The Online Resource for Massachusetts Poverty Law Advocates

Feed aggregator

Lawsuit Accuses Anthem Blue Cross Of 'Fraudulent' Enrollment Practices

Kaiser Health News - Wed, 07/09/2014 - 6:07am

California insurance giant Anthem Blue Cross misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a class action lawsuit filed Tuesday.

As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica.

Anthem spokesman Darrel Ng declined to comment directly on the lawsuit. He said Anthem has agreed to pay the claims of those who received treatment from inaccurately listed doctors during the first three months of the year. 

However, that policy would not be extended for enrollees who discovered after March 31 that their doctors had been incorrectly listed, he said. 

The suit says that Anthem, the state’s largest individual health insurer, delayed providing full information to consumers until it was too late for them to change coverage. Anthem also failed to disclose it had stopped offering any plans with out-of-network coverage in four of the state's biggest counties -- Los Angeles, Orange, San Francisco and San Diego, the suit says. 

Anthem “intentionally misrepresented and concealed the limitations of their plans because it wanted a big market share,” said Jerry Flanagan of the consumer advocacy group. Co-counsel on the case is the Claremont law firm Shernoff Bidart Echeverria Bentley, which specializes in suing health insurers.

The suit comes as Consumer Watchdog helped put a measure on the November ballot that would give the state's insurance commissioner greater authority to veto rate increases. 

Brought on behalf of Anthem enrollees who purchased individual coverage between Oct. 1, 2013 and March 31, 2014, the lawsuit reflects growing consumer pushback against so-called “narrow network” health plans, which are increasingly common, especially in the new online state and federal marketplaces. Anthem was a major player on California’s insurance exchange and the suit includes those who bought coverage online, as well as directly from the insurer. 

Insurers have defended plans with limited provider networks as a way of holding down premiums. Many expected younger and healthier customers might be willing to give up broad access to providers for these lower costs. 

But consumers are retaliating with lawsuits and complaints to state regulators. As a result of the rising complaints, state managed care regulators are investigating whether Anthem and, separately, Blue Shield of California, provided accurate information about the doctors and hospitals in their plans.

Six Enrollees' Stories

The Consumer Watchdog lawsuit names six Californians who purchased Anthem plans. Among them is Betsy Felser of Pasadena, who had coverage with Anthem for 20 years. Like hundreds of thousands of Anthem customers, she received a letter late last year stating that her preferred provider organization (PPO), which allows for in- and out-of-network care, was being cancelled, according to the lawsuit. The letter suggested a replacement Anthem plan “with the benefits you have come to count on.”

Before agreeing to switch, Felser, a physician, said she checked with five Anthem telephone representatives, making it clear she wanted to be in a PPO. 

“I would never have gotten anything that wasn’t a PPO plan,” said Felser, 47, whose insurance also covers her young son. “They said they would give me the same coverage.” 

She also checked Anthem’s website and the doctors she sees, including her son’s pediatrician, to make sure they were participating in the plans she was considering and was assured that they were, she said.  

During those calls, none of Anthem’s representatives told Felser that the insurer was no longer offering PPOs in Los Angeles County, the lawsuit alleges. Nor did they tell her that the Anthem plans offered in her area would not cover care provided by out-of-network doctors or hospitals, according to the lawsuit. 

When she received her identification cards, they were stamped with a PPO symbol. But when she tried to use the coverage, she found out her doctors – and her son’s pediatrician – were not in the network and that the plan was an exclusive provider organization (EPO), an extremely limited type of plan which pays nothing for out-of-network care.

“It pays zero, so I essentially have no coverage,” said Felser. 

Anthem, while declining to comment on the Consumer Watchdog suit, had answered questions last week about an earlier lawsuit that raised similar issues

Spokesman Ng said then that consumers were informed about what kind of plan they purchased, along with details about out-of-network benefits, in packets they received soon after enrolling. “All those materials clearly spelled out type of plan they were receiving,” he said. 

But consumers would have to dig deep in a brochure on the Anthem website to find a footnote to a page 9 chart indicating that EPO plans have no out-of-network benefits. 

Ng noted that Anthem’s EPO and PPO networks have the same doctors and hospitals for people with individual policies, although only the PPOs have out-of-network benefits. In recent weeks, Anthem said it has added 3,800 doctors to its networks.

'A Giant Mess'

As for the PPO symbol on identification cards, Ng said last week that it had been intended to protect consumers who sought emergency care out-of-state, in keeping with Blue Cross Blue Shield Association rules. Ng said Anthem recently got association approval to reissue the cards without the symbol. 

But consumers say the damage was done. Josh Worth of Los Angeles said he was unable to get accurate information after receiving notice that his Anthem plan would be cancelled at the end of 2013. He said he called Anthem, as well as all the doctors he used — including his child’s pediatrician and his wife’s obstetrician — to be sure they were participating in the network. 

“They all said, ‘yes, we’re going to be continuing to accept all Blue Cross PPOs,’ and that’s what I was told I was going to be getting,” said Worth, a 43-year-old graphic artist. In January, he said he enrolled his family in an Anthem plan with an $800 a month premium. 

Worth received an ID card in late February that called his plan a “Pathway Tiered PPO,” according to the lawsuit. His son was born on March 31. Not long after, he said he began receiving bills from his wife’s obstetrician, who was not in the network. Nor was the baby’s pediatrician, he said. 

As a result, he said he owes about $1,100 out of pocket for both. And although an Anthem telephone representative told him afterward that the hospital where his son was born was not in network, it actually is – and his bills there are being covered, he said. 

“It’s a giant mess,” said Worth, who can’t switch plans until open enrollment resumes in the fall. “I was sold something I thought was one product, but when I used it, I found out it wasn’t. I’m not going to be going through Anthem again.”

Categories: Health Care

Study: Hospitals Not Bilking Medicare Using Electronic Medical Records

Kaiser Health News - Tue, 07/08/2014 - 4:23pm

A new study says there's no need to worry about hospitals using their new electronic medical records to generate bigger bills and boost their income.

It's been a concern since at least 2012, when the Departments of Justice and Health and Human Services sent hospitals a strongly worded letter warning them against using electronic records inappropriately.

The letter followed reporting by the Center for Public Integrity and the New York Times that found hospitals that used electronic records were billing Medicare for significantly more than hospitals still using paper records. Computers, the theory goes, make it easier to charge for more procedures or more expensive procedures than a paper record would.

“When I read those articles I thought, that's interesting, I'm not surprised to hear that people are using tools to sort of maximize revenue,” says Dr. Ashish Jha, a researcher at the Harvard School of Public Health. 

But a colleague, Julia Adler-Milstein at the University of Michigan, was skeptical, Jha says: “Her take was that hospitals have already maximized their revenue generation from billing, and the chances that electronic records are somehow going to magically make that even more financially lucrative, she just didn't buy it.”

So Jha and Adler-Milstein designed a study to figure it out. They compared billing records from 393 hospitals with electronic records to 782 hospitals still using paper records. They were careful to make sure the hospitals they compared matched each other in terms of size and status as teaching hospitals or for-profit companies.

“To my surprise, we found nothing,” says Jha. “We found that electronic health records didn't really change billing practices at all.”

He concludes the study with advice for policymakers: “This worry about excessive billing, the empirical evidence says this should not be a big focus of attention.”

But Dr. Donald Simborg, a pioneer in the field of electronic health records, says this study does not touch upon the area he believes is key..

“They're looking in the wrong place,” Simborg says, “I don't think anybody's done the study that needs to be done.”

Simborg started designing computerized patient records in the 1960s. More recently, he's led a pair of government advisory panels on how to guard against fraud in digital health records.

Simborg says Jha and Adler-Milstein only looked at inpatient records, those for people who spent at least one night in a hospital. The real area of concern, he says, is in emergency departments and outpatient clinics, an increasing number of which are owned or run by hospitals.

“Hospitals already have software that helps them [maximize billing for inpatient stays].  They've been doing that for years,” Simborg says. What's new is that doctors in emergency rooms and clinics are just now getting digital record keeping tools, which sometimes prompt them to over-document.

Simborg says he's seen it happen when he was watching doctors use electronic records he designed.

“I would see that they were documenting things that I know they didn't do to the patient. And these were not crooks, it's just kind of human nature about having a tool that's so easy to click a button that puts in a lot of default information when you're in a hurry, because physicians are always in a hurry,” Simborg says.

Electronic records that automatically fill in standard protocols for certain kinds of visits, like a well- child check or a Medicare annual physical, can help doctors be more efficient. But if doctors don't delete things they chose not to do during such a visit, they can end up generating a higher than necessary bill.

Simborg says some systems even suggest ways doctors can modify their patient visits to allow them to charge more.

To Simborg, the warning letter to hospitals from federal regulators was the wrong approach. He says government watchdogs should focus more attention on the software industry.

“They can develop the guidelines that would reduce the likelihood that an electronic record would be abused,” Simborg says, like making it easier for auditors to follow a doctor's digital record keeping trail. “That's different than threatening that they're going to be prosecuted if they do these things.”

Chantal Worzala, the American Hospital Association’s director of policy, says the AHA is concerned about, “insuring we have vendors who are creating products that support compliance with best practice.”

She's pleased that Jha's study shows that hospitals aren't using electronic records to generate bigger bills for inpatient stays, but says the tools are new and will require ongoing vigilance.

“We could all benefit from learning more about how electronic health records work,” Worzala says.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Categories: Health Care

Project Louise: Lose Ugly Belly Fat Fast! Yeah, Not So Much

CommonHealth (WBUR) - Tue, 07/08/2014 - 4:00pm

(Photo: TORCH magazine via Compfight)


By Louise Kennedy
Guest contributor

I had an epiphany of sorts over the weekend: I hate my belly.

Actually, you can’t really call it an epiphany if it’s something you’ve felt for just about your entire life. And ever since I got a little chubby in second grade – a chubbiness that lasted until puberty, returned with the classic “freshman 15” in college and has waxed and waned ever since – I have gazed down at the extra flesh between my navel and my hips with a mixture of shame, disgust and self-loathing.

And let’s just say that passing the 50-year mark hasn’t helped with any of this. Here’s how we know Mother Nature has a sense of humor: Just when your body stops being capable of pregnancy, it starts looking as if you’re already about 4 months along. Permanently.

But that’s no reason to hate myself, is it? Sure, I’d like to lose the weight. But if I don’t, I don’t want to carry around this toxic mix of negativity along with the extra pounds.

So here’s the real epiphany: I don’t want to hate myself anymore, not even one imperfect part of myself. I don’t have to love my belly; I just want to stop hating it. I want to make peace with my body.

My, that sounds sane. But you may come up with another adjective when I tell you what I did next: I Googled “belly fat.”

Here’s a quick tip: Don’t do that.

Oh, go ahead if you want to. But I can save you the trouble. Here’s what I learned:

Belly fat is bad for you. Duh. It’s bad for you because it means you have excessive fat deposits around your heart, lungs, liver and other major organs, and that makes you less healthy and more prone to diabetes, heart disease, stroke and even dementia.

“Spot reducing” doesn’t work. Another duh. I can do a million situps, and probably have. I have nice strong abs to show for it. But you can’t see them, because they’re still hidden under a layer of fat. Exercise is part of losing weight, but it leads only to overall weight loss, not targeted reductions.

You’ll never guess what does work. Oh yes you will. Eat right and keep moving. Oh, and get enough sleep: Several studies show that sleep deprivation increases your body’s storage of fat right where you don’t want it. So does stress, because it raises cortisol levels, which encourage fat storage – so try to reduce your stress levels, too.

OK, I learned one new thing. Cinnamon, apparently, may help reduce belly fat, and also may improve the regulation of blood sugar. The studies aren’t conclusive, but it seems harmless enough to add some cinnamon to my diet. (And blueberries, another vaunted fat-killer. Why the heck not?) So I’ll be doing that from now on.

But there are plenty of things I won’t be doing. I won’t be buying any of the thousands of miracle diets and pills and supplements. I won’t be clicking on those “5 foods you should never eat” or “1 weird tip to lose belly fat” buttons – because I did it, just for you, and I can now tell you that they lead you into the bottomless pit of infomercial hell.

And, most of all, I won’t be doing liposuction. Let’s be frank, I was never going to be doing liposuction. But I have to confess that there is one tiny, embarrassing, retrograde part of my brain that whispers, “Just think about it – one little operation and then poof, that belly you hate so much would be gone forever!”

Trust me: Don’t Google “liposuction,” either. Yeah, I did that too. And aside from the many, many ads and “testimonials” and “objective” Wikipedia entries that seem to be under constant dispute and revision, what I found was what the rest of my brain, the smart part, already knew: Liposuction is painful, expensive and risky; often the weight comes right back, looking weirder and worse than before; it can leave you with dimply, puckered, wrinkly skin that looks even worse than a round belly. Oh, and you could die.

Yeah, I know, you could die crossing the street, too. But I personally do not want to be remembered as the woman who died because her vanity led her to have her belly fat sucked out through a tube.

So I guess I’m left with just one last epiphany: There’s no quick fix. If I want my belly to look different, I need to stick with a reasonable diet and exercise plan. And if I want to stick with my plan, I need to stop hating myself – all of myself, including that poor little belly.

I think it’s time to call my trainer again.

Readers, is there a particular part of your body that you focus on? Have you found a way to make peace with it? And, if not, what holds you back?

Categories: Health Care

Study: Pregnant Women Hungry For Better Info Earlier On

CommonHealth (WBUR) - Tue, 07/08/2014 - 1:38pm

Pregnancy test (Wikimedia Commons)

The “+” sign pops up on your pregnancy test. You call the office of the obstetrician you’ve chosen for just this eventuality, and the receptionist congratulates you and sets you an appointment four or six or eight weeks away.  “But,” you think, “I have so many questions now!” The books aren’t enough. So you turn, of course, to Google, and navigate the thickets of information alone.

If this was your pregnancy experience and it struck you as odd or off or wrong, you’re not alone, according to a recent small study that likely reflects a far broader opinion. Writes one pregnant friend: “My docs are wonderful and insanely knowledgeable, and I call them for the big stuff. However, there’s so much little stuff when you’re pregnant, especially for the first time. It’s constant googling, is this normal? Everything from symptoms, food, exercise routines, massages, whether to dye your hair – it’s endless.”

And some things you need to know early, she notes. “I did have the books – I found the Mayo Clinic guide to a healthy pregnancy to be quite good. But, not so easily searchable, especially when you’re at dinner and you’re like, ‘Can I eat xyz?’ My husband downloaded a few apps right away that allow you to search what you can eat, what to avoid. Some are obvious: alcohol, sushi, some way less so – um, lunch meat?”

From the study’s press release:

Pregnant women are using the Internet to seek answers to their medical questions more often than they would like, say Penn State researchers.

“We found that first-time moms were upset that their first prenatal visit did not occur until eight weeks into pregnancy,” said Jennifer L. Kraschnewski, assistant professor of medicine and public health sciences, Penn State College of Medicine. “These women reported using Google and other search engines because they had a lot of questions at the beginning of pregnancy, before their first doctor’s appointment.”

Following the women’s first visit to the obstetrician, many of them still turned to the Internet — in the form of both search engines and social media — to find answers to their questions, because they felt the literature the doctor’s office gave them was insufficient.

Despite the rapid evolution of technology, the structure of prenatal care has changed little over the past century in the U.S., the researchers said.

Kraschnewski and colleagues set out to gather information to develop a smartphone app for women to use during pregnancy, and incidentally discovered that many women were unsatisfied with the structure of their prenatal care.

The researchers conducted four focus groups, totaling 17 pregnant women — all of whom were over 18 and owned a smartphone. Most of the mothers-to-be agreed that the structure of prenatal visits are not responsive to their individual needs, so they turned to technology to fill their knowledge gaps, Kraschnewski and colleagues reported in a recent issue of the Journal of Medical Internet Research. However, the women were unsatisfied by the questionable accuracy of the information they found online.

That was exactly my friend’s experience: She found sites like babycenter.com helpful, but worried that much of what she read had not been medically vetted:

“I will also mention the love/hate relationship with the site forums. Sometimes, they are wildly reassuring, with women writing in with similar experiences. But plenty of other times they are downright alarming. It’s impossible to know who to trust, and there are very few moderators. One or two sites I’ve seen do have doctors weigh in, but it’s unclear who they are.”

And even once women got to the doctor, the study found them unsatisfied, data-wise:

Many of the participants found the pamphlets and flyers that their doctors gave them, as well as the once popular book “What to Expect When You’re Expecting,” outdated and preferred receiving information in different formats. They would rather watch videos and use social media and pregnancy-tracking apps and websites.

“This research is important because we don’t have a very good handle on what tools pregnant women are using and how they engage with technology,” said Kraschnewski, also an affiliate of the Penn State Institute for Diabetes and Obesity. “We have found that there is a real disconnect between what we’re providing in the office and what the patient wants.”

Kraschnewski calls for figuring out better ways to provide good information to patients. Readers, thoughts? I can imagine such simple solutions — a receptionist asking for a patient’s email or phone number during that first phone call and sending over the office’s favored online resources, including instructions for taking prenatal vitamins and avoiding alcohol. But that didn’t happen when I was pregnant a decade ago. In your experience, is it happening more now?

Categories: Health Care

The Fault in Our Stars

Medicare -- New York Times - Tue, 07/08/2014 - 12:45pm
Official rankings of nursing homes often don’t match residents’ and family members’ opinions, a new study found.
Categories: Elder, Medicare

Courts Consider Challenges To Health Law Subsidies

Kaiser Health News - Tue, 07/08/2014 - 9:45am

A federal judge weighs whether to allow a Republican senator's lawsuit challenging the awarding of tax-free federal subsidies to buy health insurance to members of Congress and their staffs. Meanwhile, a U.S. appeals court is expected to decide any day on another challenge that argues the health law's subsidies may be given only to residents of states that created their own insurance exchanges.

The Milwaukee Journal Sentinel: Ron Johnson's Obamacare Lawsuit Gets Hearing In Green Bay
A federal judge on Monday weighed whether to keep alive a lawsuit by U.S. Sen. Ron Johnson attempting to force members of Congress and their staffs to stop getting subsidies for their health insurance, one of the many flashpoints over Obamacare. Johnson, an Oshkosh Republican, argues members of Congress and their staffs are required to get insurance on their own under the Affordable Care Act, or Obamacare. He sued in federal court challenging a policy of President Barack Obama's administration that allows members of Congress and their staffs to receive health coverage as they have for decades or to buy it through a federal insurance marketplace available to small businesses in the Washington, D.C., area (Marley, 7/7).

Green Bay Press/Gazette/USA Today: Senator Gets Day In Court Against Obamacare
A federal judge will issue a decision "in short order" on whether a Republican senator's lawsuit against the Obama administration can proceed. Lawyers on both sides of the issue argued in Green Bay, Wis., for more than two hours Monday over whether U.S. Sen. Ron Johnson, R-Wis., was harmed when the administration gave members of Congress and their staff subsidies to help pay for health insurance bought on the exchange (Srubas, 7/7).

The Associated Press: Judge Hears Arguments In Health Care Lawsuit
A Wisconsin senator on Monday argued that his lawsuit challenging rules that call for congressional members and their employees to seek government-subsidized health insurance through small-business exchanges should be allowed to move forward. U.S. Sen. Ron Johnson, an Oshkosh Republican, contends the rules twist the Affordable Care Act to ensure senators, representatives and their staffers continue to receive generous health insurance subsidies and place them above the American people (7/7).

Fox News:  GOP Senator Launches Effort To Sue Administration Over Obamacare For Congressional Staffers
Sen. Ron Johnson, R-Wis., Monday launched an effort to sue the Obama administration because it gave many staffers in Congress something no other American has: tax-free money to cover their costs under ObamaCare. "Americans hate it when elected officials or people in power are exempt from laws," Johnson said after the first hearing to determine whether he has standing to sue. The original health care law was clear that lawmakers and their staffers should be treated the same as other Americans, but then the administration issued a ruling that did just the opposite (Angle, 7/7).

And in a separate case challenging the health law's subsidies -

Los Angeles Times: Obama Awaits Another Court Ruling That Could Deal Blow To Health Law
President Obama's healthcare law could be dealt a severe blow this week if a U.S. appeals court rules that some low- and middle-income residents no longer qualify to receive promised government subsidies to pay for their health insurance. The case revolves around a legal glitch in the wording of the Affordable Care Act, which as written says that such subsidies may be paid only if the insurance is purchased through an "exchange established by the state" (7/7).

CQ Healthbeat: Court Decision Could Push Effort to Shut State Health Exchanges
As early as Tuesday, the U.S Circuit Court for the District of Columbia may rule on whether federal subsidies to buy insurance can only be given to the residents of states that have established their own health law insurance exchanges. Such a decision, if upheld by the U.S. Supreme Court, could shrink the number of states with their own exchanges, according to Michael Cannon, the Cato Institute analyst who has led the charge to strike down the current system that awards subsidies irresepective whether states create exchanges under the law (Reichard, 7/7).

CBS News: Will The Supreme Court Get Another Shot At Obamacare?
The Supreme Court last week chipped away at one part of the Affordable Care Act, but its ruling in the Hobby Lobby contraception case left most of Obamacare intact. Other court cases, however, are making their way through the court system in an attempt to deliver a more fatal blow to the controversial law. As early as this week, a three-judge panel from the D.C. Circuit Court of Appeals is expected to hand down a ruling on whether the federal government can give subsidies to Obamacare recipients in states with federally-run health care exchanges. If the appeals court rules in favor of the law's opponents, it could cripple the law (Condon, 7/8).

Categories: Health Care

Senate Majority Leader Vows Response To Hobby Lobby Decision

Kaiser Health News - Tue, 07/08/2014 - 9:44am

Sen. Harry Reid, D-Nev., said Democrats will take up legislation to address the Supreme Court's decision allowing some employers with religious objections to opt out of the health law's contraceptive mandate. Meanwhile, Planned Parenthood sets up a text helpline for women who have lost or will lose contraceptive coverage.

Politico: Harry Reid: 'We're Going To Do Something' On Hobby Lobby
Senate Majority Leader Harry Reid said Monday that Democrats will take up legislation in the "coming weeks" to address last month’s Supreme Court decision that allowed some employers with religious objections to opt out of Obamacare’s contraception mandate. Democrats on Capitol Hill have overwhelmingly criticized the high court’s ruling in the Hobby Lobby case and are working to craft a response that would restore the coverage, though no specifics have yet been outlined (Kim, 7/7).

The Hill: Planned Parenthood Sets Up Post-Hobby Lobby Helpline
Planned Parenthood unveiled a text helpline Monday for women who have lost or will lose contraception coverage in their healthcare plans after last week’s Supreme Court Hobby Lobby ruling. The pro-abortion rights group says women who have lost birth control coverage or have questions about their healthcare can text the helpline to learn about their options. The Supreme Court ruled last week some employers could deny workers access to free contraception coverage under their health insurance plans if it would infringe on the employer's religious beliefs (Al-Faruque, 7/7).

Detroit Free Press/USA Today: Hobby Lobby Ruling Boosts Eden Foods' Insurance Fight
Clinton, Mich.-based Eden Foods, a natural foods company that makes soy milk and other organic products, appears on track to win its fight with the federal government over funding insurance coverage of contraception in the wake of the U.S. Supreme Court's controversial Hobby Lobby ruling. Last week, after its ruling in the Hobby Lobby case, the U.S. Supreme Court vacated a judgment against Eden Foods and sent a lawsuit back to the U.S. Court of Appeals for the Sixth Circuit for further consideration (Snavely, 7/7).

Kaiser Health News: Conflicting Views Of Supreme Court's Contraception Decision Cloud Other Cases
The Supreme Court’s decision last week that some for-profit corporations don't have to comply with the contraceptive coverage mandate under the Affordable Care Act may have raised more questions than it answered. Expect confusion – and arguments – as lower court judges and the Supreme Court itself apply the decision to other cases (Rovner, 7/8).

The Wall Street Journal’s Law Blog: Polarized Reaction To Wheaton College Injunction
Thursday’s order, which sets no legal precedent and applies only to Wheaton, allows the school to avoid covering birth control without filing a form with its insurer asserting religious objections to emergency contraception—which would trigger the third-party coverage. The order will expire once a federal appeals court rules in the school’s case. But just like with last week’s Hobby Lobby ruling, the court’s move has provoked polarized reactions among legal observers (Gershman, 7/7).

Also, another Supreme Court decision is having an impact on state efforts on abortion clinics.

Los Angeles Times: Abortion Buffer Zone Laws Begin Falling After Supreme Court Ruling
Less than two weeks after a Supreme Court ruling struck down a Massachusetts law requiring protesters to stay outside a 35-foot buffer zone around abortion clinics, cities around the country are moving to repeal similar laws or are not enforcing the buffer zones. That is leading abortion rights advocates to worry that women may not seek the medical care they need because of fear of being harassed or intimidated outside clinics (Semuels, 7/7).

Categories: Health Care

Medicare Mulls Expanding Telehealth To Wellness, Behavioral Visits

Kaiser Health News - Tue, 07/08/2014 - 9:16am

The proposed rule would also pay for rural telemedicine for providers who are closer to big cities. Elsewhere, telemedicine in treating injured workers -- especially in rural areas -- catches on.

Modern Healthcare: Proposed CMS Rule Expands Telehealth Payments, Domain 
Wellness and behavioral health visits are among a few telehealth coverage expansions the CMS wants to add to the list of Medicare-reimbursable telehealth activities under a proposal released Thursday. Providers also would be paid for telehealth services in rural areas nearer big cities under a geographical expansion in the proposed rule (Conn, 7/7).

Modern Healthcare: Telemedicine Gains Ground In Treatment Of Injured Workers
Telemedicine is gaining ground in treating injured workers, especially in rural areas, to speed their evaluation and possibly reduce the costs paid by employers. Telemedicine, which is defined in workers compensation as a remote, virtual interaction involving two or more parties in the claims process, has long involved telephone communications between workers and pharmacy benefit managers, or treating physicians and specialists, experts said. It's evolved in recent years to include remote face-to-face interactions and the remote measuring of vital signs.  The costs associated with treating workers in rural areas, in addition to more awareness about telemedicine and increased acceptance of technology, has led the industry to embrace the 40-year-old practice in new ways, said Jonathan Linkous, CEO of the American Telemedicine Association in Washington (Goldberg, 7/7).

In other health IT news -

PBS NewsHour: FDA Regulation Can’t Keep Pace With New Mobile Health Apps
The hundreds of mobile health applications produced each month outpaces the Food and Drug Administration’s ability to regulate them, a policy adviser to the agency said last month. Although lawmakers have repeatedly called on Congress to create a special office within the FDA to regulate health apps available in the mobile marketplace, the idea was rejected at a roundtable discussion on medical device security in June. “It’s just not possible,” said Dr. Bakul Patel, an FDA policy adviser in the Center for Devices and Radiological Health (Barajas, 7/7).

Categories: Health Care

State Highlights: N.Y. Legalizes Medical Marijuana; La. Medicaid Paid For Ineligible Inmate Care; Md. Checking Medicaid Rolls For Unqualified

Kaiser Health News - Tue, 07/08/2014 - 9:16am

A selection of health policy stories from New York, Louisiana, Maryland, Tennessee and Texas.

The Wall Street Journal: Cuomo Signs Bill Legalizing Medical Marijuana
New York on Monday became the 23rd state to legalize certain forms of marijuana for medical reasons as Gov. Andrew Cuomo signed legislation into law at an event in Manhattan. The measure, which passed both houses of the legislature during the final moments of the legislative session, in June, is significantly more restrictive than other medical-marijuana laws in the nation (Orden, 7/7). 

The Associated Press: Louisiana Medicaid Paid $2.7M To Ineligible Inmates, Audit Says 
Louisiana's health department made nearly $2.7 million in Medicaid payments for state prisoners, who are not eligible for the benefits, according to a state audit. The audit, released Monday, says the monthly Bayou Health and Louisiana Behavioral Health Program payments were made for 2,644 inmates over the 23 months ending Dec. 31, 2013. The Department of Health and Hospitals pays a monthly fee for each participant to the contractors which run the two programs. About 27 percent of the payments were for participants who were incarcerated before the programs began, the auditors wrote (7/7).

Baltimore Sun:  Maryland To Begin Check Of Medicaid Rolls Again
Maryland officials are poised to again review their Medicaid rolls for those who no longer qualify. The state ceased such reviews for six months as it worked to open the new online marketplace for people to buy public and private insurance plans and adjust to new rules. The absence of such reviews was estimated to cost taxpayers up to $30 million, though officials believe the amount will be lower. "There will be some kind of analysis," said Dr. Joshua Sharfstein, state health secretary. "But it could take a few months” (Cohn, 7/6).

Kaiser Health News: In Unhealthy Eastern Tennessee, Limited Patient Options Bring Some Of The Country’s Cheapest Premiums
Angela Allen’s struggle to ease her neck pain has been a huge pain in the neck. Her regular spine doctor does not accept the new insurance she bought through the federal health marketplace. Allen, who has two slipped disks in her neck vertebrae, said the closest specialist she found who would see her and take her insurance works 34 miles away in another county. She belatedly learned that her physical therapist also is out of network and she owes $900. ‘It’s been a nightmare,’ said Allen, a 42-year-old office manager (Rau, 7/8).

Texas Tribune: State Halts Foster Care Placements With Contractor
Following the drowning of two foster children in Lake Georgetown on Sunday, the Department of Family and Protective Services has placed a temporary hold on foster care placements by a state contractor that was responsible for overseeing the children’s care. DFPS said on Monday that placements of foster care children with Providence Service Corporation have been temporarily suspended pending an investigation into the death of a 4-year-old boy and his 6-year-old sister, who had been placed in a Cedar Park foster home. Officials with Providence could not immediately be reached for comment (Ura, 7/7).

Baltimore Sun: Howard Co. Health Dept. Launches Plan To Combat Rising Drug Overdoses 
The number of drug overdoses related to heroin and prescription painkillers in Howard County is on the rise -- a trend that has led the county Health Department to launch a series of initiatives aimed at reducing incidents. The prevention plan is called the Opioid Overdose Response Program, and is an 11-page document created earlier this year. Chief among the initiatives is a class that offers high-risk residents training and access to an antidote called Naloxone, a prescription drug that counteracts the debilitating effect painkillers, or opioids, have on the central nervous system (Lavoie, 7/7).

Baltimore Sun: In Maryland, Smoking Could Cost Your Job
Anyone who wants a job next year at Anne Arundel Medical Center -- whether as a surgeon or security guard -- will have to prove they don't smoke or use tobacco. The Annapolis hospital's new hiring policy might be controversial, but it is legal in Maryland and more than half of the United States. And it's a type of job screening that is gaining favor with employers -- from hospitals to companies such as Alaska Airlines -- trying to control rising health costs and cultivate a healthier, more productive workforce. Anne Arundel Medical Center, like a growing number of health systems, universities and other businesses, will require a urine test for nicotine use for all applicants starting next July. The policy -- which will not apply to current employees -- is just one piece of the hospital's existing ban on tobacco use that was expanded July 1 to apply at all hospital buildings and surrounding public sidewalks, parking lots and garages. It covers not only cigarettes, but cigars, pipes, snuff and e-cigarettes (Mirabella, 7/6).

Rochester Democrat & Chronicle: Consortium Aims To Lower Medicaid Costs
Local health providers are collaborating on a Medicaid-related, cost-cutting program that could mean more public dollars and enhanced savings for the Rochester region over time, local hospital officials said Monday. The consortium is called the Finger Lakes Performing Provider System and includes more than 200 hospitals, nursing homes, behavioral health and substance abuse programs, social services agencies, health planning organizations and other health-related entities in a region comprising Monroe and 13 nearby counties (Tobin, 7/7).

Categories: Health Care

VA Whistleblowers To Tell All To House

Kaiser Health News - Tue, 07/08/2014 - 9:16am

These whistleblowers say they were often placed on administrative leave for bringing up their concerns. Also, wait times at Connecticut VA clinics explode, even after the recent scandal came to light.

Politico: VA Whistleblowers To Detail Retribution
House lawmakers will hear testimony on Tuesday from whistleblowers who accuse the Department of Veterans Affairs of retaliating against them for exposing shoddy medical care. he VA would often force whistleblowers into administrative leave after they raised concerns about lagging health care quality stemming from overworked nurses or under-staffed medical centers, according to testimony from four witnesses set to testify before the House Committee on Veterans’ Affairs (French, 7/8).

The CT Mirror: Number Of Long Waits For VA Healthcare In CT Much Larger Than First Reported
Since the scandal this spring over long wait times and cover ups of poor performance at veterans’ health facilities, there’s been a sharp upturn in the numbers of Connecticut veterans who have waited more than 30 days to receive medical help. According to new information released by the Department of Veterans’ Affairs, in mid-May, 998 Connecticut veterans had waited more than 30 days to receive care. That number grew to 2,727 on June 3. The trend of doubling or tripling of veterans with long wait times is nationwide (Radelat, 7/7).

And the VA's ability to quickly process disability claims is questioned --

The Wall Street Journal: Jump In Appeals Dog The VA's Progress On Disability Claims
The next secretary of Veterans Affairs will face well-known problems of mismanagement at VA hospitals and long waits for doctor appointments, but also will be confronted by an issue former Secretary Eric Shinseki hailed as a success: faster processing of disability claims. Under Mr. Shinseki, the VA slashed the backlog for things such as compensation claims for injuries sustained while in the service. But that progress masked a 60 percent jump in outstanding appeals of denied claims and a slowdown in processing claims for things like adding dependents to veterans' files, VA data show (Kesling, 7/7).

Categories: Health Care

Viewpoints: Court's 'Baffling' Decision; Opposing Views On Medicaid Alternatives; Fixing The VA With Earmarks

Kaiser Health News - Tue, 07/08/2014 - 9:15am

Los Angeles Times: At Supreme Court, Baffling Decision Follows Awful Hobby Lobby Ruling
Over the weekend, without a pressing deadline at hand, I sat down to read more closely the Supreme Court's Hobby Lobby decision, and Justice Ruth Bader Ginsburg's strong dissent. Maybe, in the heat of deadline, I had missed something important when I first judged the decision deeply offensive to women. I had not. If anything, the Hobby Lobby decision -- and the court's subsequent ruling three days later in a thematically similar matter involving Wheaton College -- is even more offensive and troubling than I first thought (Robin Abcarian, 7/7). 

The Wall Street Journal: Without Reason Or Empathy
There's a good lesson in Justice Sonia Sotomayor's heated dissent from a Thursday order in the case of Wheaton College v. Burwell: When making an argument, you should be cautious about imputing bad faith to your adversaries--not only because civility has intrinsic value but also because such aggression magnifies the embarrassment if you turn out to be mistaken. That's just what Sotomayor, joined by Justices Ruth Bader Ginsburg and Elena Kagan, did in this dissent. "Those who are bound by our decisions usually believe they can take us at our word," she declared, using the first-person plural to refer to the court. "Not so today." In making that assertion, Sotomayor committed an elementary error of logic (James Taranto, 7/7).

Bloomberg: Who's The Real Hobby Lobby Bully?
[C]onsider an argument I have now heard hundreds of times -- on Facebook, in my e-mail, in comment threads here and elsewhere: "Hobby Lobby’s owners have a right to their own religious views, but they don't have a right to impose them on others." As I wrote the day the decision came out, the statement itself is laudable, yet it rings strange when it's applied to this particular circumstance. How is not buying you something equivalent to "imposing" on you? (Megan McArdle, 7/7).

The Boston Globe: The Supreme Court's Subterfuge
Alito’s reassurances that the ruling would not prevent women from receiving contraceptives also ring hollow. He explains that Obamacare already contains exceptions allowing religious groups to file a form to avoid the contraceptive requirement, which in turn triggers an obligation for insurance companies to provide contraceptives on their own tab. Religious corporations could use the same mechanism, he says. But late last week — after the term had ended — the court issued a preliminary ruling in favor of an employer asserting a conscientious objection to filing the form (Kent Greenfield, 7/8).

The Washington Post: Health-Care Sign-Up Mistakes Pose A New Challenge For Obamacare, Not A Disaster
Are hundreds of thousands of Americans getting government money they aren't entitled to because of Obamacare? Illegal immigrants, too? Is it all further evidence that the Obama administration is incompetent and the system unworkable? For critics of health-care reform, these are tempting conclusions to draw from reports that the Obama administration found nearly 3 million discrepancies between what enrollees reported when they signed up for Affordable Care Act insurance and what federal records show about them. Tempting but overblown (7/7).

USA Today: States' Obamacare Alternatives Worth Trying: Our View 
Some Republican governors have been cutting deals with the Obama administration to expand Medicaid — on the condition that it be done through private insurance. At first, that sounds like a bad deal. For all its flaws, Medicaid has very low overhead and low reimbursement rates, so it can cover more people for less money than private insurers. ... This alternative approach is worth trying. Not only will people who would otherwise have no health insurance get coverage, the new programs also might improve on traditional Medicaid (7/7). 

USA Today: 'Private Option' Won't Help Poor: Opposing View
Medicaid is far from perfect, but the private option won't be an improvement. Medicaid patients, for instance, often have trouble finding doctors. But private option Medicaid plans, like many plans on the health exchanges, have very narrow doctor and hospital networks. "Churning" is another problem: Families must often change providers as they move in and out of Medicaid eligibility. But churning will persist under the private option as people change jobs or plans change provider networks (Adam Gaffney, 7/7). 

Fox News: Don't Be Fooled, Republicans Have Lots Of Ideas About How To Fix ObamaCare
Conservatives have no ideas to help "[bring] care to the uninsured, or those with pre-existing conditions." Heard this before? It’s the New York Times editorial board’s favorite meme. It's certainly true that Republicans haven't collectively endorsed a "replace" plan to go with their "repeal" strategy. Part of the reason is tactical—while polls find ObamaCare consistently unpopular, Republicans hesitate to put forth their own comprehensive plan that would (undoubtedly) attract its own critics (Paul Howard and Yevgeniy Feyman, 7/7).

On other health care topics -

The New York Times: The Long Wait To See A Doctor
Americans are already experiencing long waits to get doctor's appointments, and experts say the delays are bound to get worse when millions of previously uninsured Americans get health coverage under the Affordable Care Act. That is the sobering news from a new survey of wait times conducted by Merritt Hawkins, a physician staffing firm, which polled some 1,400 medical offices in 15 large metropolitan areas across the country (7/7). 

Los Angeles Times: There's Family Value In Paid Parental Leave
A week ago, President Obama announced his support for paid maternity leave at the federal level. "Many women can't even get a paid day off to give birth — now that's a pretty low bar," he told the audience at the White House Summit on Working Families. "That, we should be able to take care of." He was right to voice his support. After all, only 12% of workers have access to paid leave through state programs or more generous employers. A quarter of mothers who work during pregnancy either quit their jobs or are let go when a new child arrives, and those who receive only partial pay or no pay at all face financial hardship. The inadequate policies take a toll on family health as well as wealth, because maternity leave lowers infant mortality rates, illness and hospitalization for mother and child alike (7/7). 

Politico: Earmarks Can Fix The VA
One reason for this scandalous neglect is that the U.S. House and Senate were unable to provide the resources the VA needed because there is something missing from Congress' toolbox. And that missing governmental good-wrench is the power to direct federal spending to solve specific problems, large and small. With that authority, Congress could have pointed funding for understaffed and overburdened VA hospitals toward workable solutions for reducing the wait times for medical appointments, diagnostic tests and much-needed procedures (Jim Dyer, 7/7).

Raleigh News & Observer: NC Medicaid Makes An Important Difference For Those With No Alternatives
One overall lesson from The News & Observer’s recent two-part report on the Medicaid health care system is that the system in North Carolina is in many ways working well. Costs per person have gone down at a time when spending nationally has gone up. More providers in the state, compared with the national rate, are willing to participate in services, percentage-wise. And there is better preventive care under N.C. Medicaid than in other states. ... But there is a threat that Republicans, having cut taxes excessively and seeming confused by the challenge of putting together a budget, will look to cut Medicaid services as an "easy" savings. ... It is always important, therefore, to remember who pays the price for cuts in those services and what type of pain changes in Medicaid inflict on vulnerable people (7/7).

Charlotte Observer: DHHS, Medicaid Fixes Start At Top
The sad thing in reading the (Raleigh) News & Observer's important two-part series on the state’s Medicaid woes and the dysfunctional management of the Department of Health and Human Services is that the revelations no longer have the power to amaze. Problems beset DHHS and Medicaid long before Pat McCrory was elected governor nearly two years ago. But McCrory and the current legislature haven't made things any better, and in one key way they seem to have made things worse. McCrory's hiring of Aldona Wos as secretary of health and human services was a huge blunder, one that he refuses to rectify by letting her go (7/7).

Categories: Health Care

Despite Signing Up And Paying Premiums, Some People Still Aren't Covered

Kaiser Health News - Tue, 07/08/2014 - 9:15am

News outlets report that difficulties resulting from health exchange websites and enrollment systems continue to impact insurance coverage. News outlets also report on related developments from D.C., Colorado, Wisconsin and Missouri.     

The Wall Street Journal: Some Still Lack Coverage Under Health Law
Months after the sign-up deadline, thousands of Americans who purchased health insurance through the Affordable Care Act still don't have coverage due to problems in enrollment systems. In states including California, Nevada and Massachusetts, which are running their own online insurance exchanges, some consumers picked a private health plan and paid their premiums only to learn recently that they aren't insured (Armour, 7/7).

Los Angeles Times: Healthcare.gov Site Stumps 'Highly Educated' Millennials. Here Why
Millennials who struggled to sign up for health insurance on HealthCare.gov have some simple advice for the Obama administration: Make the website more like Yelp or TurboTax. President Obama famously told doubters that they could use the government’s health insurance site to pick a health plan "the same way you shop for a plane ticket on Kayak, same way you shop for a TV on Amazon." ...  That turned out not to be the case, of course. A study published Monday by Annals of Internal Medicine lays out some of the specific ways that HealthCare.gov – a centerpiece of the Patient Protection and Affordable Care Act – went wrong (Kaplan, 7/7).

The Washington Post: Six Months Into Obamacare, Some D.C. Insurance Brokers Still Wait To Be Paid
When the District launched its federally mandated health insurance exchange last fall, officials went to great lengths to woo professional insurance brokers — launching a special broker web portal, establishing a "concierge" hotline just for brokers and holding broker-only training classes. Despite those efforts, many brokers have yet to be paid for the policies they've sold through the exchange, known as D.C. Health Link — generating frustration among professionals who say their patience in navigating the changes wrought by the Affordable Care Act has not been rewarded (DeBonis, 7/7).

Wisconsin State Journal: Wisconsin Insurer Didn't Activate Dental Policies For 299 Stand-Alone Policies
Nearly 300 people in Wisconsin who applied for standalone dental coverage from a major Wisconsin insurer through the federal health care exchange thought they had policies but didn't have them activated, according to enforcement records of the state's Office of Commissioner of Insurance. Waukesha-based Anthem Blue Cross Blue Shield Wisconsin signed a stipulation and order April 24 agreeing to stop offering inadequate insurance, activate appropriate coverage and reprocess any claims that were denied due to the company’s system error, according to documents obtained via an open records request. It is the first and so far only enforcement action taken by state insurance regulators in connection with the federal health marketplace program for the uninsured (Hesselberg, 7/7).

Denver Post: Colorado Exchange Experts Expect More To Drop Health Coverage
Colorado's health-care exchange is expecting nearly twice as many people to drop or decline to pay for their policies, resulting in $1 million less in revenue this fiscal year. In April, the staff projected 13 percent of people will drop or not pay for policies in fiscal 2015, but now they are expecting about 24 percent to drop their policies, according to the latest model. Because Connect for Health Colorado collects a fee on every policy sold through the exchange, the new model expects revenue from that fee to drop from $7.9 million to $6.9 million this fiscal year. And in fiscal 2016, the revised figures show dropped policies going from the 16 percent projected in April to nearly 22 percent, with a nearly $740,000 drop in revenue (Kane, 7/8).

The Associated Press: Missouri Governor Vetoes Health Navigator Limits
Missouri Gov. Jay Nixon vetoed legislation Monday that would have limited who could work in the state as a health insurance guide and blamed a national conservative group for injecting an error into the model legislation. The vetoed bill would have required criminal background checks for people applying for state licenses as enrollment aides for a federally run health insurance website. Anyone with past convictions involving fraud or dishonesty would have been barred from the jobs (7/7).

Categories: Health Care

Political Cartoon: 'Co-Petitioners?'

Kaiser Health News - Tue, 07/08/2014 - 9:13am

Kaiser Health News provides a fresh take on health policy developments with "Co-Petitioners?" by Chip Bok .

Meanwhile, here's today's haiku:

CHALLENGES BECOME CHALLENGING

For the health care law --
more arguments, days in court.
It's hard to keep up!
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

Family Law: A Beginner’s Guide – Part 2: Child Custody, Support, and Adoption

In Custodia Legis - Tue, 07/08/2014 - 8:39am

This post is coauthored by Barbara Bavis and Robert Brammer, legal reference specialists.

In Part Two of our Family Law Beginner’s Guide, we are shifting our focus to what the law says about children’s roles in the family—focusing on their custody and care.  Below, please find information and resources for legal researchers regarding child custody, child support, and domestic adoption.

If you are interested in resources related to dissolution of marriage, please see our previous post.

Books

Photograph shows Warren Harding’s pet dog Laddie Boy with the “child movie queen” Mariana Batista on the lawn at the White House. Washington, D.C., ca. 1923. Courtesy of the Library of Congress Prints and Photographs Reading Room

Adoption

Child Custody & Support

Subject Headings

As we mentioned in Part One, many of the laws that regulate family law are promulgated by the states. To locate treatises specific to your state’s law, please click here to use our catalog.  Specifically, to browse Library of Congress subject headings of interest, click “Browse,” use select “SUBJECTS beginning with” or “SUBJECTS containing” from the drop-down menu, and then input a subject heading using one of the examples shown below. Finally, click on a result and you can browse the materials classified under that subject heading.  Where possible, we will include a link to the subject browse result below:

If you want to find the resources classed under these subject headings in a library in your area, we suggest performing a subject search in either your local library’s catalog or the WorldCat catalog.

Statutes

To locate your state’s statutes on topics associated with family law, please see our Guide to Law Online page and click on your state. You will find a link to your state’s code under the heading “Legislative.” You will often find that family law, which is sometimes listed as “domestic relations,” has its own title or chapter.

While most laws in this area are state-specific, some federal laws can have a role as well, particularly in the area of adoption.  The U.S. Department of Health and Human Services (HHS) has created a very helpful report regarding these federal laws, titled “Major Federal Legislation Concerned With Child Protection, Child Welfare, and Adoption,” which provides citation information and helpful summaries.  For more information about how to do further research regarding federal legislation, see our prior post, “Federal Statutes: A Beginner’s Guide.”

Cases

If you are interested in court rulings in this area of the law, you may want to visit your local public law library to take advantage of their subscription(s) to commercial legal research databases, such as Westlaw and LexisNexis. You can also locate cases related to adoption, child support, and child custody using Google Scholar and other sites on the free web. Because this area of law is often state-specific, you may want to limit your results to your particular jurisdiction. You may find that you need cases that interpret and apply a particular provision of your state’s family law statutes. You can locate these cases by searching Google Scholar using the citation to a section of your state’s code.  To learn more about how to use Google Scholar to find free case law online, please view the Library of Congress video tutorial on the subject.

Rules of Procedure

Many states have distinct rules of procedure for family law. If you are submitting a pleading to a court, be sure to check the Federal or State Rules of Procedure, as well as the local court rules to ensure you have complied with their rules.  For more information about state and local court rules, and to find links to pertinent online legal information, be sure to visit each state’s Guide to Law Online page.

Online Resources

State and local court websites often contain forms related to family law, and some even contain form packets.  Again, please check our Guide to Law Online site for links to state and local court websites.  Other online sources that might be helpful include:

We hope you found this guide helpful. If you have any questions regarding your legal research, please contact the Law Library of Congress.

Categories: Research & Litigation

Conflicting Views Of Supreme Court’s Contraception Decision Cloud Other Cases

Kaiser Health News - Tue, 07/08/2014 - 8:38am

The Supreme Court’s decision last week that some for-profit corporations don’t have to comply with the contraceptive coverage mandate under the Affordable Care Act may have raised more questions than it answered. Expect confusion – and arguments – as lower court judges and the Supreme Court itself apply the decision to other cases.

This became apparent soon after the Hobby Lobby ruling when the court granted a temporary injunction to Wheaton College, a Christian school in Illinois. The college argued in a lawsuit that the special provisions provided by the Obama administration allowing it to escape the mandate are still insufficient.

(Photo by Win McNamee/Getty Images)

But the order for the college, citing the Hobby Lobby ruling earlier in the week, created some confusion over whether Wheaton employees would still get access to contraceptives under the law. And the order provoked a blistering dissent from Justice Sonia Sotomayor, joined by the court’s two other female members, Justices Ruth Bader Ginsburg and Elena Kagan. They argued that the majority was already breaking with the precedent it established only days earlier.

Here are some of the questions raised by the Hobby Lobby case and the remaining cases also challenging the contraceptive coverage mandate.

What is the contraceptive mandate?      

As part of the Affordable Care Act, most health insurance plans are required to cover, with no cost-sharing beyond premiums, a wide array of preventive health benefits. For women, that includes all contraceptives approved by the Food and Drug Administration, as well as sterilization procedures and patient education and counseling.

The mandate does not include coverage of RU-486 (mifepristone), the drug used for medical abortions after a pregnancy has been established. But it does require coverage of emergency contraceptives and intrauterine devices, which some believe can prevent the implantation of a fertilized egg. (Newer research suggests that is probably not the case, by the way.)

Who has sued to try to block the mandate?

There have been two separate sets of court cases challenging the contraceptive coverage requirements.

The first set comes from for-profit corporations that, under the law and accompanying federal regulations, are required to provide the benefits as part of their insurance plans. According to the National Women’s Law Center, there have been 50 cases filed by for-profit firms, while the Becket Fund for Religious Justice, which is representing many of those suing, counts 49. Most of those companies charged that the requirement to provide some or all of the contraceptives in question violated their rights under a 1993 federal law, the Religious Freedom Restoration Act (RFRA.)

The cases filed by Hobby Lobby, a nationwide arts-and-crafts chain, and Conestoga Wood Specialties, a Pennsylvania cabinet-making firm, were the first of those to reach the Supreme Court for a full hearing.

Religious nonprofit entities, mostly religious colleges and universities and health facilities, filed the second set of cases. The NWLC counts 59 nonprofit cases; the Becket fund, 51.

The Obama administration, under regulations issued by the Department of Health and Human Services in 2013, is not requiring those organizations to directly “contract, arrange, pay for, or refer” employees to contraceptive coverage. But the organizations say the process by which they can opt out of providing the coverage, which involves filling out a form and sending it to their insurance company or third-party administrator, still violates their religious beliefs by making them “complicit” in providing something they consider sinful.

What did the Supreme Court rule in the Hobby Lobby case?

The majority opinion written by Justice Samuel Alito said that “closely held corporations,” including those like Hobby Lobby and Conestoga Wood Specialties, can exercise religious rights under RFRA. Further, because the Obama administration was requiring those firms to directly provide the coverage, rather than offer them the same accommodation it was offering religious nonprofit groups, the requirement was not “the least restrictive means” of ensuring that women can get contraception and thus a violation of the law.

In making the case for Hobby Lobby and Conestoga Wood, Justice Alito went out of his way to praise the accommodation for religious nonprofits, saying it “does not impinge on the plaintiffs’ religious beliefs that providing insurance coverage for the contraceptives at issue here violates their religion and it still serves HHS’ stated interests.”

What impact has the Hobby Lobby decision had on pending nonprofit cases?

A fairly substantial one. Later that same day the Hobby Lobby decision was handed down, a federal appeals court in Atlanta cited it in issuing an injunction against enforcing the mandate against the Eternal Word Television Network. 

But the real fireworks erupted on July 3, when the Supreme Court granted its own injunction in the case filed by Wheaton College.

The unsigned order required the college to write to the Secretary of Health and Human Services, stating “that it is a nonprofit organization that holds itself out as religious and has religious objections to providing coverage for contraceptive services.” The order specifically said the college “need not use the form prescribed by the government, EBSA Form 700, and need not send copies to health insurance issuers or third party administrators.”

Justices Sotomayor, Ginsburg, and Kagan were furious.

“Those who are bound by our decisions usually believe they can take us at our word. Not so today,” Sotomayor wrote. “After expressly relying on the availability of the religious nonprofit accommodation to hold that that the contraceptive coverage requirement violates RFRA as applies to closely-held for-profit corporations, the court now, as the dissent in Hobby Lobby feared it might…retreats from that position.”

What happens now?

The court made clear that in granting Wheaton College its injunction (as it did earlier this year in a case filed by the Denver-based Little Sisters of the Poor), it was not prejudging the case. “This order should not be viewed as an expression of the Court’s views on the merits,” it said.  

But what is less clear is whether people covered by the health plans of those nonprofit organizations that are still in litigation will have access to no-copay contraceptive coverage.

The Supreme Court majority appears to think they can be covered. “Nothing in this interim order affects the ability of the applicant’s employees and students to obtain, without cost, the full range of FDA approved contraceptives,” the order said. “The government contends the applicant’s health issuer and third-party administrator are required by federal law to provide full contraceptive coverage regardless whether the applicant completes EBSA Form 700.”

The Obama administration, however, seems not so sure that will happen. “An injunction pending appeal would deprive hundreds of employees and students and their dependents of coverage for these important services,” the Justice Department wrote in its memorandum to the court.

One thing that is clear: Many more of these cases are yet to be decided by many more courts.  

Categories: Health Care

First Edition: July 8, 2014

Kaiser Health News - Tue, 07/08/2014 - 7:13am

Today's headlines include reports that a federal judge in Wisconsin heard arguments in a health law challenge brought by a U.S. senator.     

Kaiser Health News: In Unhealthy Eastern Tennessee, Limited Patient Options Bring Some Of The Country’s Cheapest Premiums
Kaiser Health News staff writer Jordan Rau reports: “Angela Allen’s struggle to ease her neck pain has been a huge pain in the neck. Her regular spine doctor does not accept the new insurance she bought through the federal health marketplace. Allen, who has two slipped disks in her neck vertebrae, said the closest specialist she found who would see her and take her insurance works 34 miles away in another county. She belatedly learned that her physical therapist also is out of network and she owes $900. ‘It’s been a nightmare,’ said Allen, a 42-year-old office manager” (Rau, 7/8).Read the story, which also appeared in The Atlantic.

Kaiser Health News: Insuring Your Health: Some Plans Skew Drug Benefits To Drive Away Patients, Advocates Warn
Kaiser Health News consumer columnist Michelle Andrews writes: “Four Florida insurers allegedly discriminate against people with HIV/AIDS by structuring their prescription drug benefits so that patients are discouraged from enrolling, according to a recent complaint filed with federal officials. The complaint, filed with the Office for Civil Rights at the federal Department of Health and Human Services, claims that the insurers—CoventryOne, Cigna, Humana and Preferred Medical—violated the health law and federal civil rights laws by placing all covered HIV/AIDS drugs, including generics, in the highest drug tiers that require significant patient cost sharing. The complaint was made by the AIDS Institute and the National Health Law Program, which are health advocacy organizations” (Andrews, 7/8). Read the column.

The Wall Street Journal: Some Still Lack Coverage Under Health Law
Months after the sign-up deadline, thousands of Americans who purchased health insurance through the Affordable Care Act still don't have coverage due to problems in enrollment systems. In states including California, Nevada and Massachusetts, which are running their own online insurance exchanges, some consumers picked a private health plan and paid their premiums only to learn recently that they aren't insured (Armour, 7/7).

Los Angeles Times: Healthcare.gov Site Stumps ‘Highly Educated’ Millennials. Here Why
Millennials who struggled to sign up for health insurance on HealthCare.gov have some simple advice for the Obama administration: Make the website more like Yelp or TurboTax. President Obama famously told doubters that they could use the government’s health insurance site to pick a health plan "the same way you shop for a plane ticket on Kayak, same way you shop for a TV on Amazon." Speaking at a community college in Maryland last fall, he promised that the process was “real simple” (Kaplan, 7/7).

The Washington Post: Six Months Into Obamacare, Some D.C. Insurance Brokers Still Wait To Be Paid
When the District launched its federally mandated health insurance exchange last fall, officials went to great lengths to woo professional insurance brokers — launching a special broker web portal, establishing a “concierge” hotline just for brokers and holding broker-only training classes. Despite those efforts, many brokers have yet to be paid for the policies they’ve sold through the exchange, known as D.C. Health Link — generating frustration among professionals who say their patience in navigating the changes wrought by the Affordable Care Act has not been rewarded (DeBonis, 7/7).

The Associated Press: Missouri Governor Vetoes Health Navigator Limits
Missouri Gov. Jay Nixon vetoed legislation Monday that would have limited who could work in the state as a health insurance guide and blamed a national conservative group for injecting an error into the model legislation. The vetoed bill would have required criminal background checks for people applying for state licenses as enrollment aides for a federally run health insurance website. Anyone with past convictions involving fraud or dishonesty would have been barred from the jobs (7/7).

Los Angeles Times: Obama Awaits Another Court Ruling That Could Deal Blow To Health Law
President Obama's healthcare law could be dealt a severe blow this week if a U.S. appeals court rules that some low- and middle-income residents no longer qualify to receive promised government subsidies to pay for their health insurance. The case revolves around a legal glitch in the wording of the Affordable Care Act, which as written says that such subsidies may be paid only if the insurance is purchased through an "exchange established by the state" (7/7).

The Associated Press: Judge Hears Arguments In Health Care Lawsuit
A Wisconsin senator on Monday argued that his lawsuit challenging rules that call for congressional members and their employees to seek government-subsidized health insurance through small-business exchanges should be allowed to move forward. U.S. Sen. Ron Johnson, an Oshkosh Republican, contends the rules twist the Affordable Care Act to ensure senators, representatives and their staffers continue to receive generous health insurance subsidies and place them above the American people (7/7).

Green Bay Press/Gazette/USA Today: Senator Gets Day In Court Against Obamacare
A federal judge will issue a decision "in short order" on whether a Republican senator's lawsuit against the Obama administration can proceed. Lawyers on both sides of the issue argued in Green Bay, Wis., for more than two hours Monday over whether U.S. Sen. Ron Johnson, R-Wis., was harmed when the administration gave members of Congress and their staff subsidies to help pay for health insurance bought on the exchange (Srubas, 7/7).

Los Angeles Times: Abortion Buffer Zone Laws Begin Falling After Supreme Court Ruling
Less than two weeks after a Supreme Court ruling struck down a Massachusetts law requiring protesters to stay outside a 35-foot buffer zone around abortion clinics, cities around the country are moving to repeal similar laws or are not enforcing the buffer zones. That is leading abortion rights advocates to worry that women may not seek the medical care they need because of fear of being harassed or intimidated outside clinics (Semuels, 7/7).

Politico: Harry Reid: ‘We’re Going To Do Something’ On Hobby Lobby
Senate Majority Leader Harry Reid said Monday that Democrats will take up legislation in the “coming weeks” to address last month’s Supreme Court decision that allowed some employers with religious objections to opt out of Obamacare’s contraception mandate. Democrats on Capitol Hill have overwhelmingly criticized the high court’s ruling in the Hobby Lobby case and are working to craft a response that would restore the coverage, though no specifics have yet been outlined (Kim, 7/7).

Detroit Free Press/USA Today: Hobby Lobby Ruling Boosts Eden Foods' Insurance Fight
Clinton, Mich.-based Eden Foods, a natural foods company that makes soy milk and other organic products, appears on track to win its fight with the federal government over funding insurance coverage of contraception in the wake of the U.S. Supreme Court's controversial Hobby Lobby ruling. Last week, after its ruling in the Hobby Lobby case, the U.S. Supreme Court vacated a judgment against Eden Foods and sent a lawsuit back to the U.S. Court of Appeals for the Sixth Circuit for further consideration (Snavely, 7/7).

The Wall Street Journal’s Law Blog: Polarized Reaction To Wheaton College Injunction
On the eve of Independence Day, the Supreme Court issued a temporary order giving an Illinois Christian school a way to avoid an arrangement offered by the Obama administration to religious nonprofits that object to health-care law’s contraception-coverage requirements. The reprieve granted to Wheaton College — accompanied by an unusual 17-page dissent by the court’s three female justices — could complicate efforts to sort out dozens of legal challenges tied to religious objections to the Affordable Care Act, says WSJ’s Jess Bravin (Gershman, 7/7).

Politico: VA Whistleblowers To Detail Retribution
House lawmakers will hear testimony on Tuesday from whistleblowers who accuse the Department of Veterans Affairs of retaliating against them for exposing shoddy medical care. he VA would often force whistleblowers into administrative leave after they raised concerns about lagging health care quality stemming from overworked nurses or under-staffed medical centers, according to testimony from four witnesses set to testify before the House Committee on Veterans’ Affairs (French, 7/8).

The Wall Street Journal: Jump In Appeals Dog The VA's Progress On Disability Claims
The next secretary of Veterans Affairs will face well-known problems of mismanagement at VA hospitals and long waits for doctor appointments, but also will be confronted by an issue former Secretary Eric Shinseki hailed as a success: faster processing of disability claims. Under Mr. Shinseki, the VA slashed the backlog for things such as compensation claims for injuries sustained while in the service. But that progress masked a 60% jump in outstanding appeals of denied claims and a slowdown in processing claims for things like adding dependents to veterans' files, VA data show (Kesling, 7/7).

27/7 Wall St./USA Today: Countries Spending The Most On Health Care
The United States currently spends more per person on health care than any other developed country. Health outcomes in the U.S., however, are among the worst (Allen, 7/7).

The Wall Street Journal: Cuomo Signs Bill Legalizing Medical Marijuana
New York on Monday became the 23rd state to legalize certain forms of marijuana for medical reasons as Gov. Andrew Cuomo signed legislation into law at an event in Manhattan. The measure, which passed both houses of the legislature during the final moments of the legislative session, in June, is significantly more restrictive than other medical-marijuana laws in the nation (Orden, 7/7). 

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.

Categories: Health Care

Stretch Energy Code Increases Energy Efficiency

Massachsuetts Trial Court Law Library - Tue, 07/08/2014 - 7:00am
Massachusetts muncipalities looking for a more rigorous energy efficiency standard than the Commonwealth requires have an alternative.  Appendix 115.AA of the Massachusetts Building Code, known as the Stretch Energy Code is an option for towns and cities interested in more energy efficient building standards than the state base energy code.

The Stretch Code amends the MA Base Energy Code (IECC 2009), to achieve approximately a 20% improvement in building energy performance.  Many of the improvements will be implemented at the time of construction.  While they are expected to raise the cost of construction, reduced energy costs should quickly offset those expenses.  So far 143 municipalities have adopted the code.
A summary of the Stretch Energy Code can be found here.
Categories: Research & Litigation

Some Plans Skew Drug Benefits To Drive Away Patients, Advocates Warn

Kaiser Health News - Tue, 07/08/2014 - 5:01am

Four Florida insurers allegedly discriminate against people with HIV/AIDS by structuring their prescription drug benefits so that patients are discouraged from enrolling, according to a recent complaint filed with federal officials.

The complaint, filed with the Office for Civil Rights at the federal Department of Health and Human Services, claims that the insurers—CoventryOne, Cigna, Humana and Preferred Medical—violated the health law and federal civil rights laws by placing all covered HIV/AIDS drugs, including generics, in the highest drug tiers that require significant patient cost sharing. The complaint was made by the AIDS Institute and the National Health Law Program, which are health advocacy organizations.

Under the health law, insurers are prohibited from rejecting customers because of medical conditions. They also cannot offer plans with benefit designs that discriminate based on someone’s degree of disability, health conditions, or expected length of life, among other things.

Truvada is an antiretroviral drug used to treat HIV/AIDS (Photo by Justin Sullivan/Getty Images).

People with other serious medical conditions face similar prescription drug cost-sharing problems, says Dan Mendelson, CEO of Avalere Health, which conducted a recent analysis of 123 exchange plan formularies that included every state.

The analysis, funded by the trade group for prescription drug makers, found that more than 60 percent of silver plans placed all covered medications for multiple sclerosis, rheumatoid arthritis, Crohn’s disease and some cancers in the highest formulary tier. Up to 35 percent of plans placed HIV/AIDS drugs in the highest tier, according to the analysis.

Insurers are trying to shield themselves from adverse selection, says Mendelson. Now that the health law prohibits insurers from rejecting people with serious health conditions, “if your benefit is more generous than others you’ll get everyone with that illness,” he explains.

More From This Series Insuring Your Health

For the Florida complaint, the AIDS Institute analyzed all 36 silver-level plans offered through the health insurance marketplace in the state. (Silver plans are popular on the marketplaces in part because they offer the greatest opportunity for subsidies for lower-income people.) In addition to high cost sharing for the drugs that are used to treat HIV/AIDS, the analysis found that some plans also require doctors to request prior authorization from the insurer for coverage of HIV drugs or place quantity limits on prescriptions. 

The analysis found, for example, that CoventryOne places all HIV drugs in the highest Tier 5, with a $1,000 deductible for prescriptions followed by 40 percent coinsurance. In contrast, Blue Cross, the insurer with the largest share of silver plans in Florida, places most HIV drugs in Tier 1 or Tier 2, with flat copayments ranging from $10 to $25 for Tier 1 and $40 to $70 for Tier 2, sometimes following a deductible, according to the analysis.

Coinsurance charges for high-tier drugs in the four insurers' plans could add up to $1,000 a month or more for some patients, says Carl Schmid, deputy executive director of the AIDS Institute.

“It’s not good for patients,” says Schmid. “People aren’t picking up their meds” because they can’t afford them.

Antiretroviral drug therapy, typically a combination of three or more drugs, is recommended for people who are infected with HIV, the virus the causes AIDs. 

The insurers say they’re in compliance with the law.

“The Coventry formularies meet ACA requirements and provide access to drugs necessary for treatment under the current clinical guidelines,” says Cynthia Michener, a spokesperson for Aetna, Coventry Health Care’s parent company.

“Cigna's marketplace exchange plans offer consumers a variety of benefit options so they can pick one that best meets their needs,” says Cigna spokesperson Karen Eldred. Humana offered a similar response. The company “offers several plan choices so members can select the one that best meets their needs and budget,” says spokesperson Alex Kepnes. 

“Preferred Medical’s coverage of HIV medications meets the requirements for coverage established by federal guidelines,” says James Card, a spokesperson for that insurer. 

The federal Centers for Medicare & Medicaid Services says it will keep tabs on discriminatory cost-sharing by conducting “outlier” analyses as part of the application process to sell plans on the federally facilitated marketplace, through which Florida and 26 other states sell plans.  

“That’s not good enough for us,” says Schmid.

States, which have primary responsibility for regulating health insurance, aren’t well equipped to police drug formularies either, say experts.

“A state insurance regulator doesn’t have the clinical expertise to know whether the common HIV drugs are covered and how they should be covered on a formulary,” says Katie Keith, director of research at the Trimpa Group, a consulting firm that works on lesbian, gay, bisexual and transgender issues. “That’s why you need strong federal guidelines.” 

The federal government hasn’t issued guidelines on the health law’s antidiscrimination provisions.  

Patients with HIV/AIDS are in a tough spot, say advocates. Even  though the health law caps total out-of-pocket spending at $6,350 in 2014, many of these patients are low income and coming up with $1,000 for a month’s worth of drugs is more than they can afford.

Advocates say they’re trying a number of different strategies to help HIV/AIDS patients. If they can show that someone got inaccurate information about a plan from a health insurance assister who helped them sign up, they may qualify for a special enrollment period that enables them to switch plans outside the regular enrollment period, says Vicki Tucci, a lawyer with the Legal Aid Society of Palm Beach County.

Tucci says she’s aware of up to 40 people who have contacted her office  after signing up with plans that placed HIV/AIDs drugs in the highest tier. Sometimes formulary information wasn’t available until after they signed up, she says.

If they can’t switch plans, Tucci says her organization can sometimes get funds from the federal Ryan White HIV/AIDS Program to pay for covered medications. As a last resort, they have disenrolled people from health plans so that they can qualify HIV/AIDS medication assistance that is available only to uninsured or underinsured people. 

“When we pull them off, they can go to the clinics and get their HIV care, but if they end up in the hospital because of diabetes or a stroke, they don’t have health coverage,” says Tucci.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Health Care

In Unhealthy Eastern Tennessee, Limited Patient Options Bring Some Of The Country’s Cheapest Premiums

Kaiser Health News - Tue, 07/08/2014 - 5:01am

CHATTANOOGA, Tenn. -- Angela Allen’s struggle to ease her neck pain has been a huge pain in the neck.

Her regular spine doctor does not accept the new insurance she bought through the federal health marketplace. Allen, who has two slipped disks in her neck vertebrae, said the closest specialist she found who would see her and take her insurance works 34 miles away in another county. She belatedly learned that her physical therapist also is out of network and she owes $900. “It’s been a nightmare,” said Allen, a 42-year-old office manager.

Yet these restrictions carry an enviable price tag. At $187 a month, Allen’s policy is cheaper than almost any other midlevel, or silver, plan in the nation. Just a few miles across the Georgia border in Catoosa County, a similar plan would cost someone Allen’s age $348—86 percent more. “These new rates are really, really good,” said Russ Blakely, a Chattanooga insurance broker.

Chattanooga’s success in achieving bargain-priced policies offers valuable lessons for other parts of the country as they seek to satisfy consumers with insurance networks that limit their choices of doctors and hospitals. Nationwide, about 70 percent of the lowest-priced plans included narrow networks, according to the consultants McKinsey & Company

But few places have put them into place as successfully as here in Eastern Tennessee, where BlueCross BlueShield of Tennessee, the area’s dominant insurer, cut a low price deal with one of the three big hospital systems to be the sole provider in their cheapest network. If all areas of the country had such low premiums, the federal government’s tab for subsidizing part of the cost of policies—totaling an estimated $29 billion for the fiscal year beginning Oct. 1—would be dramatically lower.

Low premiums here are striking because residents of Hamilton County, where Chattanooga is located, are more likely to be obese, smoke and suffer from hypertension than average, according to the Institute for Health Metrics and Evaluation, a Seattle-based research center. Yet premiums here are comparable to some of the nation’s healthiest regions: Minneapolis, Salt Lake City and Honolulu, where less demand for medical services allows for the nation’s least costly policies.

Though Chattanooga’s lowest cost silver plan is built around the well-regarded Erlanger Health System, some new buyers are miffed that the number of doctors is limited and their personal physicians are not included—even though that is a primary reason the premium is so low. Others view their new policies as adequately priced but nothing special. Still others who had been covered through a state program, where they only paid a third of the premiums, consider their new rates high in comparison.

Brian Taylor, a 36-year-old private investigator who had been uninsured, said he bought a $132 a month bronze plan with a $4,000 deductible because it was less expensive than being added to his wife’s employer-provided policy. “It’s probably a decent price, I guess, for what it covers,” said Taylor, who noted that he supported the insurance changes in the health law.

Limiting Coverage To One Hospital

Erlanger is a public health system with the region’s only academic teaching hospital. Erlanger also has the only high-level trauma center and neonatal intensive care unit in the area, so it can handle nearly all patient needs, said Henry Smith, the BlueCross executive who negotiated the contract.

“For the most part, they’ve got everything,” said Smith, the chief marketing officer. “We have backfill providers to make sure we have no services uncovered.”

Some employers who have examined the variety of offerings in Chattanooga’s market said they are impressed.  “In all honesty, the insurance is good and the premiums are outstanding,” said Philip Bryan, who owns a Georgia textile manufacturing company that employs many Tennesseans.

Bryan said before this year, few of his employees had enrolled in the insurance he offered because of the expense: about $1,700 a person or $3,400 a family a month. “That’s basically unaffordable insurance,” he said. “We went out and looked at what it would be on the Affordable Care Act [exchange] and how much it would be, and it was truly amazing. Anything we saw was low. I told my people there’s no reason for anybody here not to be insured.”

Bryan added half the cost of the marketplace premiums into workers’ paychecks and helped them sign up for coverage on those exchanges. Most of his workers—like 80 percent of Tennesseans who enrolled—qualified for taxpayer subsidies. “I only have one or two people who opted out of the thing,” he said.

Wes Mohney, an executive at the insurance firm American Exchange that helped enroll about 1,600 people in Tennessee’s marketplace, said most customers seemed pleased. “A lot of people are fine with staying in that skinny network,” he said.

For those who wanted more options, BlueCross created another network including Erlanger and Catholic Health Initiatives, which runs Memorial Hospital. While the Erlanger network offers 931 primary care practitioners and specialists, that two-hospital network gives patients access to 2,659 providers. Premiums are 11 percent more than the Erlanger-only network. In a third option, people could choose to add the for-profit HCA system, providing access to Parkridge Medical Center and 220 more practitioners. But that three-hospital network, with 2,879 providers, costs 30 percent more than does the narrowest network.

Confusion in Labeling

Andy Figlestahler, an insurance broker in nearby Cleveland, Tennessee, said many people buying policies did not understand that some plans gave them a restricted roster of providers. BlueCross labelled the narrow network policies with an “E.” The two-hospital network plans were identified with an “S” and policies with all three systems had a “P.”

“The ones I’ve run into are not real excited about the E network when they find out who they have access to,” Figlestahler said. The narrow network policies, he said, “should be in flashing letters: if they select E, buyer beware.”

BlueCross configured several plans around each network with different deductibles and other cost-sharing rules. Like many consumers, David Haynes compared several plans based on deductibles and out-of-pocket costs. “I actually chose the plan that was in the middle, and come to find out it’s on the E network,” he said. “You don’t find a whole lot of doctors for it.”

He said he has struggled to locate a new doctor to replace his old one, who is not part of the network. “I don’t know if they can get any worse than the network I’m on now,” he said. “I think this is one of the biggest boondoggles and fiascos.”

Charquette Forte chose the E network because of its price. But even though she is a nurse who works at Erlanger, she said she did not like that she had to give up her gynecologist who was not in the network. “It is what it is, but I would have preferred to have stayed with the same doctor,” she said. When enrollment begins for next year’s coverage, she said, “I may pay a little more and get a broader network.”

Allen, meanwhile, is disappointed with her new policy even though she qualified for a government subsidy. She is paying $141 a month with taxpayers picking up the remaining $46. Before, however, she participated in the state-subsidized CoverTN insurance program and paid $59 a month, while her employer and Tennessee split the remaining $117 premium.

CoverTN closed last year when the full provisions of the federal health law went into effect. “I was happy with where I was at,” Allen said.

Categories: Health Care

Pages

Subscribe to Mass Legal Services aggregator