Opening Day, Despite Shutdown

Certainly officials did not envision launching the first day of open enrollment on the health insurance exchanges during the first government shutdown in 17 years.  But while the Department of Health and Human Services has furloughed over half of its employees, health insurance exchanges across the country are set to begin taking applications from consumers today.

Despite being overraught with delays and system issues due to heavy traffic, federal- and state-run exchanges alike, from now through March 2014, can now enroll individuals and small businesses in health plans that cover essential benefits, pre-existing conditions, and more. Those experiencing problems accessing the online marketplace can also enroll by phone, 24/7, by calling 1-800-318-2596.

Step-By-Step Online Enrollment Instructions for Individuals:

1. Log on to www.healthcare.gov
2. Choose "Individuals & Families"
3. Watch the brief video on the right, then click "Apply Now" on the left.
4. Select your state, in the middle of the screen. If you state is running its own exchange, a green button will appear directing you to your state exchange website (i.e., Covered CA, if you live in California). (However if you live in a state whose exchange is being operated by the federal government, another green "Apply Now" button will appear instead.)

• Click "Start Here," a yellow button in the middle of the screen.
• Choose from Individual, Employer, or Employee.
• Click "Apply Now."
• Click "Set up an account."
• Agree to the terms and conditions by checking the box.
• Enter your account information.
• Begin perusing health plans.

No matter which state you're from, be prepared to wait! There are many people visiting healthcare.gov, so you may be put "on hold" until the website sends to you to the Log In page. (I waited about 6 minutes.)

Let the Campaigns Begin!

States across the country have unveiled health exchange ads to encourage citizens to enroll in health plans through state marketplaces. Here is a selection of ads for your viewing pleasure!

CONNECT FOR HEALTH COLORADO

COVER OREGON

KYNECT: KENTUCKY'S HEALTHCARE CONNECTION

ACCESS HEALTH CONNECTICUT

COVERED CALIFORNIA (ENGLISH)

COVERED CALIFORNIA (ESPANOL)

Obamacare Swindles

Beware of scams already underway to swindle consumers into buying fake health insurance and steal their identities.  The Federal Trade Commission (FTC) said that dozens of consumers have already reported fraud since healthcare reform was upheld by the Supreme Court last summer, and predicts more prevalent abuse once open enrollment begins this October.

Be on the look-out for:

• a caller promising to send a healthcare card if the person reveals personal and financial information. 
• false enrollment websites. Note: you can only enroll in a new health plan via your state's official website OR https://www.healthcare.gov/, which can direct you to purchase insurance for any state.
• companies using Obamacare to trick customers into purchasing fake insurance.

According to the L.A. Times, those who speak limited English and those who have never had health insurance before are especially at risk.  In California, where large numbers of people who are newly eligible for insurance are Spanish-speaking, the risk is compounded. 

An added potential for fraud comes from those hired by states to help consumers navigate their new healthcare options under the exchanges. For instance, California plans to hire 20,000 enrollment counselors to tell consumers about their enrollment options and potential tax penalties. While these counselors must go through training and background checks, "fraud is inevitable," said Covered California spokeswoman Dana Howard.

If you believe you have been the victim of identity theft, or want to know more about how to keep your personal information secure, visit the FTC's website on medical ID theft, or call them at 877.382.4357.

Covered California: Pediatric Dental Coverage

In 168 days when open enrollment opens for the first time on Covered California (the state's health benefit exchange), California's children will get expanded opportunities for better dental health.  Covered California has contracted with six participating dental insurers to provide stand-alone coverage for children's dental services.  This means that these dental plans (with the exception of Health Net) are priced separately and do not require the additional purchase of a regular health insurance plan. The participating insurers are:

• Anthem Blue Cross of California
• Blue Shield of California
• Delta Dental of California
• Health Net
• LIBERTY Dental Plan of California
• Premier Access Dental and Vision

Depending on where the child lives, children will be eligible to be signed up for PPO, an in-network only PPO, and an HMO dental plan.

1. The Dental Preferred Provider Organization (DPPO) -- a wide variety of provider choice, including coverage for some out-of-network services.
2. The Dental Exclusive Provider Organization (DEPO) -- like DPPO, but without coverage for out-of-network services.
3. The Dental Health Maintenance Organization (DHMO) -- limits coverage to dental providers within one's network, and generally requires a referral for a specialist.

The plans offered will provide two types of payment options.  One option requires a higher premium, but lower out-of-pocket costs. The second option offers lower premium rates, but higher than average out-of-pocket costs. Therefore depending upon how much the family anticipates needing dental services for a child, they can choose the actuarial value plan that best fits their particular situation.

For a complete break-down of plan pricing by region, take a look at this report published by Covered California last month.

Translation: No Translation

While the ACA, when fully implemented, aims to expand insurance coverage to 27 million previously uninsured Americans, it does not offer health insurance to illegal immigrants.  However, the immigrant communities that may not purchase the newly-available health insurance are not all illegal immigrants.   Researchers at UC Berkeley and UCLA estimate that three-quarters of the remaining uninsured population after Covered California takes effect, will be U.S. Citizens, or lawfully present immigrants.

As KQED's The California Report broadcasted this morning, selling healthcare reform to the nation's immigrant communities may prove difficult. Apparently the health insurance applications through Covered California, the state's health insurance exchange website, are only available in English and Spanish.  Because the first open enrollment period begins October 1, 2013, there is likely not enough time to expand applications to more languages this time around. This marketing hole will likely serve to alienate large groups of non-English speaking communities because of language barriers, such as the neighborhood of Little Saigon in Orange County - home to one of the state's largest Vietnamese populations.

Many immigrant community organizers have received grants from Covered California to expand outreach efforts to non-English speaking communities, including over a dozen organizations that will reach the state's Asian populations.  These efforts must include education about basic insurance terms, such as co-pay and deductible, as well as assurances that the ACA is not a scam to take their money. Many Asian immigrant communities, KQED reported, have a heightened sensitivity to such scams and may be extremely wary of organizations touting "Cheap Health Insurance."  

California's massive marketing campaign to enroll all eligible Californians is set to kick off next month.

Cut Waste, Save Money

Shannon Brownlee's 2007 book "Overtreated" reframed the debate over healthcare reform by exposing the unnecessary procedures and treatments that contribute to the staggeringly expensive cost of healthcare. Seven years later, the state of California takes a page from Brownlee to help doctors and patients make better choices, cut waste and make healthcare more affordable.

 

Covered California, the state's health insurance exchange, disseminated a press release yesterday announcing their collaboration with "Choosing Wisely," a partnership of the American Board of Internal Medicine Foundation, Consumer Reports, and leading national medicine societies.  The newly forged partnership aims to provide evidence-based recommendations to help physicians and patients make wise decisions about appropriate care based on individual situations.

Lists of commonly ordered (but not always necessary) procedures and tests that could cause undue harm, both physically and financially, are already being distributed to physicians and patients through consumer advocacy partners.  If successful, this effort will reduce duplication (when doctors run the same tests on patients due to incomplete medical records or misinformation) and waste (unnecessary procedures based on uninformed decision-making), and makes sure each patient receives the most appropriate care.  

For more information on Covered CA's outreach and education, visit www.CoveredCA.com.

Friday Variety: Anthem Rate Hikes, Gene Patenting, & Arizona Medicaid Bill

Anthem Blue Cross To Raise Small Business Premiums
California Insurance Commissioner Dave Jones has intensified his campaign against rising health insurance rates by asking officials working with Covered California to bar Anthem Blue Cross from it's state health exchange. Jones stated that Anthem's intends to increase small business health insurance premiums (businesses with 50 or fewer workers) by 11%.  He called this rate hike "unreasonable" and accused the company of overstating its projected medical costs and improperly adding fees related to federal healthcare law.

Under state law, Jones can assess rate hikes and request to exclude them, but he lacks the authority to block Anthem's rate increase from taking effect this month (Terhune, Los Angeles Times, 6/13).

Anthem spokesman Daryl Lang says that Anthem's rate hikes are consistent with the economic reality of rising healthcare costs, and that its exclusion from the exchange would hinder competition.

Nonetheless, Anthem has actually imposed three rate hikes for small businesses over a seven-month period:

• 10.6% rate hike announced in January;
• 10.5% rate hike announced in March; and
• 7.6% rate hike scheduled to take place July 1 (Robertson, Sacramento Business Journal, 6/13)

(Read more: http://www.californiahealthline.org/articles/2013/6/14/jones-wants-anthem-excluded-from-small-business-exchange.aspx#ixzz2WCmqnuKy)

Meanwhile, Jones has praised UnitedHealth Group Inc. for cutting worker premiums for such small businesses.

Covered California will announce final health plans and rates for small businesses this August.

Supreme Court Rules Human Genes May Not Be Patented

The Supreme Court announced a unanimous ruling Thursday that naturally occurring human genes may not be patented. As a result, the costs of of getting gene tests are likely to drop as other companies can now compete with Utah-based Myriad Genetics, against whom the claims in this case were brought.

Synthetically produced genetic material, however, may still receive patent protection.

Arizona "Sweet Victory:" Medicaid Expansion Bill Passed

Thursday afternoon, the Arizona legislature approved a Medicaid expansion bill after a three-day special session.  This approval comes five months after Arizona Gov. Jan Brewer vowed to pass Medicaid expansion in her state. The bill, part of the state budget, must clear a final vote in each chamber before it goes to Brewer for her signature.