ambiguous. But even with the ambiguity, they said that the IRS had the right to interpret the law to allow the subsidies in the federal exchange. That case is known as King v. Burwell. (The IRS set the rules for the subsidies, which take the form of premium tax credits.)
The question in very simple terms is this: Did the ACA allow the subsidies through the federal exchanges? The plaintiffs argue no – and cite a specific section of the law that refers to subsidies for people enrolled “through an Exchange established by the State.” They say it’s clear as day – the subsidies are tied to state exchanges. The administration and its supporters say that’s far too narrow and literal an interpretation. The whole law is designed to expand coverage and the federal exchanges are meant to stand in when the states don’t stand up exchanges.
Now what? Continue reading
Carla K. Johnson
When Illinois awarded a $33 million contract to a high-priced PR firm to promote insurance coverage under the Affordable Care Act, Carla Johnson began filing open records requests under the state’s Freedom of Information law.
Eventually Johnson, a medical writer for The Associated Press, filed 10 FOIA requests while reporting on how public money was spent to promote the health law.
She says the “88-page contract, obtained through a records request, contained clues about other existing documents, such as monthly detailed explanations of invoices and a ‘work plan’ required by the contract.” She continued filing requests until she had enough documentation to detect some trends.
Read more about how Johnson reported the story, what she learned and tips for other reporters.
We posted some data tools from the Robert Wood Johnson Foundation for the health reform beat and AHCJ’s New York chapter recently got to hear about them in more detail with some help from RWJF. If you’ve done stories using this data, we’d love to see them and learn about how you used the data. Send them to email@example.com.
Charles Ornstein Storyfied the meeting and we have this guide for you from RWJF. Continue reading