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State Health Exchanges Leaning Toward Insurers

From The Huffington Post:

Wendell Potter–7/14/11 12:29 PM ET

The insurance industry made it abundantly clear this week that it is in the driver’s seat–in both Washington and state capitals — of one of the most important vehicles created by Congress to reform the U.S. health care system.

The Affordable Care Act requires the states to create new marketplaces — “exchanges” — where individuals and small businesses can shop for health insurance. In the 15 months since the law took effect, insurers have lobbied the Obama administration relentlessly to give states the broadest possible latitude in setting up their exchanges. And those insurance companies have been equally relentless at the state level in making sure governors and legislators follow their orders in determining how the exchanges will be operated.

When Health and Human Services Secretary Kathleen Sebelius announced the proposed federal rules governing the exchanges on Monday, insurance executives must have been doing high fives all over the country.

Insurers had several main objectives. First, they did not want the feds to require states to negotiate with health plans on price and benefit design. And they did not want plans that failed to meet certain criteria to be excluded from the exchanges. Insurers did want the states to feel free to appoint people with ties to the industry to run the exchanges. Continue reading

State Health Care Cuts Could Fill Nursing Homes

From The Associated Press:

By JOHN SEEWER–7/16/2011

Born with cerebral palsy, Jennifer McPhail relies on a home health aide to help her get dressed for work and ready for bed at night.

Her motorized wheelchair keeps her active, working as an organizer with a disability rights group in Austin, Texas, and volunteering to help people find housing and to staff hurricane shelters. She now fears deep cuts in the state’s Medicaid spending will prevent her from living independently.

“What it says to me is that the state doesn’t value the lives of people with disabilities,” said McPhail, 39. “A lot of people are going to be hurt in a very intimate way.”

It’s a concern facing families across the country as states with gaping budget deficits cut home health services that help keep the elderly and disabled out of nursing homes. States are reducing how much time a nurse can spend making house calls and ending meal deliveries for the homebound. Many also are gutting adult day care programs that give seniors a safe place to spend their days while their relatives are at work. Continue reading

Health Officials Move To Loosen State Requirements

By Noam N. Levey–July 12, 2011

Washington— The Obama administration moved Monday to ease some requirements on states to help them set up new insurance exchanges in 2014, a key feature of the healthcare law the president signed last year.The state-based exchanges are intended to make buying health insurance comparable to shopping the Internet for an airline ticket or a hotel room. And by 2019, the exchanges are expected to provide insurance for an estimated 24 million Americans who don’t get their health insurance from their employer, according to the nonpartisan Congressional Budget Office.

Small employers with fewer than 100 workers also will be able to use the exchanges, which will have to offer plans with a minimum level of coverage. No plans will be able to deny coverage to people with pre-existing conditions.

Premium Cuts For Consumers With Preexisting Conditions

From The Washington Post:

By Michelle Andrews–July 4

Uninsured sick people got some good news recently, or some of them did, anyway. Starting July 1, the Obama administration reduced the premiums by up to 40 percent in special high-risk insurance plans that the federal government is running in 17 states and the District.

These preexisting condition insurance plans, or PCIPs, were created under the 2010 health-care overhaul to provide guaranteed coverage to people who have medical conditions that often make them uninsurable in the individual insurance market.

On the low end, Mississippi will reduce premiums by 2 percent. Several states will cut monthly rates in the 15 to 25 percent range, including the District , which will reduce premiums by 18 percent. Six states, including Virginia, will reduce their premiums by 40 percent.

The change means that a 55-year-old District resident who would have owed $551 per month under the old rates for the standard plan will now owe $450. In Virginia, the same person’s premium would now be $297 monthly, compared with $498 before.

The new premium rates take into account more state-specific data and thus more closely track the standard rates for individual policies in each state, as the law requires. “Now the program has been up and running for six to nine months, and . . . we’ve had an opportunity to refine the methodology,” says Steven Larsen, director of the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services. Continue reading

Repeal Benefits Blue Cross Blue Shield

From The Post and Courier:

By Renee Dudley–Sunday, July 3, 2011

In 2006, the South Carolina Legislature repealed a decades-old insurance code, stripping the state’s authority to regulate discounting in contracts between hospitals and insurers.

The deletion allowed the state’s biggest health insurance company, Blue Cross Blue Shield, to negotiate contracts that could cripple its competitors and raise costs for consumers. And Blue Cross was among the special-interest groups lobbying for the repeal, according to a legislator who requested it.

Although the state apparently had not enforced that section of the law, the repeal stripped regulators of authority to step in if it became necessary to regulate anticompetitive activities.

The code appears to have forbidden types of “most-favored-nation” contracts with hospitals and doctors, which some economists said have played a significant role in driving up health care costs in South Carolina. Continue reading

Bachmann Medicaid Hypocrisy

From Today.com:

Michael Isikoff–6/28/2011 7:46:46 PM

While Rep. Michele Bachmann, R-Minn., has forcefully denounced the Medicaid program for swelling the “welfare rolls,” the mental health clinic run by her husband has been collecting annual Medicaid payments totaling over $137,000 for the treatment of patients since 2005, according to new figures obtained by NBC News.

The previously unreported payments are on top of the $24,000 in federal and state funds that Bachmann & Associates, the clinic founded by Marcus Bachmann, a clinical therapist, received in recent years under a state grant to train its employees, state records show. The figures were provided to NBC News in response to a Freedom of Information request.

The clinic, based in Lake Elmo, Minn., describes itself on its website as offering “quality Christian counseling” for a large number of mental health problems ranging from “anger management” to addictions and eating disorders. Continue reading

Health Care Reform Saves Seniors A Combined $260 Million

From The Hill:

By Julian Pecquet – 06/28/11 10:07 AM ET

Almost half a million seniors on Medicare had saved a combined $260 million on their medicines by the end of last month thanks to the healthcare reform law, the Obama administration announced Tuesday.

A total of 478,272 people have taken advantage of the law’s 50 percent prescription discount for seniors in the Medicare “doughnut hole,” according to the Centers for Medicare and Medicaid Services. The month of May saw a sharp increase in the number of beneficiaries benefiting from the provision, up 76 percent from 270,900 at the end of April.

“As more and more beneficiaries hit the donut hole through the rest of this year,” CMS Administrator Don Berwick said in a statement, “the numbers will continue to climb. All of these beneficiaries will see savings on their drug costs that were not available in previous years.”

The agency also released a state-by-state breakdown of the numbers, showing that California saw the greatest benefit, with 54,586 seniors saving almost $30 million.

RomneyCare: Program Review Shows Appealing Efficacy

From The Boston Globe:


June 26, 2011|By Brian C. Mooney, Globe Staff

Second of two stories on Mitt Romney and the state health care overhaul.

On a sunny autumn afternoon in October 2008, Mitt Romney and his wife, Ann, met New Hampshire portrait artist Richard Whitney at the State House and went to the governor’s office he once occupied on the third floor.

About eight months earlier, Romney had dropped out of the race for the Republican presidential nomination, and his successor, Deval Patrick, had arranged for them to use his office to shoot photos to be used for Romney’s official portrait, which would be unveiled the following year.

The artist and former governor had already met at Romney’s vacation home in Wolfeboro,, N.H., to discuss the painting, and Romney was clear on the image he wanted to convey for posterity.

He would be at his desk, wearing a light blue business suit and tie. Visible in the frame would be symbols of what he held dear and how he wanted to be remembered.

One was a photo of Ann, center of his personal universe.

The other was an official-looking document, with the symbol of the medical profession — the caduceus — embossed in gold on the cover. It stood for the Massachusetts health care law, passed in 2006, his final year as governor. Easily the most memorable achievement of his political career, it is now perhaps the biggest hurdle to achieving his presidential dream. Continue reading

RomneyCare: A Look At Massachusetts Health Care

From The Boston Globe:


May 30, 2011|By Brian C. Mooney, Globe Staff

First in a series on Mitt Romney and the Massachusetts health care overhaul.

In late spring 2005, Mitt Romney gathered with a dozen top policy and political advisers in a conference room near the governor’s suite on the third floor of the State House.

For two years, they had grappled with the abstruse complexities of health care reform, sifting data, evaluating input from experts, and testing theories to craft a plan that would expand coverage to nearly everyone in the state and not break the bank.

This was a bold move for a first-term Republican governor, some of whose more conservative advisers doubted the wisdom of a foray deep into policy turf long dominated by Democrats. One privately called the idea Dukakis II, a reference to the 1988 Democratic-led effort by Governor Michael S. Dukakis to phase in near-universal coverage — even though Romney’s approach was fundamentally different.

 But Romney was resolute in pushing forward. And on the table this day was a critical decision that would, in many ways, define the plan, and also Romney’s political ambitions, wherever they would lead him. Continue reading

Healthcare Reform As A Market-Based Solution

From The Huffington Post:

Tommy Thompson– 06/27/11 06:44 PM

I am writing to suggest that governors of both political parties have tremendous opportunity to use free market principles and set up health insurance exchanges which work and give constituents freedom of choice. There is a lot of discussion about health insurance exchanges as it relates to President Obama’s Affordable Care Act. Some governors have a negative opinion of insurance exchanges and I believe that by doing so they are giving up a tremendous opportunity to use marketplace choice and allow insurance companies to compete in their respective states. It would be a terrible mistake to have governors give up that opportunity to set up exchanges and forfeit that opportunity back to the federal government which would limit states’ rights and their constituents’ ability to pick and choose the best insurance for themselves and their families.

Just as governors did during welfare reform, by using these kinds of free market principles to chart a new course in dealing with welfare, they gave people hope for a job and independence and did not lock them into welfare dependency. Exchanges can be and should be a market-based solution. As a Republican and an advocate of market-placed innovation, I believe that health care should possess the same entrepreneurship zeal and leverage of technology that allows us to create an Apple iPhone or Amazon e-commerce portal. Continue reading