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What’s At Stake In The Supreme Court Obamacare Case

Kaiser Health News - Tue, 04/21/2015 - 5:00am

The Affordable Care Act mandates that all Americans get health coverage or pay a penalty. To help people pay for that insurance, the federal government subsidizes insurance premiums for millions of Americans.

In just a couple of months, the Supreme Court will rule in a major case concerning those subsidies. The question is whether the law allowed for them across the country or just in the minority of states that set up their own insurance exchanges. A decision to take away those subsidies could leave millions without insurance.

Attorney Tom Goldstein, who runs SCOTUSblog, has been following the case and says the law is ambiguous. “This is a real, serious question,” he says. “The law doesn’t tell you whether Congress wanted to limit the subsidies only to those states where the state itself went to the trouble of setting up the exchange or whether Congress wanted everybody who needed the help to be able to get the subsidies.”

Louisiana is a state where a lot of people could be affected. It runs healthcare.gov and about 186,000 people there have used the site to buy health insurance. Nearly 90 percent of them in Louisiana get subsidies.

We traveled to the state to interview many of these people who could lose subsidies if the Supreme Court rules against them. Here are our first three profiles:

Carlton Scott, 63, at his house in Prairieville, Louisiana. Scott is too young for Medicare and Louisiana hasn’t expanded Medicaid, so Obamacare was a good option for him (Photo by Jeff Cohen/WNPR).

Carlton Scott
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Carlton Scott is 63. Sitting at his kitchen table at the house he owns in Prairieville, near Baton Rouge, he says he worked at a chemical plant for 30 years before he retired. He found out last fall that his company was scaling back his retiree benefits.

“’Round October they wrote me a letter saying, in December we’ll no longer be covered,” he says.

That included his health insurance, which he was really counting on.

“I thought they would take me to my grave. I really thought the company would take me to my grave,” he says. When it went away, “That pissed me off. Because, god——, I been through 30 years and you come with this bullsh–? That pissed me off.”

This story is part of a partnership that includes WNPR, NPR and Kaiser Health News. It can be republished for free. (details)

And he was in a bind. At 63 he is too young for Medicare and Louisiana hasn’t expanded Medicaid. Obamacare was a good option for him.

He signed up for a BlueCross BlueShield of Louisiana plan. He says he pays $266.99 per month, “to the penny.” Like a lot of people, he could rattle off the exact amount. Money is tight and people track their expenses carefully.

Scott could be in a position to lose his subsidy and his health insurance. He says if he had to pay more, he could for a while. He gets $2,600 a month between Social Security and his pension. But he worries about his friends.

“Everybody don’t make the same amount of money, that’s what I’m saying. I got a friend of mine, stay down the street. He gets Social Security and pension, too. But it’s not as much as mine, not half as [much].”

When asked about the case in front of the Supreme Court, he laughs.

“They all got insurance, too. I guarantee you that. They all got insurance.”

He says the court should, “Leave it like it is. I mean, what are people going to do? Get sick, go to the hospital, ‘I don’t have insurance. Won’t you please help me anyway?’ Hell, no. That ain’t going to happen,” he says.

LaTasha Perry
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LaTasha Perry is at the other end of her career. She’s 31 and works at the front desk of a community health center in Plaquemine, La. She got covered under Obamacare because it was cheaper than paying the penalty.

LaTasha Perry, 31, works at a community health center in Plaquemine, Louisiana. Perry says getting insured under Obamacare was cheaper than paying the penalty (Photo by Jeff Cohen/WNPR).

She says her children have Medicaid as their health coverage. Her job offers health insurance, but she says she can’t afford to buy it.

“I would pay at least $100 a month for the insurance here,” she says. “With my subsidy, I pay $13.”

Now she’s got money left over for necessities: “Food for my kids. I’m a single parent, so it’s hard.”
 

Charles Dalton
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Charles Dalton wanted health coverage. He’s 64 and after he retired as a paramedic, he didn’t have health insurance. Then he got sick. He says his condition is too personal to talk about. “I’m disabled,” he says. “But I would be totally incapacitated without seeing this doctor.”

Charles Dalton, 64, a retired paramedic says losing his insurance was not an option (Photo by Jeff Cohen/WNPR).

The Affordable Care Act says insurers can’t take into account whether somebody is sick, like they used to. That made insurance unavailable or unaffordable for many sick people. And now — with subsidies — Dalton says he pays $149 a month. He hopes the Supreme Court doesn’t touch the subsidies.

“They’re just going to make a difficult situation more difficult,” he explains. “Because of the Affordable Care Act, it’s helping me to be able to make this existence more livable. You’re not asking for a handout. But if you get a helping hand, the last thing you need is for it to be snatched out from under you.”

Regardless of the politics, there are a lot of people like Dalton who could feel that the Supreme Court would be taking something away. Goldstein of SCOTUSblog says the court has a tough job.

“This is a case that requires the justices to be both lawyers and try and look at the words that Congress used, but also to struggle with the human dimension of the case,” he says. “The consequences are so real and so powerful that, if the challengers win here — and maybe they deserve to win, maybe it’s what Congress intended — but it’s hard to avoid the conclusion that millions of people would lose access to health insurance.”

This story is part of a reporting partnership that includes WNPR, NPR and Kaiser Health News.

Categories: Health Care

Advocates Push For Paid Medical, Family Leave

Kaiser Health News - Tue, 04/21/2015 - 5:00am

It’s been more than 20 years since passage of the landmark Family and Medical Leave Act, which allows workers to take up to 12 weeks of unpaid time for medical or family reasons without losing their jobs. Some advocates and politicians say it’s time to plug a big hole in the law by requiring that workers get paid while they’re on leave. But the measure faces stiff opposition from some small business and other groups.

Saying the reality for many families is that both parents must work, President Barack Obama has pushed for paid family leave, calling it an “economic necessity” in his January State of the Union address. He proposed $2.2 billion in next year’s budget to help five states get paid leave programs up and running, and an additional $35 million for states to conduct planning and start-up activities.

Meanwhile, Democrats have reintroduced the Family and Medical Insurance Leave Act that would create a national paid leave program that would cover two-thirds of people’s wages for up to 60 days annually. With Republicans in control of Congress, however, there’s little chance it will pass.

Supporters say that many workers cannot afford to take unpaid leave and others aren’t eligible because they work for small employers. The law allows workers to take time off to care for a newborn or adopted child, or if they or a family member has a serious health condition. But it doesn’t apply to companies with fewer than 50 workers, and workers have to have worked for at least a year and logged at least 1,250 hours in the previous year to qualify for the benefit.

More from this series

 

Only 13 percent of workers had access to paid family leave in 2013, according to the Department of Labor’s 2014 national compensation survey. Meanwhile, 59 percent were eligible for unpaid leave in 2012, according to DOL.

State experiences with paid family leave may provide guidance for a national paid family leave law. Since passage of the federal law, four states have enacted such programs.

Three of them — California, New Jersey and Rhode Island – fund the programs entirely by withholding employees’ wages. The programs are administered by states’ unemployment insurance agencies in conjunction with temporary disability insurance programs, according to human resources consultant Mercer. (Washington state has a paid leave program on the books but it has not been implemented because legislators haven’t approved funds.)

This KHN story can be republished for free (details).

Rhode Island protects workers’ jobs if they take family leave, while the other two state programs do not. The federal law offers job protection for those working for large employers, but does not help those at small firms although other state laws may offer some protection.

California’s program is well established after more than a decade. It allows workers up to six weeks of leave annually at 55 percent of their weekly pay, up to a cap of $1,104 weekly in 2015.

When her children, now aged 5 and 2, were born, Allison Guevara took paid time off each time from her half-time job as a field representative for the American Federation of Teachers-affiliated union that represents librarians and lecturers at the University of California.

Guevara, 36, says that getting just 55 percent of her salary might have been problematic, but she was able to negotiate with her employer to use accrued vacation and sick time to make up the other 45 percent of her pay.

Altogether, she took off at least three months with pay for each baby. Her husband, who works for the city of Santa Cruz, was not so lucky. The law typically doesn’t apply to public sector employees.

“The time off was very necessary,” says Guevara. In addition to bonding with her kids, “breastfeeding was very difficult with my first one, it took eight weeks to get that going.”

Guevara stumbled upon the information about her paid leave options by accident.  That’s not surprising. A survey conducted last fall for the California Center for Research on Women and Families found that just 36 percent of Californians knew about the state’s paid leave program, a decline from three years earlier when 43 percent said they knew about the law.

“Those who know about it are those who disproportionately work for employers who already do it,” says Vicki Shabo, a vice president at the National Partnership for Women and Families. “That leaves out many lower-paid workers.”

California employers are generally positive about the paid family leave law, according to a study prepared for the U.S. Department of Labor last year. Ninety percent of employers in a 2010 survey said the law had either a positive effect on productivity, profit and morale, or it had no effect.

California, New Jersey and Rhode Island have built their programs around existing short-term paid disability program infrastructures; only five states have such disability programs in place, says Catherine Stamm, a senior associate at Mercer.

“It’s not as difficult or momentous for these employers,” Stamm says.

Under the Democrats’ bill, workers and employers would split the cost of the program, which would be administered by the Social Security administration.

But that’s a problem for small business owners, says Jack Mozloom, national media director for the National Federation of Independent Business, a trade group. Many of their members have fewer than 10 employees, Mozloom says, and if someone’s out on leave, it’s likely they have to hire a temporary worker or pay someone overtime to do the job.

Financing a paid leave program would “represent a real expense that some of them cannot absorb,” he says.

“When it’s mandated, it puts them in a hole.”

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

Categories: Health Care

New Law to Strip Social Security Numbers From Medicare Cards

Medicare -- New York Times - Tue, 04/21/2015 - 12:00am
After years of warnings about the risk of theft, a new way to identify beneficiaries will be devised under a broader measure signed last week.
Categories: Elder, Medicare

Blankets And Broth: Hypothermia The Main Medical Issue At 2015 Boston Marathon

CommonHealth (WBUR) - Mon, 04/20/2015 - 6:07pm

Lauri Perry, of Austin, Texas, is used to getting really hot when she runs. She thought she was being cautious ahead of Monday’s Boston Marathon, when she added a layer over her running top.

“I started out with something on and I threw it away at mile six because it was warmer. Then the rain started at about mile 10 or so, and then the wind got worse,” Perry said, her voice trailing off.

By the time Perry crossed the finish line on Boylston Street she was soaking wet, numb, blue and shaking.

“Uncontrollable shaking,” Perry repeated with emphasis. “I couldn’t even hold my drink because it was splashing out.”

Lauri Perry, of Austin, Texas, went into the medical tent to warm up after finishing the Boston Marathon Monday. (Martha Bebinger/WBUR)

Perry has run the Boston Marathon five times and notes with some pride that she has never needed medical assistance after the race. But Monday, when a member of the medical team asked if she wanted to step inside the big white tent, she gave in.

“I would normally say no,” Perry said, looking disappointed. “I’m a pretty strong person but I knew that I would not be able to walk all the way back to my hotel in the condition I was in.”

Perry and hundreds of runners on Monday fell victim to hypothermia, a condition where despite a runner’s hyper-exertion, their body temperature drops dangerously low. Inside a medical tent at the finish line, Perry peeled off her wet clothes and shoes and sat wrapped in multiple Mylar and cotton blankets, drinking warm fluids. But some runners needed more active warming.

“We use what’s called a ‘bear hugger,’ where you have this air flow system that goes around and warms them,” explained Dr. Pierre d’Hemecourt, co-medical director of the Boston Marathon.

Across the vast medical tent Monday afternoon there where signs of the standard post-race issues — some of the runners needed fluids or help with cramping. But for most the issue was standard hypothermia, with the body temperature of some runners falling into the low 90s.

“It’s interesting, we’re seeing more people than normal but far less acute,” d’Hemecourt said.
“It’s basically just babysitting and getting them warmed up.”

One of the medical tents filled up and had to close at one point Monday afternoon. The overflow of shivering runners were loaded onto buses to warm up. As of 5:30 p.m., 1,310 runners had been treated in the medical tents and 36 transported to area hospitals.

For d’Hemecourt, who’s been co-medical director since 2007, Monday was a first.

“I’ve never quite seen as many cold people come in at one time,” he said. “It just goes to show, every year you show up here you see something different.”

But on balance, the medical team says cold is easier on the body than heat.

Categories: Health Care

Cash-And-Carry Health Insurance For Some In Los Angeles

Kaiser Health News - Mon, 04/20/2015 - 2:44pm

The largest publicly run health plan in the nation, L.A. Care, will allow customers who do not have traditional bank accounts to pay their health insurance premiums with cash.

One in four Americans who were previously uninsured and eligible for federal insurance subsidies do not have a bank account, relying instead on pre-paid debit cards, money orders and cash to pay bills, according to a study by Jackson Hewitt Tax Service.

After advocates for low-income consumers raised concerns to the U.S. Department of Health and Human Services over how so-called ‘unbanked’ households would pay their monthly insurance premiums, the Obama administration ordered health plans to accept payment methods that didn’t require a credit card or checking account.

Starting Monday, customers of L.A. Care Covered, one of the health plans for sale on Covered California, the state’s insurance marketplace, can pay monthly premiums in cash at more than 680 locations, including 7-Eleven and Family Dollar Stores. At the register, customers scan a bar code sent to their smart phone and hand over their cash.   The payment posts to L.A. Care within 24 hours, and  the service is free to customers.

“It’s as quick as buying a Slurpee,” said Danny Shader, PayNearMe’s founder and CEO, the for-profit company that established the electronic cash transaction network.

L.A. Care, like most health insurers around the country, pays fees to Visa, MasterCard and banks to process debit and credit card transactions. Laura Jaramillo, Director of Commercial and Group Plan Operations at L.A. Care, said the health plan negotiated a similar surcharge to PayNearMe for cash payments.

This KHN story can be republished for free (details).

“It should not increase our administrative costs,” Jaramillo said. L.A. Care estimates up to 25 percent of its marketplace customers mail in money orders each month. Now, members who don’t have a bank account can pay in cash, said Jaramillo, “instead of sending us money orders.”

Some low- and moderate-income households shun bank accounts, researchers find, because checking account and overdraft fees can wreak havoc on their precarious finances. These same households, however, rely heavily on cell phones—68 percent of unbanked households have mobile phones.

L.A. Care is the first health plan to use the PayNearMe network, although the company’s method of cash collection is already in use in other ways elsewhere: By Nebraska parents who owe child support, Pittsburg water customers and bike share riders in Philadelphia who can pay cash at local convenience stores to settle bills.

“What goes in is cash, and what comes out is an electronic payment,” said Shader. “We think everybody ought to do it.”

Categories: Health Care

Traumatic Turning Point: How The Marathon Bombing Shifted One Woman’s Depression

CommonHealth (WBUR) - Mon, 04/20/2015 - 9:55am

By Annie Brewster, M.D.

Jennifer on Marathon Monday 2013, before the runners started coming in. (Courtesy)

Jennifer’s depression was deep and at times debilitating. For years, she tried various treatments but succes was always temporary.

Something changed on the finish line at the Boston Marathon in 2013. It was, Jennifer says, “a turning point” in her life, but not in the ways you might expect.

As a marathon volunteer stationed a block from where the first bomb exploded, she witnessed the confusion and terror that ensued, and played an important role in helping one scared runner reunite with his family.

After the ordeal, Jennifer felt lucky to walk away alive. Her life goals changed that day and she says she now feels it’s her responsibility to help others. She continues to find concrete ways to do so.

Listen to Jennifer here:

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She had already signed up to participate in a program at the Henry-Benson Institute of Mind-Body Medicine at Massachusetts General Hospital the week following the bombing. Primed by her experience during and after the race, she devoured the course. It deepened her sense of self-acceptance and gave her skills to manage her own depression, but also strengthened her resolve to help others. She ultimately went on to become a peer counselor at the institute.

Now, her central message is this: while we can’t necessarily control what happens to us in life, we can control the meaning we make of our experiences.

Jennifer says she’s determined to make the events of April 15, 2013, mean something, and to translate this meaning into action. As far as her depression, she has come around to recognizing “some of the good things about depression” namely her appreciation for the small things in life, and her increased sense of empathy for others. “It’s like any other illness”, she says. “It doesn’t have to limit you. It’s all about making it mean something.”

Dr. Annie Brewster, M.D., is founder and executive director of Health Story Collaborative, a nonprofit in Boston.

Categories: Health Care

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