When the annual sign-up period for individual Obamacare coverage ended earlier this month, it meant that in general, people are locked into their plans for the year. There are exceptions, however, for those who experience life changes such as marriage, the birth of a child or the loss of their job-based coverage.
The list of situations that trigger a special, 60-DAY enrollment period will get longer in April, when a new rule issued by the Department of Health and Human Services takes effect.
The rule’s additional circumstances include:
— Losing a dependent or dependent status because of divorce, legal separation or death. This provision would enable someone who no longer needs family coverage, for example, to switch to single coverage. Although not required until 2017, exchanges are encouraged to offer this as soon as possible.
— An increase in an individual’s income to the federal poverty level in states that haven’t expanded Medicaid to adults with incomes up to 138 percent of the federal poverty level ($16,243 in 2015). At that income level, the person could qualify for premium tax credits that are available for those with incomes between 100 and 400 percent of the poverty level to make marketplace coverage more affordable.More from this series
Last year, such individuals could also qualify for a special enrollment period, “but we read this as a bit broader,” says Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities. Last year, “you had to have applied for Medicaid to qualify.” Now, that’s not necessary.
–If a court order requires someone to provide health insurance, the coverage must be available the first day the court order takes effect.This KHN story can be republished for free (details).
“It’s extremely important for ensuring the coverage of children,” says Dania Palanker, senior counsel at the National Women’s Law Center.
–People who are currently enrolled in non-calendar year plans will qualify for a special enrollment period when that coverage ends, even if they could renew them.
Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.
Mary Agnes Carey speaks with Melissa Attias of CQ- Roll Call about Department of Health and Human Services Secretary Sylvia Burwell’s visit to Capitol Hill, where she faced a torrent of questions about the pending Supreme Court arguments concerning health law subsidies and the impact the ruling may have on the millions of people who now have coverage because of the subsidies.
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MARY AGNES CAREY: Welcome to Health on the Hill, I’m Mary Agnes Carey. Department of Health and Human Services Secretary Sylvia Burwell faced some tough questioning today on Capitol Hill about the upcoming Supreme Court arguments concerning health law subsidies that help millions of people afford coverage. With us now is Melissa Attias, who was at that House hearing and covers health care for CQ-Roll Call. Thanks for joining us.
MELISSA ATTIAS, CQ-ROLL CALL: Thanks for having me.
MARY AGNES CAREY: As expected, several Republicans on the House Energy and Commerce Health Subcommittee asked Sec. Burwell about how the administration intends to respond if the court rules that people in about three dozen exchanges that are run by the federal government are no longer entitled to get subsidies to help purchase coverage. But subcommittee Chairman Joe Pitts asked the secretary about an alleged 100-page HHS document detailing potential actions that the agency could take if the court rules that the subsidies can’t exist in federal exchanges. What was her response?
MELISSA ATTIAS: Pitts asked about this document. He said he had heard from a source within HHS that it exists, and Burwell said she was not aware of the document. She instead cited a letter that she sent out to Republican offices on Capitol Hill Tuesday that said her department doesn’t know of any administrative action that could undo the damage that would happen if the court ruled against the government and that therefore they don’t have a plan that could accomplish that kind of action. And she also reiterated that she thinks the Obama administration is going to prevail in the court case. The Supreme Court is going to hold oral arguments next week, March 4, and a ruling is expected by the end of June.
MARY AGNES CAREY: Hasn’t the administration acted before in the sense of changing requirements on the employer mandate – is one that comes to mind – or the special enrollment period they just created for people who find out they owe a penalty this year because they didn’t have health coverage? Why doesn’t that power extend to having an answer on the subsidy issue?
MELISSA ATTIAS: The administration has already taken a number of actions administratively to smooth implementation of the law, you named the employer mandate; that’s a great example, so I think it would surprise many people if the administration isn’t making some sort of contingency plan, because most would expect that the administration is going to do anything they can to soften the blow if the subsidies are taken away from the federal exchange.
MARY AGNES CAREY: While Republicans focus their questions today on the upcoming Supreme Court case, Democrats looked into a different area. Can you tell us about that?
MELISSA ATTIAS: Sure, Democrats were asking Burwell, whether she was aware of any Republican plans that provide comparable coverage to the Health Care law and they repeatedly tried to hammer home that point one after another. Congressman Eliot Engle who is a New York Democrat urged lawmakers to pass legislation if the court rules against the administration to make sure that people can continue to get affordable coverage through the health exchange. He said that’s what Democrats intended and congressman Kurt Schrader of Oregon also said he thinks its ironic that Republicans keep asking for the administration’s contingency plans for the case, but he thinks it Congress’ responsibility and noted that the Republicans control both chambers of Congress right now. Democrats also pointed out that Republicans are the ones supporting the lawsuit. Chairman Pitts of the health subcommittee for example is one of those who has signed on to a friend of the court brief in support of the challenge.
MARY AGNES CAREY: Chairman Pitts also asked about an issue in California that deals with health insurers and abortion coverage. What’s happening there?
MELISSA ATTIAS: Pitts said he was deeply concerned about a lack of HHS action in California, where there is a new policy for health plans to cover abortion. And Pitts said that policy is in violation of the Weldon amendment; that refers to an amendment that’s attached to annual spending bills and it bars funding for a federal agency or state or local government and I’m going to quote here and the quote is that : “Subjects any institutional or individual health entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of or refer for abortion,.“ So Burwell said they have opened an investigation within the office for civil rights and that they take the issue seriously. The issue also came up at a house appropriations sub-committee hearing yesterday.
MARY AGNES CAREY: I want to ask you about another item that came up at the hearing I know it’s on your radar screen. We’ve talked about it before. This is the sustainable growth rate; the way Medicare pays physicians. The current formula expires at the end of March. What’s new there?
MELISSA ATTIAS: Lawmakers came up with a bipartisan compromise on the policy last year. But they weren’t able to find a way to pay for it, so they went with a patch as you mentioned which as you mentioned expires at the end of March. The cost of the policy proposal recently went up by $30.5 billion earlier this month because the Congressional Budget Office added another year to the budget window compared to an estimate the Congressional Budget Office released in November. And the latest estimate is that the cost $174.5 billion from fiscal 2015 to 2025. At the hearing Congressman Michael Burgess, who’s a Texas republican, said he’s looking at the Medicare changes President Obama proposes his budget for offsets.
MARY AGNES CAREY: Thank you Melissa Attias of CQ-Roll Call
MELISSA ATTIAS: Thanks for having me.
By Alison Bruzek
Cancer, whether in the pancreas, the ovaries or the liver, can take on different characteristics and spread in different ways. That’s why, unfortunately, there’s no one-size-fits-all drug to help patients fight back.
But a new, quick test can personalize treatment and help oncologists choose which chemotherapy route to take.
The test, called Dynamic BH3 Profiling, quickly predicts whether or not a drug will work for a patient by first trying that drug on a tumor sample in the lab. A paper describing the method, which researchers say could become more widespread within a couple of years, was published in the journal Cell this week.
The idea echoes how we choose the most effective antibiotics, says study author Dr. Anthony Letai, a cancer researcher with the Dana-Farber Cancer Institute.
“When we’re trying to choose antibiotics for people … we simply isolate the bacteria that’s causing the problem and expose it to all the drugs that are available,” he says. Then researchers choose the drugs that best put a lid on the multiplying bacteria.
“That has operated for many, many decades,” Letai says, “so we thought, why not do that for cancer cells?”
Letai’s team isn’t the first to think of this strategy. “People have tried to do this kind of thing in years past but there have been a variety of advances in technology … that make it more feasible this time around,” says Levi Garraway, a cancer researcher at Dana-Farber who was not involved with the study.
What’s different about Letai’s work is its speed: It can quickly determine whether a drug, or combination of drugs, is working. The test looks not at when the tumor cells are dead, but rather when they’re beginning to die.
The ‘Death Switch’
The researchers found that there is a point of no return, a threshold of doom, when cells begin to die that is indicative of their actual death. The team looked at varying types of cancer cells (breast, lung, melanoma) and saw that there was essentially a death switch that when flipped on, ensured the cell’s destruction.
Examining if a cancer drug flipped this switch, instead of waiting to see if the cells would eventually die, allowed the researchers to know, in about 16 to 24 hours, which drugs were working.
Without knowing this switch, it can take days of growing cells in the lab (not an easy task).
From there, it was just a matter of testing drugs. “What we really wanted to be able to figure out is what are the cancer drugs that make cancer cells move toward this threshold of death,” says Letai.
In a trial with 16 women with ovarian cancer, the test found a fifth of the tumor samples were responsive to the drug carboplatin. In the clinic, they found that the same women whose tumors responded to the drug saw a slower progression of their cancer than those whose tumors did not.
In the future, the researchers say the method could be used to determine if new drugs in development work on real tumor samples.
“What is exciting about [the test] is that it’s something that we may very well see in the clinic soon,” says Michael Hemann, a professor of biology at the Koch Institute for Integrative Cancer Research and unaffiliated with the study. However, he cautions that the tricky part will be ensuring that any sample taken from a tumor is a good representative of the tumor as a whole.
Hemann also says one of the test’s strengths is that it’s a practical solution. “Most of us, in thinking about advancing tumor therapies, look at what are the characteristics of a tumor that are going to determine if a therapy succeeds or fails. This approach says essentially, that doesn’t matter,” he says.
Another growing field of tests looks at the genetics of a tumor, analyzing the DNA of cancer cells. This involves sequencing the genome, looking at possible mutations, and then understanding how those mutations affect how cells grow.
But Letai says unlike genetics, his test can provide immediate results for patients – either a drug works or it doesn’t. The test is already being used in clinical trials. “What we want to do with this,” says Letai, “is have [patients] waste less of their time on therapies that don’t help.”
Gonzalo Méndez, William Guzmán, Frank Palomino, Thomas Estrada, and Lorenzo Ramírez, as citizens of the United States, and on behalf of their minor children, and as they allege in the petition, on behalf of ‘some 5000′ persons similarly affected, all of Mexican or Latin descent, have filed a class suit pursuant to Rule 23 of Federal Rules of Civil Procedure, against the Westminster, Garden Grove and El Modena School Districts, and the Santa Ana City Schools, all of Orange County, California, and the respective trustees and superintendents of said school districts.
The complaint, grounded upon the Fourteenth Amendment to the Constitution of the United States 1 and Subdivision 14 of Section 24 of the Judicial Code, (Title 28, Section 41, subdivision 14, U.S.C.A., 2 alleges a concerted policy and design of class discrimination against ‘persons of Mexican or Latin descent or extraction’ of elementary school age by the defendant school agencies in the conduct and operation of public schools of said districts, resulting in the denial of the equal protection of the laws to such class of person among which are the petitioning school children.
So begins the Conclusion of the United States District Court, Southern District of California, Central Division in the case of Méndez v. Westminster (Civil No. 4292-M), which was issued on February 18, 1946.
This month provided many historical moments, present and past, for Méndez v. Westminster. Instead of rehashing this case, I would like to speak a bit about Sylvia Méndez, and the recognition she and this moment in history have received.
Sylvia Méndez was born in Santa Ana, California, in 1936. She is the daughter of Gonzalo Méndez and Felicitas Méndez. Her father was a Mexican immigrant and her mother was Puerto Rican. On September 15 2004, Sylvia was invited to the White House on the occasion of National Hispanic Heritage Month where her story, among highlights of the achievements of other Hispanic Americans, was shared with the guests that filled the East Room.
On February 15, 2011, she was awarded the 2010 Presidential Medal of Freedom by President Obama. According to the White House, “Sylvia Mendez was thrust to the forefront of the civil rights movement when she was just a child. Denied entry to the Westminster School because of her Mexican heritage, she sought justice and her subsequent legal case, Mendez v. Westminster, effectively ended segregation as a matter of law in California. The arguments in that case catalyzed the desegregation of our schools and prevailed in the landmark case Brown v. Board of Education, forever changing our nation. Today, Sylvia Mendez continues to share her remarkable story and advocate[s] for excellence and equality in classrooms in America.”
In 2014, Duncan Tonatiuh, the Mexican-born author and illustrator, published a book recounting the lives of Ms. Méndez and her family*. According to the publisher: “Years before the landmark U.S. Supreme Court ruling Brown v. Board of Education, Sylvia Mendez, an eight-year-old girl of Mexican and Puerto Rican heritage, played an instrumental role in Mendez v. Westminster, the landmark desegregation case of 1946 in California.”
On February 6, 2015, the American Library Association (ALA) announced that the book had received the 2015 Pura Belpré Illustrator Honor Award, and the 2015 Robert F. Sibert Information Honor Book Award. The book also received the 2015 Tomás Rivera Award for Younger Readers.
As we continue to celebrate the legacy of the Civil Rights Act of 1964, we should also remember the stories of the Hispanic-Americans who fought for equality and whose legal strife paved the way for victory against social, legal and political inequality, and injustice.
COLORADO SPRINGS, Colo. — Jars labeled butterscotch, chocolate mint and caramel macchiato tea glisten inside the lit refrigerator. The shelf above is stacked with pizza, flatbreads and butter. The one below has lemon bars, brownies and cookies.
The fridge could be in any higher-end grab-and-go lunch stop. But to shop here, you must present a medical marijuana patient card. And the ingredient list includes the type of pot, along with flour, sugar, milk, etc.
This is Trichome Health Consultants, a medical marijuana dispensary tucked into a line of glass storefronts on a semi-commercial strip in Colorado Springs, Colorado. As Massachusetts prepares to open its first dispensary, possibly in April, this is a glimpse into the future.Medical Marijuana In Mass.
- Timeline: Key Dates In Massachusetts:
- 11/6/12: Medial Marijuana Legalized In Mass.
- 8/23/13: 181 Apply For Dispensary Licenses
- 1/31/14: 20 Dispensaries Approved
- 6/27/14: DPH Disqualifies 9 Planned Dispensaries
- 11/7/14: 4 More Dispensaries Approved
- 1/2/15: First Mass. Dispensary Cleared To Grow
- More Medical Marijuana Coverage:
- What’s In Your Medical Marijuana?
- 10 Things To Know Before Using
- What A Dispensary Worker Needs To Know
- Bracing For ‘Big Marijuana’
- Complete Coverage: Medical Marijuana
At first glance, it’s a dizzying array of options.
There 11 different kinds of chocolates, granola bars, dog treats, lotions, lip balms and salves along one wall. Colorful pipes, vaporizers and other marijuana accessories line shelves. A long glass case is filled with jars of the classic product: marijuana buds.
Customers are buzzed into Trichome’s sales room. There are security cameras at the front door and back door, and one that scans the room constantly.
All marijuana sold here is grown by Trichome.
“We don’t trust that someone didn’t use a pesticide or they may have powdery mold or pest issues,” says Cami Hall, the CFO and a Trichome co-founder. “If you don’t know how it’s grown, you don’t know how it’s going to affect your patients.”
Massachusetts requires that dispensaries grow the marijuana used in all products, a rule called “seed to sale.” Colorado is less strict. Trichome buys some of the products it sells — the bottled teas, for example — from another company.
Every jar, plastic bottle or wrapper has a label that traces the marijuana to a specific plant. In Massachusetts, labels will list the breakdown of cannabinoids — the chemical compounds in marijuana — in each product.
Prices vary a lot. Those flavored teas, with 300 milligrams of marijuana, may be the best value at $16 a bottle, says Hall. Some of the higher-end strains of dried buds go for $200 or more an ounce.
Health insurance does not cover marijuana in Colorado or Massachusetts, and the cost of treating pain or other ailments with the drug can add up.
Kevin Bailey spends $600-$700 a week treating headaches he says date back to a childhood head injury. At Trichome this day he’s buying a strain called Sour Diesel, which goes for $175 an ounce.
“That’s premium, that’s grade A,” says Bailey, who turns toward glass cookie-style jars filled with Grade B, or lower strength, marijuana buds at the other end of the counter. “It depends on what kind of potency that you need. For different people, some of these lower potencies aren’t good enough.”
Bailey has been prescribed various pain medications over the years, but he prefers marijuana.
“This for me is best for me,” he says. “Some people might feel like prescription pain pills is good for them, but in the long run that’s poison. I feel like it’s poison.”Map: Marijuana Dispensaries
Patients generally figure out which type of marijuana works for them, and the best way to take it, through trial and error. Trichome co-founder J. Card keeps a database of every patient, their ailment and the types of marijuana they’ve tried. He uses the information to help new patients find a useful strain.
“So whatever patients we had with Crohn’s disease we can go in there and see that 10 patients with Crohn’s habitually used these types of strains because they seemed to work more than other strains,” Card says.
Card is not required to track patient’s responses to marijuana and there is no such requirement in Massachusetts.
Bailey pays in cash, as do most patients at this dispensary. Trichome has been able to accept credit cards, but this is not a stable option. Credit card companies are not allowed, by federal law, to process illegal transactions. Marijuana sales are still illegal under federal law.
Trichome has had trouble finding a bank willing to handle its finances. The dispensary has opened, and been forced to close, six accounts since it opened in 2008.
Card says he’s worked hard to establish to Trichome’s professional image in the community and distance himself from the tie-dye T-shirt culture.
“Our consultants here wear medical scrubs,” he says. “They train every day on how to help people with ailments, on which strain helps them.”
Card only sells marijuana to registered patients and has no plans to expand to the recreational marijuana market, which is now legal in many counties in Colorado.
“My fear is that recreational [marijuana] is going to overcast medicinal and the true valuable aspects of the medicinal are going to be taken away because of the people who just want to use it to get high,” Card says.
That tension — between the supporters of medical marijuana and those building the recreational pot market — has not hit Massachusetts yet.
Here, more than two years after voters approved a medical marijuana law, there are no dispensaries open yet. The first may, if there are no further hitches, open this April or May in Salem. So far, there are 4,975 registered patients in Massachusetts, awaiting the dispensaries.
Making health insurance available and affordable to millions of people who buy their own coverage was a key goal for backers of the federal health law known as Obamacare.
But if the Supreme Court strikes down the insurance subsidies of millions of Americans who rely on the federal insurance marketplace, it could leave many worse off than they were before the law took effect, say experts.
“The doomsday scenario could materialize and it does impact everyone” — those getting subsidies, as well as those paying the full cost of their plans on the individual market in states using the federal exchange, said Christopher Condeluci, an attorney who worked for Iowa Republican Sen. Charles Grassley on the Senate Finance Committee staff during the drafting of the law.
That’s because millions of consumers likely would drop their policies, which they could no longer afford without subsidies.
Most insurers could not drop plans without giving one-to-three months’ notice. But the companies remaining in the market would likely seek sharp increases in premiums for the following year, anticipating that the consumers most likely to hold onto their plans would be those needing medical care.This KHN story can be republished for free (details).
One Rand analysis projects that unsubsidized premiums could increase by almost half — an average annual increase of $1,600 for a 40-year-old — and that 70 percent of consumers would cancel their policies.
Those price increases, in turn, would drive more people to drop coverage, spurring further price hikes and potentially leading to what insurance experts call “a market death spiral.”
“It’s not the subsidy market that will fall apart, it’s the whole market” for everyone who doesn’t get job-based insurance coverage, said Robert Laszewski, a consultant for the insurance industry who is no fan of the health law. “There will be millions of Republicans who are not subsidy-eligible who are also going to get screwed.”
At issue in King v. Burwell — slated to be argued before the Supreme Court March 4 — is the basis of subsidies that go to millions of low- and moderate-income Americans in the approximately three dozen states that rely on the federal marketplace. More than 85 percent of the 8.6 million people who purchased plans in those states qualified for subsidies, administration officials say.
The law’s challengers point to four words in the Affordable Care Act that say subsidies shall be distributed through marketplaces “established by the state.” They argue that that wording bars the government from subsidizing insurance purchased through a federally administered exchange.
Supporters of the law argue that Congress intended the subsidies be available through both federally run and state-run markets, which they say is clear in reading the overall bill.
The ruling would have no effect on the subsidies provided to residents through state-run markets, such as those in California, New York and Washington.
The Obama administration has declined to discuss contingency plans, expressing confidence that it will prevail with the justices. “Congress would not pass a law that 87 percent of folks would not get subsidies, but people in say, New York, would,” Health and Human Services Secretary Sylvia Mathews Burwell said Wednesday.
Experts say Congress could also apply “fixes,” such as voting to allow subsidies to continue through the rest of the year.
But whether a Republican-controlled Congress that has pledged itself to the law’s repeal would agree to that is uncertain.
Aetna spokeswoman Cynthia Michener said the insurer is talking with lawmakers from both parties “about how to make a grand bargain should the Supreme Court decide against federal exchange subsidies.” A decision to strike the subsidies would likely “spur bipartisan action to resolve the issue promptly,” she added.
At the state level, officials could decide to establish state-run marketplaces, but they would have to move fast before the start of open enrollment for 2016, tentatively set to begin Nov. 1. And lawmakers in many GOP-led states are likely to resist such steps, citing opposition to the law.
Governors in at least five of the states — Louisiana, Mississippi, Nebraska, South Carolina and Wisconsin — told Reuters they would not create their own exchanges if the court invalidated subsidies.
In another four — Georgia, Missouri, Montana and Tennessee — politics could make it very difficult to set up a state program, Reuters reported.
Florida and Texas, where there is strong opposition to the health law, but also large numbers of residents benefitting from subsidized coverage, officials would face even tougher decisions. “Florida has the highest number of enrollees in the federal marketplace and guess who is running for president? The former governor of Florida,” said Condeluci.
That might make Florida lawmakers more agreeable to a solution that would keep subsidies flowing, he said, noting that “Republicans are going to be blamed for the subsidies ceasing.”
Insurers that sell plans in the federal exchange states would find themselves in a drastically changed market.
Joel Ario, a managing director at consultancy Manatt Health Solutions, said insurers are already working on rates for 2016, which are scheduled for submission by April — two months before the court is expected to rule.
Some insurers have asked state regulators if they could submit two sets of rates for 2016, one that would reflect the subsidies being struck, he said. That idea was backed this week in a letter to the Obama administration by the professional society of the nation’s actuaries, who help insurers set rates.
As for the states, Ario estimated that perhaps one third would set up their own markets fairly quickly. If states move at the same rate as they have to expand Medicaid, it could take several years before two-thirds of states have their own markets he said.
Even if insurers wanted to drop coverage immediately in the event the high court struck the subsidies, most could not do so legally. State laws require anywhere from 30 days to 90 days’ notice for an insurer to exit a market. And, if they withdraw, they have to pull all their plans, not just those offered through the federal exchange. Under state rules, they may not be allowed back into the market for years, creating a disincentive to bail out, said Laszewski, whose clients include major insurers.
Many insurers don’t yet have contingency plans, he said, partly because it’s so hard to tell what may happen or what alternatives might be available.
“This is the nuclear option and there really isn’t a contingency plan for nuclear destruction,” Laszewski said.
Others don’t see a ruling against the administration in such dark terms.
“The Supreme Court generally doesn’t go out of its way to wreck the economy or the health system,” said Stuart Butler, a conservative scholar and senior fellow at the Brookings Institution.
He believes the court is likely to offer some temporary remedy, such as a grace period when the subsidies could continue to flow.
“The idea that there will be some cataclysm the day after is extremely unlikely,” Butler said. “We’ll see a number of states moving toward essentially setting up a state exchange. We could still see Texas and a few others saying no. But if two-thirds of states find a way to accommodate it, I don’t see that a critical mass for the collapse of the Affordable Care Act is there.”
Gov. Charlie Baker has asked for and received the resignations of four members of the state’s Health Connector board, including MIT economist Jonathan Gruber.
Gruber came under fire for saying it was “the stupidity of the American voter” that led to the 2010 passage of President Obama’s heath law. Gruber was called to testify before Congress in December. He told lawmakers that he was “inexcusably arrogant” when he made the statement.
Baker also asked for the resignations of board members George Gonser, John Bertko and Rick Jakious, all appointees of former Gov. Deval Patrick.
The board oversees the state’s health care law.
In a letter, Baker said he’s establishing a new leadership team and wants to take a fresh look at the Connector and improve the operation of that agency.
In a phone interview, Gruber told WBUR Baker’s move isn’t about politics.
“I think it’s about wanting to make sure that the people that are on the board align with his vision of where health care should go in Massachusetts,” Gruber said.
With reporting by The Associated Press and the WBUR Newsroom