ANA\C-Policy Page Covering the Affordable Health Care Act

ANA\C will keep you updated with the latest information you need to know on both the Federal & State level.
The full ACA goes into full swing on 1.2014.

 

Covered California Update
October 7, 2014
Covered California - One year ago, a new era of health care began in California and across the nation. On Oct. 1, 2013, the Affordable Care Act went from being just an idea to being the new reality for our country, as we started to enroll Americans in coverage that would start in January.
The Los Angeles Times - Now, after years of premium hikes in health insurance, voters have the chance to extend that authority to individual and small-group health policies. Proposition 45 would let the commissioner reject any change in premiums, deductibles or related factors found to be excessive, inadequate or "unfairly discriminatory."
California Healthline - California officials have approved 2015 premium rates for health plans offered through the state health insurance exchange.
Sacramento Business Journal - Covered California has signed a $14 million contract for peak-time call center in south Sacramento that's expected to hire 500 people in the next 30 days.
California Healthline - Gov. Jerry Brown (D) has signed a bill (SB 964) to increase oversight of insurers' provider networks.
NPR - Exactly one year ago, the Obamacare insurance exchanges stumbled into existence. Consumers struggled to sign up for its online marketplace - and the Obama administration was pummeled. Eventually, HealthCare.gov's problems were mostly fixed, and two weeks ago, the administration announced 7.3 million people have bought insurance through it so far this year.
The Washington Post - Thousands of consumers who were granted a reprieve to keep insurance plans that do not meet the federal health law's standards are now learning those plans will be discontinued at year's end, and they will have to choose a new, possibly more costly policy.
Politico- A federal judge in Oklahoma has ruled that Obamacare subsidies cannot go to residents of states that are not running their own insurance exchanges, a second blow to the Obama administration on a issue that threatens a key element of the health law's coverage expansion.
The Wall Street Journal - The clock is ticking for Tommy Cain and thousands of other U.S. employers facing deadlines to make changes to the health insurance they offer their employees under the Affordable Care Act.
Forbes - The majority of Americans who continue to oppose Obamacare should be greatly pleased to learn that the Supreme Court is likely to get a do-over on this misguided and too-often-lawlessly-implemented law. Ours is a nation of fresh starts and second chances: it is only fitting that SCOTUS be handed an opportunity to undo the convoluted, flagrantly political and highly controversial decision it made in June 2012.

California Healthline - Affordable Care Act advocates are preparing for the second open enrollment period by targeting the millions of consumers who mostly for financial reasons did not sign up for coverage last fall.

The California Society of Health-System Pharmacists offers free accredited continuing education for pharmacy, nursing and behavioral science professionals.

 

 

Covered California Update
September 29, 2014

Capitol Public Radio - Covered California is asking small businesses to check out its new offerings for group coverage over the next few months. The state's health insurance marketplace says small businesses will have new choices for coverage purchased through Covered California starting in October.
The Sacramento Bee - Gov. Jerry Brown has vetoed a bill that Rancho Cordova's vision insurer, VSP Global, says was necessary to let it sell coverage through the state-run health care marketplace, Covered California.
California Healthline - Health insurers offering plans through Covered California likely will continue to have narrow physician networks during the state health insurance exchange's second open enrollment period.
The Los Angeles Times - California's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall.
CNN - Days ahead of the one-year anniversary of the rollout of HealthCare.gov, the Affordable Care Act's health care exchange website that was originally plagued with numerous technical glitches, the Department of Health and Human Services has released a report highlighting the impact of the law on hospital costs.
The New York Times - The Obama administration increased the pressure on states to expand Medicaid on Wednesday, citing new evidence that hospitals reap financial benefits and gain more paying customers when states broaden eligibility.
The Wall Street Journal - Most states will have at least one more insurer selling health plans under the Affordable Care Act in the second year of the program's full implementation, the Obama administration said. Some 33 states out of 43 where insurers have filed their intentions for the coming enrollment season are set to have a net increase in plans on offer through the law's online exchanges, including two states that only had one insurer for 2014, the Department of Health and Human Services said.
Fortune - A fast-growing company called Teladoc has raised $100 million to pair up physicians and patients over the web. Obamacare might not let you keep your old doctor, but it may pay for a virtual-reality physician-and you won't even have to get out of bed to get diagnosed.
Forbes - In 2012, the conventional wisdom among conservatives and Republicans was that the presidential election of that year was of paramount importance. If Mitt Romney didn't defeat President Obama, Obamacare's trillions in health care subsidies would go online, and the law would become "impossible to repeal." That was then. Today, repeal remains the official position of the GOP. But Republicans haven't put as much thought into how to address the disruption that a careless version of repeal could incur.

Chicago Tribune - So far one of the most maddening aspects of Obamacare is the law's stubborn refusal to irreparably destroy America. We were promised malevolent death panels, grandmothers expiring while waiting in blockslong lines outside hospitals and the complete collapse of our way of life.

The California Society of Health-System Pharmacists offers free accredited continuing education for pharmacy, nursing and behavioral science professionals.

 

 

 

Covered California Update

Sacramento Business Journal - Covered California will offer the same six health plans next year in its Small Business Health Options Programs - better known as SHOP - but add flexibility for employers, greater choice for employees and the option of buying adult dental coverage.
Sacramento Business Journal - Despite concerns that Covered California could be hurt by a ballot measure designed to hold down health costs, the agency's board on Thursday decided not to take a position on the measure.
SFGate - Proposition 45 - a measure sponsored by groups that stand to make millions of dollars from it - threatens the significant progress our state has made in reforming health care.
CBS - The number of Americans enrolled in the new Obamacare marketplaces, and who have paid their premiums, stands at 7.3 million as of Aug. 15, an administration official told Congress today. Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, gave the updated figure to the House Oversight and Government Reform Committee on Thursday.
The Wall Street Journal - One of the most expensive and contentious initiative campaigns in California this year pits progressive Democrats against the state's ObamaCare exchange. The progressives want to give the state insurance commissioner veto power over health-insurance rates while the exchange backers want to prevent ObamaCare from imploding.
Politico - There are widespread instances of Obamacare insurance plans violating the rigid rules surrounding whether customers can use federal health care subsidies on insurance policies that cover abortion procedures, according to a Government Accountability Office investigation.
Politico - The administration's announcement that 7.3 million people are now enrolled in health insurance plans on the Obamacare exchanges immediately ignited a new round of arguments about the success or failure of the health law.
Forbes - Given the massive effort behind convincing us that Obamacare is a resounding success, it's almost surprising that a recent NBC News/Wall Street Journal Poll found support languishing at 34%. Part of the problem is the credibility Obamacare supporters lose by attempting to prove two questionable propositions. First, that Obamacare is having a positive impact on our health care system and, second, that it's doing so without any negative impact on our economy.

CBS - The next Open Enrollment for the Affordable Care Act (also known as "Obamacare") will begin on November 15, 2014. But with almost a year under its belt, has the Affordable Care Act impact as many people as it originally set out to?

The California Society of Health-System Pharmacists offers free accredited continuing education for pharmacy, nursing and behavioral science professionals.

 

 

Covered California Update-September 2014

Covered California Update
Covered California - Building on high enrollment in 2014, Covered California launched its community outreach campaign for 2015 on Monday, including new grants to community groups and a comprehensive advertising campaign aimed at attracting new consumers and encouraging them to enroll in the state's health benefit exchange.

California Healthline - The percentage of voters who have an unfavorable view of the Affordable Care Act has declined, from 53% to 47%, while the percentage of voters who support the law has dropped from 38% to 35%.

California Healthline - As Covered California checks enrollees' incomes to verify eligibility for health coverage and subsidies, some state residents are being abruptly switched from private coverage to Medi-Cal or are losing health coverage altogether.
Forbes - Democrats are trumpeting preliminary estimates indicating that premiums on Obamacare's insurance exchanges will rise modestly, on average, in 2015. These early indications have led to a peculiar type of crowing from Obamacare supporters: "See, Obamacare isn't collapsing!" And it's true: Obamacare isn't collapsing. But in the real world, we don't measure the success of the "Affordable Care Act" by its failure to collapse. We measure it by looking at the underlying affordability of American health care. And there can be no doubt that health care today is more costly than it would have been without Obamacare.

California Healthline - On Wednesday, Gov. Jerry Brown (D) signed into law a bill (AB 1522) that requires a minimum of three paid sick days per year for employees who work 30 or more days in a calendar year.

California Healthline - Prop. 45 was put forward by the Consumer Watchdog advocacy group and has since been supported by Insurance Commissioner Dave Jones (D). The measure would allow the insurance commissioner to reject health insurers' rate increases if they're deemed unjustified, analogous to how automobile and property rates are controlled. Thirty-five states have adopted similar measures to Prop. 45, and in 55 days, Californians will decide whether they want it, too.
Sacramento Business Journal - Although executive director Peter Lee said at a board meeting in August that the SHOP line-up would be announced Sept. 15, the date has shifted, says Covered California spokesman.
California Healthline - Los Angeles County's Department of Health Services is installing a new countywide electronic health record system that officials say could end up being a model for other health care organizations across the country.
California Healthline - The House on Thursday voted 247-167 to pass legislation (HR 3522) that would allow insurers to continue to sell employer-based health plans that do not comply with the Affordable Care Act's minimum coverage standards through 2018.
The New York Times - SO far, opponents of the Affordable Care Act have lost every major battle to repeal or invalidate it. Some of them are now urging the courts to interpret the health reform law in a way that would guarantee its failure. This is a significant threat - potentially as grave as the previous main legal challenge to the law, which the Supreme Court rejected, 5 to 4, in 2012. If the new effort succeeds, it would create total chaos.

California Healthline - The headlines in November 2013 told a scary story about health care reform in California, with roughly one million individual market enrollees getting cancellation letters from insurers.

California Healthline - A glitch in an online federal calculator used to certify that insurance plans comply with the Affordable Care Act's minimum coverage standards is allowing dozens of large employers to offer health coverage that lacks some basic benefits, according insurance brokers and consultants.
California Healthline - The majority of individual health plans purchased through California's insurance exchange under the Affordable Care Act were offered by Wellpoint or Blue Shield of California, according to a recent analysis by Avalere Health.
The California Society of Health-System Pharmacists offers free accredited continuing education for pharmacy, nursing and behavioral science professionals.

 

 

Covered California Update-August 2014

The California Society of Health-System Pharmacists offers free accredited continuing education for pharmacy, nursing and behavioral science professionals.
California Healthline - States that have fully embraced the Affordable Care Act have seen the most reductions in uninsured residents, according to a Gallup poll released Tuesday, the New York Times' "The Upshot" reports (Sanger-Katz, "The Upshot," New York Times, 8/5).
California Healthline - The Internal Revenue Service was 100% accurate from Oct. 1, 2013, to Oct. 14, 2013, in calculating the maximum monthly insurance subsidies for individuals purchasing coverage through the Affordable Care Act's insurance exchanges, according to an audit released Tuesday by the Treasury Inspector General for Tax Administration,Reuters reports (Morgan, Reuters, 8/5).

California Healthline - Nearly 90% of the 30 million U.S. residents who are uninsured will not have to pay a penalty under the Affordable Care Act's individual mandate in 2016 because of a growing list of exemptions, according to a report from the Congressional Budget Office and the Joint Committee on Taxation, the Wall Street Journal reports (Armour,Wall Street Journal, 8/6).

The Wall Street Journal - Almost 90% of the 30 million Americans expected to be uninsured in 2016 won't pay a penalty under the Affordable Care Act because most will qualify for one or more exemptions, according to a June report by the nonpartisan Congressional Budget Office and the Joint Committee on Taxation. A page-one article in The Wall Street Journal examines the expansion of exemptions.

BizJournals.com - Last week, Covered California announced a lower-than-expected proposed average rate increases of 4.2 percent for 2015 - a move heralded by insurance brokers, consumer advocates and others. Now pressure is mounting to push insurers to increase the size of provider networks.

Martinez News-Gazette - Due to federal regulatory requirements and the resulting cost implications and financial burdens, Contra Costa Health Plan (CCHP) has informed Covered California Exchange that it will not seek recertification for the 2015 Plan Year. The CCHP, which says its 1,100 new enrollees will remain covered through the end of the year, did not qualify under a recently clarified rule that insurers must offer the same plan inside or outside the exchange.


July 2014:

Covered California Update

Covered California Announces Director of Plan Management and Chief Financial Officer Appointments
CoveredCA.com - Covered California Executive Director Peter V. Lee announced the appointments of Anne E. Price as director of the Plan Management Division and James D. Lombard as chief financial officer. 

ACA Provision Allows Some Covered Calif. Enrollees To Switch Plans
California Healthline - Under a provision of the Affordable Care Act, Covered California enrollees can switch plans outside of the exchange's open enrollment period if they were given misleading information from insurers, the Contra Costa Times reports.  

Anthem Misled Millions About Health Plan Networks, Lawsuit Alleges
California Healthline - On Tuesday, Consumer Watchdog filed a class-action lawsuit alleging that Anthem Blue Cross misled "millions" of consumers who enrolled in its health plans about which physicians and hospitals were included in their provider networks, Kaiser Health News reports.

Bay Area Family Satisfied With Covered California, Location May Play A Role
KPIX San Francisco - A Contra Costa County family describes their positive experience on the insurance exchange.

Could the Affordable Care Act Improve the U.S.' Failing Health-Care Grade?
DailyFinance.com - When it comes to the health care system in the United States, we might be closer to the end of unaffordable services and the barriers to access they create. But we're not out yet.

Some Doctors Refuse To See Obamacare Enrollees
Kaiser Health News - Subscribers are running into closed doors from some doctors listed in their plans' networks, reports The Miami Herald. Meanwhile, Connecticut advocates express concern about how a proposed overhaul of the state's health care system could change Medicaid, and in Washington state, providers scramble to keep up with demand.

Rate of Uninsured Californians is Halved Under Obamacare, Survey Finds
Los Angeles Times - The percentage of Californians without health insurance was cut in half in the last nine months during the federal health law's expansion of coverage, a new survey shows.

Schedule a Covered California Presentation at Your Organization
The California Society of Health-System Pharmacists offers free accredited continuing education for pharmacy, nursing and behavioral science professionals.
Schedule a presentation at your organization today!

 

 

July 2014: Covered California Announces Promotion and New Appointment to Senior Leadership Team:

SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee has announced the appointments of Yolanda R. Richardson as chief deputy executive director of strategy, marketing and product development; and Susannah C. Johnsrud as the new chief deputy executive director of operations. In her new role, Richardson is responsible for developing and implementing the agency’s strategic approach to product development, marketing and sales to ensure Covered California is well-positioned to retain its strong customer base and continue its rapid growth by providing a solid value proposition for individuals and small businesses.

“Yolanda Richardson has not only done a stellar job in getting us more than up and running; she also brings to Covered California deep experience in private health plan operations,” Lee said. “She embodies the Covered California spirit of listening, learning and adjusting.” Richardson joined Covered California in April 2012 as deputy chief operations officer, playing an instrumental leadership role in setting up the new exchange’s operations. She provided executive-level leadership over the direction of day-to-day operations for the agency. She also provided leadership over the design and management of internal control systems, organizational structure, all business operations and human resources. The salary for Richardson’s new position with Covered California is $210,000.

Johnsrud most recently served as director of the Financial Information System for California (the FI$Cal Project), which is integrating financial management for the state of California. Previously, she was chief operating officer of the governor’s office, providing counsel on fiscal, human resources, information technology and other issues statewide. She also has served as chief administrative officer and chief financial officer for the state Department of Justice. The salary for her position with Covered California is $190,000.

“Sue Johnsrud has a wealth of experience in information technology, operations, human resources and complex financial management,” Lee said. “She comes to us with a great background and perspective to help us as we continue to grow and mature as an organization.

“Covered California has a big mission, big aspirations and a big job. With the team we are building — including Yolanda, Sue and our entire staff — we are positioned well to manage the challenges that lie ahead.”

About Covered California

Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information on Covered California, please visit www.CoveredCA.com.

 

June 2014:

CMS NEWS FOR IMMEDIATE RELEASE Contact: CMS Media Relations GroupJune 16, 2014 (202) 690-6145 or email press@cms.hhs.gov

CMS initiative helps people make the most of their new health coverage“From Coverage to Care” outreach to engage doctors and new patients

Today, the Centers for Medicare & Medicaid Services (CMS) launched a national initiative “From Coverage to Care” (C2C), which is designed to help answer questions that people may have about their new health coverage, to help them make the most of their new benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement.

“Helping to ensure that new health care consumers know about the benefits available through their coverage, and how to use it appropriately to obtain primary care and preventive services is essential to improving the health of the nation and reducing health care costs,” said Dr. Cara V. James, director of the CMS Office of Minority Health. Dr. James noted that, “to achieve these goals, we need to make sure that people who are newly covered know that their coverage can help them stay healthy, not just help them get better if they get sick.”

C2C will be an ongoing project. As more and more people obtain coverage, there will be a continuous need to ensure that people have answers to questions they might have about their new coverage and are appropriately connected to the health care system to help them live long, healthy lives.

Today’s launch also marks the release of the new Roadmap to Better Care and a Healthier You, http://marketplace.cms.gov/help-us/c2c-roadmap.pdf?linkId=8267630, which includes 8 steps to help consumers and health care providers be informed about the diverse benefits available through their coverage and how to use it appropriately to access to primary care and preventive services. Among other things, the “Roadmap” contains information on health care coverage terms, the differences between primary care and emergency care, and the cost differences of decisions to seek care in- and out-of-network, where applicable to the consumer’s health plan.

More information about C2C and other helpful resources, including a 10-part video series, to help those with new health care coverage make the most of their coverage, and raise awareness about the importance of getting routine primary care and regular preventive care are available at: http://marketplace.cms.gov/c2c. People with related questions about the C2C initiative should write to Coveragetocare@cms.hhs.gov ###

Blog Posts

English: https://www.healthcare.gov/blog/from-coverage-to-care-a-roadmap-for-using-your-new-coverage/

Spanish: https://www.cuidadodesalud.gov/es/blog/from-coverage-to-care-a-roadmap-for-using-your-new-coverage/


ANA\C Secretary Alice Benjamin has written a progress report on the Affordable Care Act.

The first regional report examining implementation of the Affordable Care Act comes from the Nelson A. Rockefeller Institute of Government, the public policy research arm of the State of New York, and is cosponsored by the Fels Institute of Government at the University of Pennsylvania

Managing Health Reform: California Round 1 State-Level Field Network Study of the Implementation of the Affordable Care Act. Read this report.

 

Health Insurance Market Place Open:
There is considerable information that everyone needs to know about the new Health Insurance Market.

Health Insurance Marketplace Basics

  • The Health Insurance Marketplace is the new way for Americans to get health care coverage according to their budget and needs. Open enrollment begins TODAY online at Healthcare.gov, by phone at 1-800-318-2596, or in person at local health centers and other facilities.
  • For an overview of the Health Insurance Marketplace, get the latest resources here. Training materials and presentations are also available here.

For state-specific information and resources and to sign up for email and text alerts, visit the State by State and How the Health Care Law Benefits You webpages on Healthcare.gov.


Access Downloadable Materials

To help answer any questions that you or your patients may have about the Health Insurance Marketplace, access two publications:

Health Insurance Marketplace: 10 Things Providers Need to Know (http://marketplace.cms.gov/getofficialresources/publications-and-articles/10-things-providers-need-to-know.pdf)

Health Insurance Marketplace: 10 Things to Tell Your Patients (http://marketplace.cms.gov/getofficialresources/publications-and-articles/10-things-to-tell-your-patients.pdf)

Community Resources

Host community meetings/nursing rounds in webinar, teleconference or in-person formats to talk about the ACA. To help you with the presentation, access PowerPoint slides, talking points and other educational materials at http://marketplace.cms.gov/training/get-training.html. CMS can offer an Administration official to offer specifics and engage your members and community.

Web, Social Media Resources

Visit HealthCare.gov (Spanish: CuidadoDeSalud.gov) for state-specific information to sign up for email and text alerts, or contact the call center at 1-800-318-2596 1-800-318-2596 (TTY: 1-855-889-4325 1-855-889-4325). Help is available 24/7 in 150 languages.

Add marketplace widgets (http://marketplace.cms.gov/getofficialresources/widgets-and-badges/mp-badges-english.html) to your email signature.

Connect through social media at Facebook.com/HealthCare.gov (Spanish: Facebook.com/CuidadoDeSalud.gov) and follow Healthcare.gov on Twitter, @HealthCareGov
(Spanish: @CuidadoDeSalud)

Educational Resources

Obtain free Continuing Education via the Medscape module [login required], “What the Healthcare Marketplace Means for Practices and Patients”. Please take advantage of these opportunities to learn more about the Marketplace so that you can provide information to your patients, communities and fellow nurses. The Marketplace will help people get healthy and stay healthy, so please do your part to provide this critical information.

ANA will continue to share updates, announcements and resources as they become available.

 

Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for Durable Medical Equipment (DME):
On September 9, 2013 CMS announced they will be postponing the active enforcement and full compliance of the durable medical equipment face-to-face signature requirement until unspecified date in 2014. Section 6407 of the ACA established a F2F encounter requirement for certain items of DME. The law requires that a physician must document that a physician, nurse practitioner, physician assistant or clinical nurse specialists has had a face-2-face encounter with the patient. CMS has twice postponed implementation of this rule.

 

Health Affairs Explores the "Thorns" Awaiting the Affordable Health Care Act:
With just weeks before the health insurance exchanges across the US open their web portals for business Health Affairs focuses on who stands to gain, or lose in their September issue. Read the attached.

 

Health Insurance Market Place Survey:
CMS requests healthcare providers to answer the Health Insurance Marketplace Survey for healthcare providers. Please send the completed survey to matthew.brown@cms.hhs.gov. Print survey.

 

Mandatory Expansion of Medi-Cal Under ACA:
Information about the fiscal estimate of the Administration's proposal on the expansion of Medi-Cal.

Please consult www.dhcs.ca.gov for more detailed information.

Report From Covered California (formerly California Health Care Exchange)

California was the first state to enact legislation creating a Health Benefit Exchange following the passage of the Patient Protection and Affordable Care Act. Since its creation, Covered California has begun building the foundations that will be essential to the success of this new innovative health coverage marketplace. In 2011 Covered California adopted its vision, mission and values statement, setting the framework for doing business with a primary focus being on making it easy and affordable for Californians who are eligible to obtain health coverage. Enrollment for new subsidized coverage will begin on October 1, 2013-90 days in advance of when coverage begins on January 1, 2014. A full annual report is provided which covers in detail the work of Covered California.

Report from Director Peter Lee as of 1.23.13

 

We have archived reports from 2010-2012 on a variety of health care reform issues.