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Must-Reads Of The Week From Brianna Labuskes

Kaiser Health News - Fri, 12/13/2019 - 1:21pm
The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

Happy Friday! If you’ve been able to tear your attention away from the soap opera that is the ever-escalating (and public and messy!) feud between HHS Secretary Alex Azar and CMS Administrator Seema Verma, you’re a better person than I. (But hey, I’m not alone — the White House itself is apparently riveted by the drama).

The week kicked off with reports that Verma had filed a claim for $47,000 worth of jewelry and other property that was stolen while she was on a work trip. Then came the accusations that HHS leaked the story and then came more accusations that Verma leaked the info that eventually brought down former HHS Secretary Tom Price.

They were both called to a meeting at the White House and told to make nice. (Oh, to have been a fly on that wall …). Because as fun as it is to watch the drama unfold, the feud seems to be derailing President Donald Trump’s health agenda during a time when that is a less-than-ideal thing to happen.

The Washington Post: Infighting Between Alex Azar, Seema Verma Stymies Trump Health Agenda

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OK, onward to the rest of the news of the week before I risk turning into a Page Six gossip column.

House Democrats passed a sweeping drug-pricing bill that would allow Medicare to negotiate drug prices, among other things. Like most bills these days, its purpose is more political than anything else — it will live a full life on the 2020 campaign trail long after it’s killed in the Senate.

The New York Times: House Votes to Give the Government the Power to Negotiate Drug Prices

Stat: Drug Pricing Bill Is a Sneak Peek at Democrats’ 2020 Campaign Message

It was all around not a great weak for drugmakers. The industry was spitting mad at what they deemed was an “unforced error” from Trump that “was a reflection of the weakness of the negotiating skills of the president.” The error? Trump stripped a 10-year exclusivity provision for biologics from the new trade deal with Mexico and Canada.  The blow to pharma is just the latest reminder that they can’t assume any wins just because a Republican is in the White House.

Stat: With New Trade Deal, Trump Deals a Blow to Drug Makers

The government’s word was on trial at the Supreme Court this week when the justices heard arguments over the health law’s “risk corridor” program. It was a slice of the financial carrot to get insurers to participate in the risky marketplaces, but then Congress stripped the funds from the budget. Insurers — who say they’re owed $12 billion — were less than pleased. The justices seemed sympathetic to the insurers, with Justice Stephen Breyer summing it up well: “Why doesn’t the government have to pay its contracts just like everybody else?”

Reuters: U.S. Supreme Court Justices Lean Toward Insurers on $12 Billion Obamacare Claims

And speaking of the health law, the IRS inadvertently ran an experiment on the importance of health coverage when it sent a letter to the nearly 4 million people who were fined because they didn’t have insurance. The letter prompted people to enroll and thus that little letter saved about 700 lives.

The New York Times: The I.R.S. Sent a Letter to 3.9 Million People. It Saved Some of Their Lives.

Back to the Supreme Court: The justices decided to leave in place a Kentucky law that requires physicians to show and describe ultrasounds to patients seeking abortions. The law requires the physicians to continue with the process even if the patient objects and shows signs of distress.

Reuters: U.S. Supreme Court Leaves in Place Kentucky Abortion Restriction

Side note: The story below is less about abortion and more about congressional committees and their inner workings, but I found it a fascinating read (at least for all you wonkish types out there).

Politico: Impeachment Committee’s Rancor Forged by Decades of Abortion Battles

South Carolina is the latest state to be granted a waiver to add work requirements to its Medicaid program. It’s the 10th one so far, but the move is still notable. That’s because, unlike other states, South Carolina never expanded the Medicaid to begin with. That means that the work-age population on its Medicaid rolls is made up almost entirely by poor mothers. Research also suggests that research found the population subject to the new requirements is disproportionately black.

The New York Times: South Carolina Is the 10th State to Impose Medicaid Work Requirements

What a roller-coaster ride this year has been for surprise medical bills. It seemed like low-hanging fruit that even in this particular Congress everyone could agree was bad. But alas, we can always find something to argue about, and progress stalled when lawmakers couldn’t agree on how to solve the problem. Then after months of stagnation, a new deal emerged (which the White House backs). How did they manage that? They actually *gasp* compromised between two of the strategies.

Bills under $750 would be paid at a default price; ones over that could be brought to arbitration, and the final price decision would be binding.

But wait, the ride isn’t over. The House Ways and Means Committee released its own version that would at first let insurers and doctors try to work out payment on their own before an arbitration system kicked in. However it all shakes out, it’s certainly not the easy bipartisan win that was expected.

The Associated Press: White House Backs Emerging Deal on Consumer Health Costs

The Hill: Ways and Means Committee Announces Rival Surprise Medical Billing Fix

South Bend, Ind., Mayor Pete Buttigieg released a list of clients he worked with during his tenure at McKinsey, a powerhouse consulting firm that has drawn fire lately for its work with the Trump administration’s immigration plans. One of Buttigieg’s clients was Blue Cross Blue Shield of Michigan, which eventually went on to lay off about 10% of its workforce. Buttigieg defended his work for the insurer, saying he was focused on administrative costs and cutting overhead expenses.

The New York Times: How Pete Buttigieg Spent His McKinsey Days: Blue Cross, Best Buy, U.S. Agencies

There was nothing particularly notable about Dr. Stephen Hahn’s confirmation process, but I’d be remiss if I didn’t include the fact that the Senate approved him as the new FDA commissioner. Hahn during his hearing sidestepped lawmakers’ attempts to pin him down on e-cigarettes, but any concerns about how he’d handle the epidemic weren’t enough to sink his ship.

The Associated Press: Senate OKs Trump’s FDA Nominee Despite Unclear Vaping Agenda

The FCC approved switching to a three-digit number (988) for the National Suicide Prevention Lifeline. Considering how clunky the old one (800-273-TALK ) was, the change has advocates celebrating. It was interesting that the FCC report had to note that the increase in costs associated with the presumed increase in calls would be offset by avoiding medical expenses such as hospitalizations or emergency department visits.

CNN: FCC Unanimously Approves Proposal for New 3-Digit Number As Suicide Prevention Hotline

A group of doctors carried out a three-day protest in front of a Border Patrol regional headquarters in San Diego. They were demanding that the agency offer flu vaccines to detained migrants — an issue made even more relevant by the fact that three children have died in U.S. custody because of the illness. But Border Patrol says it doesn’t make sense to vaccinate all the people who move through the system.

The Associated Press: Doctors End Protest to Demand Flu Vaccines for Migrants

That’s it from me! Have a great weekend.

Categories: Health Care

Watch: The House Approved H.R. 3, The Pelosi Drug Bill. What Does That Mean?

Kaiser Health News - Fri, 12/13/2019 - 11:28am

This story also ran on PBS NewsHour. This story can be republished for free (details).

KHN correspondent Emmarie Huetteman appeared on PBS NewsHour to discuss efforts on Capitol Hill to curb the cost of prescription drugs.

On Thursday, the House approved H.R. 3, the measure introduced by Speaker Nancy Pelosi. But Senate Majority Leader Mitch McConnell has signaled that he will not bring that bill to the floor.

The Senate, though, has another drug bill, this one backed by Senate Finance Committee Chair Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.). Huetteman breaks down the moving parts of these legislative proposals.

Categories: Health Care

State Highlights: Staff At NYC Hospital For Criminally Insane Voices Alarm About Relocation Plans; Advocates Wary Of Rising Rates Of Uninsured Young Children In Missouri

Kaiser Health News - Fri, 12/13/2019 - 8:48am
Media outlets report on news from New York, Missouri, Massachusetts, Mississippi, Minnesota, Illinois, Florida, Georgia, California, Oregon, Indiana, New Hampshire, Texas, and Kentucky.
Categories: Health Care

Longer Looks: A Runner’s Asthma; Choosing The End; Artificial Intelligence; And More

Kaiser Health News - Fri, 12/13/2019 - 8:48am
Each week, KHN finds interesting reads from around the Web.
Categories: Health Care

FDA Reverses Course And Approves Once-Rejected Treatment For Duchenne Muscular Dystrophy

Kaiser Health News - Fri, 12/13/2019 - 8:48am
In August, the maker of the treatment, Sarepta, said the FDA rejected the drug over the risk of infections seen in animal experiments. The new approval announcement made no mention of the prior rejection.
Categories: Health Care

‘We’re All Concerned’: Women’s Health Advocates Fault Health Care After Deaths Of 8 Inmates In Georgia

Kaiser Health News - Fri, 12/13/2019 - 8:48am
“I told them if they didn’t correct this stuff, they’d have a lot of girls who had cancer,” said Dr. Cheryl Young, an OB/GYN. “I told them that, but they didn’t want to hear it, because they didn’t want to spend the money.” News on health care for inmates is on the enormous financial gains of one doctor, as well.
Categories: Health Care

Very Odd Flu Season: It’s Highly Active Among Young Children, Getting Off To Earliest Start In Years

Kaiser Health News - Fri, 12/13/2019 - 8:48am
Another difference is the type of influenza being seen in parts of the south: Type B is preceding Type A. So far, the northeast is being spared, but it's coming, health specialists warn. Public health news is on aims to get consistent results in psychology studies, ways to reduce the risk of dying, treatment of volcano burn victims, and a potential HIV vaccine, as well.
Categories: Health Care

With Primary Care Tending To Be Pretty Cheap, This Pittsburgh Doctor Thinks Accepting Insurance Is Just Inefficient

Kaiser Health News - Fri, 12/13/2019 - 8:48am
More physicians are eschewing the traditional insurance model and opening clinics based on set fees or subscriptions. Dr. Timothy Wong talks about why he no longer accepts insurance.
Categories: Health Care

Whistleblower Investigation Finds Veterans Are Being Sent To Collection Agencies Because Of Deeply Flawed System

Kaiser Health News - Fri, 12/13/2019 - 8:48am
The errors highlight persistent issues at the VA, including failures to update antiquated computer systems and the confusion and lack of accountability that has come from an increase in the use of private health care among veterans. News from the administration also focuses on public housing, medical care for immigrants and deferred deportations.
Categories: Health Care

FCC Unanimously Approves Three-Digit Suicide Prevention Number Amid Escalating Crisis In U.S.

Kaiser Health News - Fri, 12/13/2019 - 7:19am
The easy 988 number will replace the clunkier 800-273-TALK (8255) for anyone to reach the National Suicide Prevention Lifeline. The FCC said in an earlier report that the increased costs that will come from more calls would likely be offset by avoiding medical costs such as hospitalizations or emergency department visits
Categories: Health Care

As Health Law Enrollment Deadline Nears, Remember The Insurance That Looks Too Good To Be True Probably Is

Kaiser Health News - Fri, 12/13/2019 - 7:11am
Some consumers in North Carolina are receiving robocalls that come across like ads for plans with names like "Trump Health Care" touting affordable coverage. But those options are often skimpy and don't offer even some of the basic coverage Americans have grown used to under the Affordable Care Act. The deadline for signing up for a 2020 plan is Sunday. News comes out of Georgia, Florida and California, as well.
Categories: Health Care

First Edition: December 13, 2019

Kaiser Health News - Fri, 12/13/2019 - 6:29am
Today's early morning highlights from the major news organizations.
Categories: Health Care

San Francisco Hopes To Improve Care For People With Mental Illness Living On Streets

Kaiser Health News - Fri, 12/13/2019 - 5:00am

San Francisco Mayor London Breed has promised to tackle her city’s homelessness crisis, a vexing situation involving drug abuse and mental illness that is compounded by the city’s high housing costs. Breed has asked Dr. Anton Nigusse Bland, most recently the medical director for psychiatric emergency services at Zuckerberg San Francisco General Hospital, to help solve the problem.

In March, she appointed him to the newly created position of director of mental health reform. His main role is to help the city improve its mental health and addiction treatment for people experiencing homelessness.

“I had the opportunity being there on the front lines, providing services directly to clients, to better understand and appreciate when a person has that combination of homelessness, mental illness and substance abuse,” said Nigusse Bland. He has worked in several Bay Area county mental health systems, first as an integrated care psychiatrist with Alameda Health System, then as chief of psychiatry for Contra Costa County.

The mayor backed a new state law, SB-1045, which establishes pilot programs to expand the use of conservatorship — a controversial practice that allows the city to take people with mental illness or substance abuse issues off the streets without their consent and put them into treatment.

To identify the people most in need of services, city employees used data on the 18,000 residents in need of immediate shelter. They identified about 3,700 who were experiencing what Nigusse Bland calls the “trifecta” of homelessness, mental illness and substance use. Many of them have repeatedly visited ERs or been jailed multiple times in the past year.

Of those 3,700 people, 237 were identified as immediate priorities. Nigusse Bland said the key is coordinating care to get them into housing and services they may not know are available.

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San Francisco is the only jurisdiction so far to create such a conservatorship pilot program, though the law also allows Los Angeles and San Diego counties to do so.

San Francisco officials also recently reached an agreement on how to allocate mental health funding for those with the most urgent needs. Their plan includes a 24-hour service center and an outreach team.

Nigusse Bland sat down last month with California Healthline at the San Francisco Department of Public Health in the city’s Civic Center, which has long been a hub of homelessness and open-air drug use, to talk about the daunting task facing him. His comments have been edited for space and clarity.

Q: What were some of your first steps when you took this job?

We had a couple of challenges ahead of us, one of which was being clear about who is affected by homelessness, mental illness and substance abuse and finding the root cause of why they’re having this experience right now. In this population, care coordination works, and you have to be very thoughtful about deploying evidence-based practices to get those services to those individuals.

One of the overwhelming assumptions about this group of individuals is that they’re all getting high on crystal meth, but we were surprised to learn that 95% of these people have an alcohol-related problem. The good thing is that there are many things we can do about alcohol.

Q: What services will be available to the 237 people you identified as having the most urgent needs?

Dr. Anton Nigusse Bland was recently appoint San Francisco’s new director of mental health reform to help the city improve its mental health and addiction treatment for people experiencing homelessness. (Courtesy of the San Francisco Department of Public Health)

Those individuals will receive an advanced care coordination team coupled with street responders, mental health specialists, a psychiatrist, and caseworkers who are actively reaching out to these people in the community.

If they are found in an emergency setting, we will go to that setting and help navigate them to a safe place, which might be a substance use treatment program, a mental health residential program or directly into housing.

Q: Allowing city officials to hold people against their will is controversial. What do you think about using conservatorship to treat people with mental illness or substance abuse disorders?

We have to be very thoughtful in the balance between autonomy and restoring a person’s dignity and health. It’s inhumane to allow someone to suffer on the streets with serious mental illness and substance abuse when there are alternatives available to them. In many of those cases, those individuals who are so severely affected may not even understand what’s happening to them at that moment. They’re struggling.

Through conservatorship, we have an opportunity to help restore that person’s capacity. I see it as an opportunity. In some cases, it can be the right thing to do to help that person get back on track.

Q: How will you get people the services they need given historically limited funding?

Our mayor has made a significant investment by adding over 200 new behavioral health beds into our pipeline with plans to add over 800 new beds.

We have commitments to increase the number of our intensive case managers, especially in mental health services for individuals with complex mental health and substance abuse issues.  We’ve made a commitment to reduce intensive case managers’ workloads to be able to meet the needs of these clients.

We want to make sure the ones most severely affected are getting into housing and get the support to stay in housing.

Q: How will you gauge success?

We should see changes in people experiencing homelessness, the amount of time they spend in jail and the emergency room, and their engagement in some kind of meaningful activity.

There are a couple of things that I think are going to make an impact, one of which is our Drug Sobering Center for those suffering the consequences of methamphetamine use. If someone appears confused, is having difficulty keeping their clothes on or yelling at someone, there’s a safe place that’s not jail, that’s not the emergency room, where they can recover and get counseling. And, if they’re ready, they can go into a treatment program as a next step.

That person doesn’t have to spend another night on the street and has the opportunity to get into services rather than having a jail record. And there’s the indirect impact of our emergency departments likely experiencing less crowding.

Q: What else should people know about this work?

Thirty-five percent of those 3,700 individuals in that trifecta are black and/or African American, a group that represents only 5% of San Francisco’s population, so they are disproportionately represented in the most vulnerable among us. We want to see an equitable San Francisco so everyone has a fair shot at wellness and recovery.

Sometimes that first opportunity isn’t successful and you might have to engage again to get that person on the right track, but what we know is that with every opportunity, they can make progress. It might be incremental, and it’s on their own timeline, but they can get better.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

In The Fight For Money For The Opioid Crisis, Will The Youngest Victims Be Left Out?

Kaiser Health News - Fri, 12/13/2019 - 5:00am
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Babies born to mothers who used opioids during pregnancy represent one of the most distressing legacies of an opioid epidemic that has claimed almost 400,000 lives and ravaged communities.

In fact, many of the ongoing lawsuits filed against drug companies refer to these babies, fighting through withdrawal in hospital nurseries.

The cluster of symptoms they experience, which include tremors, seizures and respiratory distress, is known as neonatal abstinence syndrome, or NAS. Until recently, doctors rarely looked for the condition. Then case numbers quadrupled over a decade. Hospital care for newborns with NAS has cost Medicaid billions of dollars.

Studies indicate more than 30,000 babies with the condition are born every year in the U.S. — about one every 15 minutes. Although their plight is mentioned in opioid-related litigation, there are growing concerns that those children will be left out of financial settlements being negotiated now.

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Robbie Nicholson, of Eagleville, Tenn., tried to comfort her second child while the baby slowly underwent withdrawal from drugs Nicholson had taken during pregnancy.

“The whole experience is just traumatizing, really,” Nicholson said.

Nicholson’s ordeal began right after her first pregnancy. To help with postpartum recovery, her doctor prescribed her a pile of Percocets. That was the norm.

“Back then, it was like I was on them for a full month. And then he was like, ‘OK, you’re done.’ And I was like, ‘Oh, my God, I’ve got a newborn, first-time mom, no energy, no sleep, like that was getting me through,'” she said. “It just built and built and built off that.”

After developing a full-blown addiction to painkillers, Nicholson eventually found her way into recovery. In accordance with evidence-based guidelines, she took buprenorphine, a medication that helps keep her opioid cravings at bay. And then came another pregnancy.

Robbie Nicholson now works as a mentor with a company called 180 Health Partners that helps women with addiction go through pregnancy. Her own newborn went through drug withdrawals, related to the medications she took to control her opioid cravings. She says most women she works with need a stable place to live and reliable transportation.(Blake Farmer/Nashville Public Radio)

But buprenorphine — as well as methadone, another drug used in medication-assisted addiction treatment — is a special kind of opioid. Its use during pregnancy can still result in withdrawal symptoms for the newborn, although increasingly physicians have decided that the benefits of keeping a mother on the medication, to prevent a potentially fatal relapse and overdose during pregnancy, outweigh the risk of her giving birth to a baby with neonatal abstinence syndrome.

Treatment protocols for NAS vary from hospital to hospital, but doctors and neonatal nurses have become better at diagnosing the condition and weaning newborns safely. Sometimes the mom and her baby can even stay together if the infant doesn’t have to be sent to the neonatal intensive care unit.

Treating The Tiniest Opioid Patients

But not much is known about the long-term effects of NAS, and parents and medical professionals worry about the future of children exposed in utero to opioids.

“I wanted her to be perfect, and she is absolutely perfect,” Nicholson said. “But in the back of my mind, it’s always going to be there.”

There are thousands of children like Nicholson’s daughter entering the education system. Dr. Stephen Patrick, a neonatologist in Nashville, Tenn., said schools and early childhood programs are on the front lines now.

“You hear teachers talking about infants with a development delay,” he said. “I just got an email this morning from somebody.”

Studies haven’t proven a direct link between in utero exposure to opioids and behavior problems in kids. And it’s challenging to untangle which problems might stem from the lingering effects of maternal drug use, as opposed to the impacts of growing up with a mother who struggles with addiction and perhaps unemployment and housing instability as well. But Patrick, who leads the Center for Child Health Policy at Vanderbilt University, said that is what his and others’ ongoing research wants to find out.

As states, cities, counties and even hospitals go after drug companies in court, Patrick fears these children will be left out. He pointed to public discussion of pending settlements and the settlement deals struck between pharmaceutical companies and the state of Oklahoma, which make little or no mention of children.

Settlement funds could be used to monitor the health of children who had NAS, to pay for treatment of any developmental problems and to help schools serving those children, Patrick explained.

“We need to be in the mix right now, in schools, understanding how we can support teachers, how we can support students as they try to learn, even as we work out [whether there was] cause and effect of opioid use and developmental delays or issues in school,” he said.

New mothers in recovery for opioid addiction meet with a support group in Oak Ridge, Tenn. Most had newborns who endured drug withdrawals at birth, known as neonatal abstinence syndrome.(Blake Farmer/Nashville Public Radio)

But it’s a nuanced problem with no consensus on where money is most needed, even among those who have worked on the problem for years.

Justin Lanning started Nashville-based 180 Health Partners, which works with mothers at risk of delivering a baby dependent on opioids. Most are covered by Medicaid. And Medicaid departments in each state pay for most of the NAS births in the U.S.

“We have a few departments in our country that can operate at an epidemic scale, and I think that’s where we have to focus our funds,” he said.

Lanning sees a need to extend government-funded insurance for new mothers, since in states like Tennessee that never expanded Medicaid, these moms can lose health coverage just two months after giving birth. That often derails the mother’s own drug treatment funded by Medicaid, he said.

“This consistency of care is so key to their recovery, to their productivity, to their thriving,” Lanning said of new mothers in recovery.

Nicholson now has a job at 180 Health Partners, assisting and mentoring pregnant women struggling with addiction. Nicholson said their biggest need is a stable place to live and reliable transportation.

“I just feel kind of hopeless,” she said. “I don’t know what to tell these women.”

There are many needs, Nicholson said, but no simple fix. Those who work with mothers in recovery fear any opioid settlement money may be spread so thin that it doesn’t benefit their children — the next generation of the crisis.

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

Categories: Health Care

Californians Without Health Insurance Will Pay A Penalty — Or Not

Kaiser Health News - Fri, 12/13/2019 - 5:00am

Californians, be warned: A new state law could make you liable for a hefty tax penalty if you do not have health insurance next year and beyond.

But some of you need not worry: The law contains several exemptions that will allow certain people to avoid the penalty, among them prisoners, low-income residents and those living abroad.

“It will be really important that people get clear guidance and instruction to make sure they don’t inadvertently pay a penalty when they are eligible for an exemption,” says Laurel Lucia, director of the Health Care Program at the University of California-Berkeley’s Center for Labor Research and Education.

California’s penalty is modeled on the one originally in the federal Affordable Care Act. Congress eliminated the federal penalty, effective this year.

The Golden State will join Massachusetts, New Jersey, Rhode Island, Vermont and Washington, D.C., in requiring their residents to have health coverage and dinging those without it.

Most types of insurance, including Medi-Cal, Medicare and employer-sponsored coverage, will satisfy California’s coverage requirement. People who purchase insurance for themselves and their families, either through Covered California, the state’s health insurance exchange, or the open market, will have until Jan. 31 to buy a health plan for 2020.

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If you aren’t covered and owe a penalty for 2020, it will be due when you file your tax return in 2021. The penalty will amount to $695 for an adult and half that much for dependent children. Some people with higher incomes instead will have to pay 2.5% of their income, which could make their penalty quite a bit heftier.

Penalty payments are expected to raise $317 million in the first year they are collected, according to the state Legislative Analyst’s Office. The money will help pay for new state subsidies intended to make insurance more affordable for some people.

You won’t have to pay the penalty if you are uninsured for three consecutive months or less during the year, or if you are incarcerated or are Native American. Likewise, if you are in the U.S. illegally.

General hardship exemptions also are available if you are facing personal or family difficulties, including homelessness, domestic violence, bankruptcy, eviction or the consequences of a natural disaster.

And you’re off the hook if your household income is below the threshold for filing a tax return. This was the most common exemption from the federal penalty, according to Internal Revenue Service data based on 2016 returns. It might be even more popular under the California law, since the state’s filing threshold is higher than the federal one, Lucia says.

You can also claim an exemption if you would have to spend more than 8.24% of your income on insurance premiums in 2020. This so-called affordability exemption was also among the most common under the federal law.

How you claim an exemption depends on the type you are seeking.

Covered California will handle three types of exemptions: religious conscience, general hardship and affordability. Each will require filling out a different application, and the applications will be available starting in January, says James Scullary, an exchange spokesman.

For other exemptions, you’ll need to apply when you file your 2020 return with the Franchise Tax Board in early 2021. A tax board spokeswoman promises that “our tax forms and instructions will include information for all exemptions claimed on the tax return.”

You can also apply to the tax board for an affordability exemption when you file your return.

Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research, says the 8.24% threshold to qualify for the affordability exemption is too high and pushes many middle-class families to pay a penalty even when they are hard-pressed to buy insurance.

Steven Morelock, a resident of Los Angeles, paid hundreds of dollars in federal penalties for several years because he felt too financially stressed to plunk down $250 a month for a high-deductible health plan. He was already shelling out nearly half of his $2,500-a-month salary in rent alone.

“I would have had to change my habits very dramatically,” says Morelock, 41, a labor organizer. “It would have cut the amount of money I had for non-fixed costs by about half.” He finally got employer-sponsored insurance late last year.

Another exemption that has stirred some debate is for membership in a health care sharing ministry — an association of religiously like-minded people, primarily Christians, who cover one another’s medical costs.

Legislators and others who opposed including this exemption in California’s law argued that the ministries are subject to little regulatory scrutiny, the coverage they offer is limited, and it’s not guaranteed. More recently, concerns have arisen about sham ministries engaged in deceptive business practices.

Dr. Dave Weldon, president of the Alliance of Health Care Sharing Ministries, acknowledges some of the limitations and says the organizations he represents “all counsel their members that this is not insurance, there’s no contract, there’s no obligation to pay.”

Bob Stedman, pictured with his wife, Teresa Stedman, and four of their five children, says his family was exempt from the federal tax penalty because of their membership in a health care sharing ministry. He plans to take the same exemption under the new California law. (Courtesy of Bob Stedman)

Bob Stedman, 55, says he and his family were exempt from the federal penalty every year because of their membership in Samaritan Ministries International. The Lake Forest, Calif., resident plans to take the same exemption under the California law.

Stedman figures he’s saving about $1,000 to $1,500 a month in premiums compared with regular insurance, and was pleased when the $50,000 bill he received following a stroke was heavily discounted by the hospital and then almost entirely covered by other ministry members. And knowing his money is not being used to finance abortions, which most commercial health plans in California are required to cover, gives him “the benefit of a clear conscience,” he says.

Weldon says the exemption is warranted on those grounds alone. “This nation has a long history of religious accommodation,” he says.

If you’re not sure whether you might qualify for an exemption, you can get more information from Covered California or the tax board.

Contact Covered California at or by phone: 800-300-1506. For the tax board, log on to or call 800-852-5711.

But don’t limit yourself to those two agencies. Insurance agents and tax preparers across the state are trying to master the details of the new law, and they can help.

For a list of insurance agents whose help is free, log on to the Covered California website and click on “find help” or go to the website of the National Association of Health Underwriters ( and hit “find an agent.” The California Society of Tax Consultants ( and the California Society of CPAs ( can help you find a tax preparer.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

Some Rejoice Over New California Health Insurance Subsidies. Others Get Shut Out.

Kaiser Health News - Thu, 12/12/2019 - 4:20pm

Syd Winlock bought one of the cheapest health insurance policies he could find for himself and his wife, Lisa, this year: a high-deductible plan with lousy coverage and a $1,500-per-month price tag.

For coverage next year, the Elk Grove, Calif., resident qualifies for new state-funded health insurance subsidies totaling about $870 per month. This aid allows him to buy a better plan with a lower deductible for about $1,200 per month.

That’s still high, he said, but any help is welcome.

“It made a huge difference,” said Winlock, 61, a small-business owner who provides accounting and point-of-sales systems to other businesses. “We were thinking that in 2020 we wouldn’t be able to keep our plan,” let alone afford an upgrade, he said.

Heather Altman, an independent environmental consultant in Long Beach, also hoped to qualify for the new state financial aid. But, after checking with a health insurance agent, she learned she won’t get anything. “At first I thought it might be a mistake,” she said. “It was disappointing.”

Starting Jan. 1, California will offer financial aid to some consumers who buy health coverage through Covered California, the state’s Affordable Care Act insurance exchange.

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Some of the subsidies will go to people who already qualify for the federal tax credits available to some Covered California consumers, primarily those with low incomes. But the assistance will also be extended to middle-income people such as Winlock who make too much money to qualify for the federal tax credits and have had to bear the entire cost of their premiums. California will be the first state to offer such help to middle-class consumers.

With open enrollment for Covered California going full steam — sign-ups for 2020 coverage end Jan. 31 — consumers are eagerly trying to determine whether they might qualify for the new aid and, if so, how much.

The results are mixed.

“It’s brought higher-income earners to call me, but most still earn too much” to qualify, said Kevin Knauss, a Sacramento-area insurance agent who also has clients in Los Angeles and the Bay Area. “Others are picking up $15 to $25.”

More than 486,000 people have already qualified for the new state subsidies, with more expected as open enrollment continues, Covered California announced Thursday. This includes about 23,000 middle-income enrollees who make too much to qualify for federal tax credits, said Covered California Executive Director Peter Lee.

Lee added that new enrollment is up by 16% compared with this time last year, largely due to the new state financial aid and insurance requirement.

This “is a small slice of who will sign up,” he said. “We’re optimistic there will be many, many more people covered by these state subsidies for the middle class.”

Earlier this year, Gov. Gavin Newsom signed a 2019-20 state budget that includes nearly $429 million for the subsidies. To help pay for them, the state is imposing a tax penalty starting next year on people who don’t have health insurance — similar to the federal penalty the Republican-controlled Congress eliminated effective this year.

Covered California has estimated that nearly 1 million Californians could benefit from the new state money.

Some of the aid will go to low- and moderate-income people who earn between 200% and 400% of the federal poverty level, or roughly $25,000 to $50,000 for an individual and $51,500 to $103,000 for a family of four, based on 2019 figures. This group also qualifies for federal tax credits. The average household state subsidy in this category would be $21 a month, Covered California estimates.

The majority of the state assistance, however, will go to people whose incomes are between 400% and 600% of the poverty level — too high for federal aid but still low enough to make health care financially challenging. That’s between about $50,000 and $75,000 a year for an individual and $103,000 to $154,500 for a family of four. The average state assistance for this group will be about $460 a month, according to Covered California.

But falling into this income bracket doesn’t guarantee subsidies, as Altman learned.

She estimated she will make $60,000 next year, which puts her within the income range to qualify as an individual, but she won’t be getting any aid, and she doesn’t quite understand why.

Besides income, household size, location and age play a role in eligibility for the subsidies, Covered California’s Lee explained. For example, older people who live in areas with high health care costs have a higher chance of getting help, he said.

Altman, 47, who has severe asthma and is on multiple medications, said she can’t go without coverage, so she will pay $640 every month for a health plan next year, up $70 from this year.

“I was just glad that it was only an 11% increase,” she said. “In previous years, I’ve seen a 20-something percent increase.”

Winlock said he feels grateful he qualified for the state financial aid because it allowed him to buy a better plan. Now he can seek care that he has been avoiding.

“We’re pretty healthy, and I’m very active, but I do have an issue with arthritis that I haven’t been pursuing because just testing alone is very expensive,” he said.

Evette Tsang, an insurance agent in Sacramento, said that while news of financial aid is driving some customers to her office, the new insurance requirement — and the accompanying tax penalty — are ultimately motivating most people to sign up.

People who don’t have insurance in 2020 will have to pay the penalty when they file their state tax returns in 2021. The penalty will amount to $695 for an adult and half that much for dependent children. Some people with higher incomes instead will have to pay 2.5% of their income, which could make their penalty quite a bit heftier.

Tsang saw clients drop their coverage when the federal penalty was eliminated. “Now they’re coming back,” she said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

KHN’s ‘What The Health?’: Legislate-A-Palooza

Kaiser Health News - Thu, 12/12/2019 - 3:15pm
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Mary Agnes Carey

Kaiser Health News


Read Mary Agnes' Stories Emmarie Huetteman

Kaiser Health News


Read Emmarie's Stories Joanne Kenen



Read Joanne's Stories Kimberly Leonard

Washington Examiner


Read Kimberly's Stories

The House overwhelmingly passed a 2020 National Defense Authorization that included a provision that would give 12 weeks of paid parental leave for federal workers. The measure is expected to pass the Senate, and President Donald Trump has said he would sign the measure ― a priority for his daughter and special adviser Ivanka Trump ― into law.

Meanwhile, the bipartisan leadership of key health care committees on Capitol Hill announced compromise legislation to address “surprise” medical bills, but a deal on a final package is far from clear. The House passed Speaker Nancy Pelosi’s package to lower prescription drug costs, but the measure is dead on arrival in the Senate, where a bipartisan proposal from leaders of the Senate Finance Committee is pending.

This week’s panelists are Mary Agnes Carey from Kaiser Health News, Kimberly Leonard of the Washington Examiner, Joanne Kenen of Politico and Emmarie Huetteman of Kaiser Health News.

Among the takeaways from this week’s podcast:

  • The House passed a defense measure that includes 12 weeks of paid parental leave — which represents the biggest change to family leave policy since the Clinton administration. It also highlights a rare case of bipartisanship. The measure is on track to clear the Senate, and Trump has said he would sign it into law. The legislation would put parental leave benefits for federal employees more in line with those for military personnel. Federal employees’ benefits are more narrow, though.
  • There has been lots of talk and now maybe some Capitol Hill movement on the topic of surprise medical bill legislation. Earlier this week, the bipartisan leadership of the House Energy and Commerce Committee and the Republican leader of the Senate Health, Education, Labor and Pensions Committee (HELP) announced a compromise measure to curb these often-high unexpected bills. Midweek, the House Ways and Means Committee also announced that it had come to terms on an approach. These are clear signs of progress. What is not clear is when all the parties will coalesce. Key players, such as HELP ranking member Patty Murray (D-Wash.) and Senate Minority Leader Chuck Schumer, have yet to sign on. If a plan doesn’t crystallize in the immediate future, Congress will likely tackle it during the first few months of 2020.
  • Even as the podcast was being taped, the House was taking up H.R. 3, the drug-pricing bill backed by Pelosi. The measure is expected to pass the House easily with Democratic support. But Senate Majority Leader Mitch McConnell has said it will not get a vote on the Senate floor. This is an interesting issue because the problem of the high cost of prescription drugs has the attention of Democrats, Republicans and the White House. House passage could create momentum in the Senate to address the issue through another measure, this one drafted by Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.).
  • The feud between Centers for Medicare & Medicaid Services Administrator Seema Verma and Health and Human Services Secretary Alex Azar continues. The two officials were called this week for White House meetings, but the battle has been open, public and vituperative, and policy areas ― such as the administration’s plan for an Affordable Care Act replacement as well as for high drug costs ― have been affected.
  • Open enrollment for coverage under the Affordable Care Act, or ACA, expires Sunday. So far this year, enrollment is a bit behind last year’s pace. Important reminders: There is automatic enrollment for people who don’t opt for another plan and, if history holds, there will be a last-minute enrollment rush before the deadline.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Mary Agnes Carey: The Washington Post’s “A Stunning Indictment of the U.S. Health-Care System, in One Chart,” by Christopher Ingraham

Joanne Kenen: Politico’s “Impeachment Committee’s Rancor Forged by Decades of Abortion Battles,” by Alice Miranda Ollstein

Kimberly Leonard: Undark’s “Wheelchairs on Planes: Why Can’t Passengers Use Their Own Onboard?” by Michael Schulson. The story appeared on NPR Shots.

Emmarie Huetteman: The New York Times’ “The I.R.S. Sent a Letter to 3.9 Million People. It Saved Some of Their Lives.” by Sarah Kliff

To hear all our podcasts, click here.

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Categories: Health Care

Research Roundup: Charitable Food Assistance; Bias In Medical Research; Developmental Milestones; And More

Kaiser Health News - Thu, 12/12/2019 - 8:49am
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Categories: Health Care


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