HEALTH CARE - Persuading the Young on ACA Enrollment

"Administration Plays to Young in Health Push" by MICHAEL D. SHEAR and TANZINA VEGA, New York Times 3/19/2014

Russian troops were rolling through Crimea when Denis R. McDonough, the White House chief of staff and a foreign policy expert, was deployed on a mission to do media outreach.  But the focus of Mr. McDonough’s calls to local talk radio stations was not geopolitical tensions in Eastern Europe, it was health care.

Mr. McDonough chatted with Andy Baskin and Jeff Phelps, hosts of a popular sports talk radio program on WKRK-FM (92.3) in Cleveland, about the coming N.F.L. draft, basketball at the White House and his days playing college football in Minnesota.  Mr. McDonough then pitched a new website featuring games, videos and superstar athletes explaining the benefits of health insurance: a sports-themed portal to HealthCare.gov.

“We’ve all seen it happen,” said Mr. McDonough, promoting the portal, GamePlan4Me, to the hosts of “Baskin & Phelps” and their mostly young, mostly male audience.  “Somebody’s playing hoops, and they blow out a knee or something.  And then all of a sudden, if you don’t have health care, you’re going to bankrupt yourself.”

Persuading millions of young people — especially African-Americans and Latinos — to buy insurance using HealthCare.gov is consuming every spare moment at the White House as President Obama and his aides race against a March 31 deadline, when enrollment ends for the year.  They are waging their final public relations push with a zeal that underscores how critical success is for Mr. Obama’s political legacy, and how far behind they remain.

Officials have scaled back their original estimate of signing up seven million people, to six million.  But according to enrollment figures released Monday, more than one million sign-ups will be needed to reach the reduced goal by the end of March.  And there is concern that the administration still needs a larger proportion of 18- to 34-year-olds, the young and presumably healthy people whom insurance companies need as customers in order to keep premiums reasonable for everyone.

In an effort to reach young men, the White House is trying to turn March Madness into a frenzy about health care coverage as well as basketball.  Mr. Obama’s N.C.A.A. tournament bracket, released on Wednesday, was accompanied by a “16 Sweetest Reasons to Get Covered” bracket. LeBron James, the Miami Heat star forward, is starring in 30-second ads promoting HealthCare.gov that will air during the college basketball games.

On Thursday, Mr. Obama will urge daytime TV viewers to sign up for coverage in an appearance on “The Ellen DeGeneres Show” from the White House.  In the past three weeks, Mr. Obama has met with YouTube personalities in the Roosevelt Room, hosting some of the younger generation’s online favorites: a science geek, a drunken chef and an Obama impersonator.  He dialed into Rickey Smiley’s hip-hop radio show and sat down in the Diplomatic Reception Room for separate interviews with the comedian Zach Galifianakis and a health care expert from WebMD.

“We are going to leave no stone unturned,” said Valerie Jarrett, a senior adviser to the president and the leader of the White House public engagement office, which is coordinating the Affordable Care Act effort.  “Our goal is to meet people where they are.”

Michelle Obama, the first lady, urged people to sign up in an appearance at a health center in a black neighborhood in Miami, and made the pitch on ABC’s “Good Morning America.”  Vice President Joseph R. Biden Jr. plugged the health care site at Mary Mac’s Tea Room in Atlanta.

From January until the end of March, the Centers for Medicare and Medicaid Services, which runs the HealthCare.gov site and administers the Affordable Care Act, will have spent $52 million on paid media, officials said.  Conservative opponents of the law have concentrated their spending on ads focusing on Democratic candidates and sowing doubts about the viability of the law.

The final push comes at a time when the administration is juggling other priorities.  On March 6, at the height of the crisis in Ukraine, Mr. Obama spoke on the phone with President Vladimir V. Putin of Russia for an hour before going across town to urge Latinos to enroll during a town-hall-style meeting at a museum broadcast on three Spanish-language television networks.  He returned to the White House a couple of hours later to announce the first sanctions on Russia.

“We’ve organized our outreach in a way so we can take care of the non-A.C.A. business that needs to be taken care of while devoting a great deal of time and energy to this effort,” Ms. Jarrett said.

Outside of Washington, the president’s allies are staging a final surge to enroll as many people as possible.

The targets in the last few days of the campaign are young people and minorities, with a particular focus on Hispanic and black youths — two crucial groups that are more likely to be underinsured, officials said.  On a conference call last week with almost 3,000 pastors, Mr. Obama declared it “crunchtime” and asked them to do whatever they could do to urge members of their churches to sign up.

At a small church in the Tampa, Fla., neighborhood of Sulphur Springs, the Rev. Timothy Wynn took up the challenge on Sunday.  In front of about 50 parishioners, he delivered a sermon that combined his religious guidance with a pitch for insurance.

“I know you came here for the word of God, and I’m going to give you the word of God,” he said.  But before delivering that word, the pastor asked his parishioners, most of whom are black, to take out their cellphones and text friends to remind them to come to the church and sign up.  He also asked them to go to the church’s Facebook page and “like” an open-enrollment flier there.

“Can you do that for me?” he said.  “God not only cares about our spiritual being, he cares about our physical being as well.”

At the back of the church, All Nations Outreach Center, two health care “navigators” were positioned at tables with stickers and information pamphlets about how to sign up.  At the end of the service, about 10 people stopped to ask questions.

Tiffany Pate, 33, a hairstylist in Brandon, Fla., who was the sole person to enroll on site, said that while she already had health insurance, her new plan would save her $50 a month.  “It made sense,” she said of the switch.

In addition to trying to galvanize clergy and black mayors around the country, the Obama administration has been working hard to attract African-Americans and Hispanics through such media efforts as interviews on popular black and Hispanic radio programs like “The Steve Harvey Morning Show” and “Erazno y La Chokolata,” a Spanish-language program based in Los Angeles.  It has also begun social media campaigns in English and Spanish and hosted Google chats.

“People get busy in their daily lives,” Ms. Jarrett said.  “But as you approach a deadline, it’s easier to get people’s attention and say, ‘OK, come on now, you only have a few weeks left.  It’s time to get serious about this, go on the website, explore your options and sign up.’ ”

Though the administration is spending heavily on airtime, it is also courting unpaid endorsements that might go viral on the Internet.  In late February, nine stars of hit YouTube videos were invited to a conversation about health care at the White House.  Among them was Michael Stevens, the star of “Vsauce,” a popular video show about science that regularly gets millions of views online.

“The 15- to 35-year-old group is the heart of my audience,” Mr. Stevens said in an interview.  “The White House made it clear they want to talk to everyone.”

His wonky videos ask questions like “Why do we kiss?” and “What if you were born in space?”  He is working on a special video about the science of assessing risk — and the need for insurance.

Another YouTube star at the meeting was Hannah Hart, whose show “My Drunk Kitchen” is irreverent and hugely popular.  An episode about making a grilled cheese sandwich while tipsy has gotten more than three million views, and a brunch episode, during which Ms. Hart repeatedly downs mimosas as she cooks pancakes and eggs, has gotten two million.  In a video she made after leaving the White House meeting, Ms. Hart plugged the president’s website for her viewers.

“If you want to show your body that you love yourself, go ahead and sign up for health insurance at HealthCare.gov,” she said.

“I’m simply talking to all my friends who are independent business professionals who think they are going to live forever,” she continued.  “Get covered!”

Since it was posted on March 4, her video has been seen about 250,000 times.

ACA HEALTH CARE - Is the Federal Exchange Site Ready?

"Is healthcare.gov ready for its close-up?" PBS Newshour 11/30/2013

Excerpt

HARI SREENIVASAN (Newshour):  Starting tomorrow administration officials hope the website will be able to service as many of 50,000 Americans at once.  Their goal is to sign up seven million people by the end of March.  For more about all this we are joined by Sharon Pettypiece, she’s a healthcare reporter for Bloomberg News who has worked the beat for the past decade.

Thanks for joining us.

It’s odd for me to be almost asking for a website update – but how is it doing?  Is it better than those problems we heard about?

SHANNON PETTYPIECE:  Well, it’s better than October 1st, that’s for sure but that doesn’t mean too much because if you remember October 1st, people were logging on and not getting past the homepage.  They have been making progress.  But as of (late) last week, myself and my colleagues were out talking to people – talking to consumers; talking to insurance brokers; talking to non-profits that were trying to sign people up – they were saying that this site is still in pretty rough shape.  A couple people gave it four out of ten as far as its functioning, obviously ten being the best.

One of the problems we’re hearing about most from people is that though the site has improved and now you can get to the last step – you can create an account, shop around for plans, find out if you are eligible for subsidies – but you get to the point where you say ‘OK, I’m ready to buy insurance,’ which if you recall is the whole point of this website, that’s where it locks up.  That’s where it breaks down.  So only a trickle of people is actually being able to buy an insurance plan.

ACA HEALTH CARE - Reactions Series Part 3, Sick Americans

"Sick Americans find solace in health reform's pre-existing conditions guarantee" PBS Newshour 11/13/2013

Excerpt

GWEN IFILL (Newshour):  That brings us to another chapter in our series featuring reactions to the Affordable Care Act, as more people become aware of the details.

Yesterday, we aired the story of a Washington, D.C., lawyer who was angry that her current insurance policy had been canceled.

Tonight, we hear from a Colorado woman who was diagnosed with cancer just before her husband lost his job and his health care plan.

Here's some of what she told us:

ACA HEALTH CARE - Kentucky's Example of How It Should Work

"For Uninsured, Clearing a Way to Enrollment" by ABBY GOODNOUGH, New York Times 11/4/2013

Excerpt

Kelli Cauley’s fingers raced over her keyboard as she asked the anxious woman at her side a series of questions.  What was her income?  How many people lived in her household?  Did she smoke?  (“That’s the only health question it asks,” Ms. Cauley said of the application they were completing.)

The woman, a thin 61-year-old who refused to give her name, citing privacy concerns, had come to the public library here to sign up for health insurance through Kentucky’s new online exchange.  She had a painful lump on the back of her hand and other health problems that worried her deeply, she said, but had been unable to afford insurance as a home health care worker who earns $9 an hour.

Within a minute, the system checked her information and flashed its conclusion on Ms. Cauley’s laptop: eligible for Medicaid.  The woman began to weep with relief.  Without insurance, she said as she left, “it’s cheaper to die.”

Known as “navigators” or “assisters,” people like Ms. Cauley are going to work across the country, searching for the uninsured and walking them through the enrollment process.  Under the Affordable Care Act, these trained, paid counselors typically work for community groups or government agencies, with a mandate to provide impartial guidance.  Given the problems plaguing the federal online insurance exchange used by 36 states, the workers have become even more important in helping people understand their insurance options.

But in Kentucky and some of the 13 other states that have their own exchanges, which in general are running more smoothly than the federal site, watching navigators on the job also provides the clearest view yet of how enrollment could work once the technical problems of HealthCare.gov are resolved.

President Obama and proponents of the health care law have held up Kentucky in recent weeks as a model for the national enrollment effort.  The state is far ahead of most of the nation in signing up people: As of Nov. 1, more than 27,854 Kentuckians had enrolled in Medicaid under the law’s expansion of that program, and 4,631 had signed up for private plans through the state-run exchange, known as Kynect.  The state says it is enrolling 1,000 people a day.

In contrast to the federally run exchange with all its problems, Kynect has had relatively few — for several reasons, Kentucky officials said.  The primary contractor, Deloitte, worked closely with the state agency that runs health programs, ensuring guidance and oversight.  Unlike the federal government, the state tested its online exchange early and often, so problems were addressed before the website went live.  And people can check whether they qualify for Medicaid or subsidies without creating an account, a requirement that caused huge bottlenecks on the federal exchange.

While most states lack enough navigators to reach all who need help, Kentucky is spending $11 million in federal money to promote its exchange, and it shows: Ads for Kynect blanket television and radio, city buses and highway billboards in Louisville.

“Compared to other states, we’re sitting pretty,” said Jacquelynn Engle, who is overseeing the sign-up effort at Family Health Centers, a network of seven clinics in Louisville that treats thousands of the city’s uninsured.  The clinics enrolled 421 people in October and helped an additional 260 start the application process.  Officials in Louisville, a city of 600,000, have set a goal of enrolling about 29,000 people in Medicaid and 27,000 more in private plans by mid-2014.

So far, a total of 5,200 have signed up in Jefferson County, which includes Louisville, far more than in any other county in the state.

Still, the first month’s tally barely starts Kentucky on the path toward enrolling the 640,000 uninsured residents in the state who are eligible for health coverage, a goal that Gov. Steven L. Beshear, a Democrat, has said is urgent because the state has high rates for smoking and obesity, among other health problems.  And if Medicaid sign-ups continue to far outpace enrollments in private exchange plans, with only the sickest people buying private coverage, the cost of premiums could rise.

Though people can sign up on their own, navigators can help those confused by the sea of insurance options.  The navigators listen to people voice their hopes and fears about the law, and their hard stories about being uninsured.  Often hugs are exchanged.  Sometimes tears flow.

ACA HEALTH CARE- Winners and Losers

"A Month in to Healthcare.gov, Real-Life Winners and Losers" by Charles Ornstein, ProPublica 11/1/2013

Chart from Economist Justin Wolfers says it all:

"Under Health Care Act, Millions Eligible for Free Policies" by REED ABELSON and KATIE THOMAS, New York Times 11/3/2013

Excerpt

Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs.

Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.

The bulk of these plans are so-called bronze policies, the least expensive available.  They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.

Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available.  A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company.

The latest analysis was conducted by McKinsey’s Center for U.S. Health System Reform, whose independent research has been cited by the federal government and others.

“The whole point of the law was not only to cover the uninsured, but so people didn’t have to make choices between food or drugs, or going to the doctor or dentist,” said Karen Davis, a health policy expert at the Johns Hopkins Bloomberg School of Public Health.  “It’s what it is designed to do.”

Many insurers tried to price their least expensive plans so they would become free or nearly free with the addition of subsidies that are set based on a person’s income and the cost of a midlevel, or silver, plan.

POLITICS - Secretary Sebelius Before U.S. House Committee

"Sebelius apologizes over website launch 'debacle' but contends it is secure" PBS Newshour 10/30/2013

Excerpt

KWAME HOLMAN (Newshour):  For Secretary Sebelius, the first order of business before the Energy and Commerce Committee was mea culpa.

KATHLEEN SEBELIUS, U.S. Health and Human Services:  I am as frustrated and angry as anyone with the flawed launch of healthcare.gov.  So, let me say directly to these Americans:  You deserve better.  I apologize.  I am accountable to you for fixing these problems, and I'm committed to earning your confidence back by fixing the site.

KWAME HOLMAN:  But Sebelius faced new questions that go beyond technical problems on the website.  They involve a government memo showing, before the site launched on October 1, Medicare officials worried inadequate testing left it vulnerable to security breaches.

REP. MIKE ROGERS, R-Mich.:  You allowed the system to go forward with no encryption on backup systems.  They had no encryption on certain boundary crossings.

You accepted a risk on behalf of every user of this computer that put their personal financial information at risk because you didn't even have the most basic end-to-end tests on security of the system.  Amazon would never do this.  ProFlowers would never do this.  Kayak would never do this.  This is completely an unacceptable level of security.

COMMENT:  Before I fully retired I worked for two companies (9yrs & 5yrs) where the companies change health insurers twice.  Which meant I had to choose new doctors, etc.  So having health coverage canceled for those who buy on there own should not be a surprise, especially with the new minimums on what is covered, and more coverage would mean higher premiums.

The mistake Obama made is the choice of words.  He should have said, "If you like your health insurance provider, you can keep them," which does not imply the same plan at the same price.

"President Obama defends ACA benefits, confronts cancellation claims" PBS Newshour 10/30/2013

Excerpt

SUMMARY:  President Obama told a crowd in Boston that he is "not happy" about the rocky HealthCare.gov rollout, but assured Americans the site would be fixed as soon as possible.  The president also touted the benefits of the ACA and disputed claims that health care reform has caused some insurance plans to be cancelled.

HEALTH EXCHANGES - Spin From Medicare Chief Marilyn Tavenner

"Congress grills Medicare head as some insurance holders get cancellation notices" PBS Newshour 10/29/2013

Excerpt

SUMMARY:  Medicare chief Marilyn Tavenner faced questions on Capitol Hill about the rocky rollout of HealthCare.gov and the administration's proposed timeline for fixes.  Kwame Holman reports.  Jonathan Gruber of MIT and industry consultant Robert Laszewski join Gwen Ifill for more on Americans whose insurance policies are being canceled.

MARILYN TAVENNER, Centers for Medicare and Medicaid Services:  To the millions of Americans who have attempted to use healthcare.gov to shop and enroll in health care coverage, I want to apologize to you that the website has not worked as well as it should.

KWAME HOLMAN (Newshour):  At the outset, health program administrator Marilyn Tavenner acknowledged the myriad problems with the federal exchange website that launched Oct. 1.

But she ran into Republican skeptics over the administration's new timeline to fix the computer access roadblocks by the end of November.

REP. KEVIN BRADY, R-Tex.:  You had nearly four years to get it ready.  Now you're saying, in four weeks more, it will be great.  So what's different?  Why should anyone believe these claims?

MARILYN TAVENNER:  Because I think we have identified two major problems.  One had to do with the initial volume.  And despite our best volume projections, we underestimated the volume, the interest in the site.  The second thing is, we have found some what I will call functional or glitches, as we call them in the public term, in the actual application itself, which we're repairing.

Like I said, spin.

FEDERAL HEALTH EXCHANGE - The Blame Finger Pointing Starts

"HealthCare.gov contractors testify they warned of glitch risks before launch" PBS Newshour 10/24/2013

Excerpts

ANDREW SLAVITT, OPTUM/QSSI:  We did fully talk about the risks that we saw, and we passed those along all along the way.

HARI SREENIVASAN (Newshour):  Contractors who developed healthcare.gov insisted today that they warned the Centers for Medicare and Medicaid Services about not fully testing the system before it went live October 1.  Andrew Slavitt with QSSI and Cheryl Campbell of CGI Federal told Republican Greg Walden of Oregon that they were pressed for time.

REP. GREG WALDEN, R-Ore.:  What's the standard protocol?  What's the recommended industry standard for end-to-end tests before rolling up a major website like this?

ANDREW SLAVITT:  Months would be nice.

GREG WALDEN:  Months would be nice.

Ms. Campbell, is that accurate for your company as well?

CHERYL CAMPBELL, CGI Federal:  That's correct.

GREG WALDEN:  And you were given two weeks, and yet months would have been nice?
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HARI SREENIVASAN:  Campbell said that CMS made the ultimate call to go ahead.

CHERYL CAMPBELL:  We're there to support our client.  It is not our position to tell our client whether they should go live or not go live.

BS - If software is not ready, a responsible company DOES say no, an irresponsible company says yes.

AFFORDABLE CARE ACT - Federal Health Insurance Exchange Web Site Fix?

Being a retired Computer Specialist and IT Technician, with some experience in programming, weather or not a 'fix' adds more complication has to do with WHO actually does the fix.

One potential problem I can see today is putting a political manager in charge of fixing Obama Care.  A person with experience in computer and system ENGINEERING should be in charge.

A manager is NOT what is needed.

PS:  The type of testing in the discussions is called Beta-Testing, so consumers are Beta-Testers.

"Will the rush to correct the health care website problems add more complication?" PBS Newshour 10/23/2013

Excerpt

SUMMARY:  The Obama administration has said it is making efforts to improve the health care website, but tech experts warn the problems are far from fixed.  For more on what contributed to the flawed launch and the challenges ahead, Hari Sreenivasan speaks with John Engates of RackSpace and Bill Curtis of CAST Software.

HEALTH CARE - Federal Exchange Overload Problem

Note that the problems have nothing to do with 'Obama Care' law, these are technical problems due to the unexpected demand when insurance exchanges first opened for business.  The software/hardware engineers just underestimated the demand, which was really dumb.  With all the anti-Obama-Care scare tactics people were stampeded into trying to sigh-up fast, when in fact there is plenty of time to do so.

Note that the state-run exchanges are working just fine.  This overload problem is with the Federal site, which in turn is due to all the states who did NOT setup their own site (which would have spread the demand load).

"Glitches far from fixed for online insurance exchange shoppers" PBS Newshour 10/18/2013

Excerpt

SUMMARY:  Beset with glitches and registration problems, the launch of the online insurance exchanges at the start of October were rockier than expected.  For an update on the status of the site and user experiences, Ray Suarez talks to Sarah Kliff of The Washington Post and Louise Radnofsky of The Wall Street Journal.

JUDY WOODRUFF (Newshour):  Now, as the federal government restarts its engines and the debt ceiling battle fades away, we return to the matter that triggered Republican anger at the outset: the rollout of the health insurance exchanges mandated by the Affordable Care Act.

The online launch of the federal version, a marketplace at healthcare.gov that operates in more than 35 states, has been beset by glitches.

OPINION - Shields and Brooks 10/18/2013

"Shields and Brooks on who will come out ahead after the shutdown 'cease-fire'" PBS Newshour 10/18/2013

Excerpt

SUMMARY:  Syndicated columnist Mark Shields and New York Times columnist David Brooks join Judy Woodruff to discuss the week's top political news, including outcomes of the shutdown fight for the Republican party and the president, the outlook for the online insurance exchanges, plus remembrances of former House Speaker Tom Foley.

MARK SHIELDS, syndicated columnist:  Tom Foley, I heard him say time and again, you are the speaker of the House.  There were only two -- he was a great historian, scholar.  He said, there are only two offices that are defined in the Constitution, the president of the United States and the speaker of the House.

And he said, you're not speaker of a party.

HEALTH INSURANCE EXCHANGES - Preventive Services With No Co-Pay (Series Part 8)

"Under the Affordable Care Act, preventive services with no co-pay" PBS Newshour 10/5/2013

Excerpts

SUMMARY:  The new health care law has given one little known agency the power to mandate insurance companies to provide certain preventive services.  Find out what the U.S. Preventive Services Task Force (USPSTF) might have to say about your next visit to the doctor.  Doctor Emily Senay reports.
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EMILY SENAY:  The group operated with little notice for nearly 30 years…using letter grades to recommend to primary care physicians which preventive services to offer their patients and what insurance companies.

Before the affordable care act was passed in 2010, an “A” or a “B” grade was only a recommendation.

But under the new law, either of those grades now requires private insurance companies and Medicare to pick up 100 percent of the costs.

Doctor Virginia Moyer is the chair of the task force.

VIRGINIA MOYER:  The Affordable Care Act includes a provision that says that, ‘any recommendation that receives an A or B grade from the U.S. Preventive Services Task Force is paid for first dollar,’ so no copay for those recommendations.

Since the passage of the Affordable Care Act, the Task Force has recommended more than a dozen preventive services:  screenings for HIV, cervical cancer and osteoporosis, as well as counseling for obesity and tobacco use, along with vision screenings for children.

People, who need these preventive services, can now get them within their insurance networks fully covered.

VIRGINIA MOYER:  A preventive service is something that is intended to keep something bad from happening.  What we do as a task force is we carefully evaluate the science, the science that tells us whether a preventive service is going to benefit people.
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EMILY SENAY:  And the decision of insurance companies like AETNA has been to stick with the task force says.  Doctor Lonny Reisman is its chief medical officer.

DR. LONNY REISMAN:  We've mostly covered all of the mandates already.  So they're baked into our premiums, and we're not expecting a significant increase in costs.

EMILY SENAY:  But he says the real financial challenge will be to manage costs and at the same time satisfy customers as more services are mandated in coming years.

DR. LONNY REISMAN:  We are compelled to cover it, we are committed to covering it.  And any increases in costs will be covered in our premiums, but we will explain the basis for in fact increasing premiums as a result of increasing medical costs.

EMILY SENAY:  That could mean no out of pocket expenses for preventive services at the doctor’s office…but higher insurance bills for consumers.
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DR VIRGINIA MOYER:  We want to be independent and we want our recommendations to be based on science, not politics.  If you look at our website, it ends in .org.  It doesn't end in .gov, so we're an independent panel.  We are epidemiologists and primary care clinicians.  We are not policymakers (aka politicians).
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BARBARA HILLARY:  Living is not inhaling and exhaling.  Living is-- you know you feel it.  And if you don't feel it, baby you ain't livin'.

Barbara's comment is philosophy of the day.

HEALTH INSURANCE EXCHANGES - Opening Day Rush (Series Part 7)

"Examining affordability of health care via more accessible new exchanges" PBS Newshour 10/2/2013

Excerpt

SUMMARY:  In its opening days, the new online insurance exchanges have experienced a rush of interest and some technical difficulties along the way.  Despite the glitches, will consumers find affordable plans?  Gwen Ifill gets views from Sabrina Corlette of Georgetown University and Joe Antos of the American Enterprise Institute.

CALIFORNIA - Educating Latinos on Health Insurance Exchanges

"California Reaches Out to Educate Latino Community on New Insurance Exchange" PBS Newshour 9/30/2013

Excerpt

JUDY WOODRUFF (Newshour):  As we heard earlier, even with a possible government shutdown looming tonight over the fate of the health care law, one thing won't change: Money to implement the law has already been allocated.

And, tomorrow, the federal government and 16 states are poised to open new online insurance marketplaces.

One of the key groups being targeted for enrollment, Latinos, who make up a third of the uninsured nationwide.

Kwame Holman reports.

KWAME HOLMAN (Newshour):  Hundreds of people, young and old, stood in line on a recent morning outside the Cesar Chavez Civic Center in Oakland, Calif.

The occasion was a health fair organized by community groups, and the mood was festive, as the largely Hispanic participants prepared to sign up for programs, including food stamps, get free medical screenings, and even free healthful food.  But the biggest draw was the large area devoted to health insurance.

WOMAN:  What do you think are the chances for me to qualify?

WOMAN:  It just depends on the income.

KWAME HOLMAN:  Here, specially trained staff explained what type of insurance people would be eligible for under the Affordable Care Act, known as Obamacare, which requires everyone to be insured.

Of the nation's 53 million Latinos, about 10 million are uninsured, four million of them in California.  There's a big push to get them enrolled in the state's new insurance exchange, Covered California.  Lower-income residents may qualify for premium subsidies or be enrolled in Medicaid, known here as Medi-Cal.  Undocumented individuals are not eligible.

HEALTH INSURANCE EXCHANGES - What Can Older Americans Expect? (Series Part 6)

"What Kinds of Changes Can Older Americans Expect Under Health Reform?" PBS Newshour 9/26/2013

Excerpt

SUMMARY:  How does the Affordable Care Act alter Medicare or other insurance coverage for older Americans?  Mary Agnes Carey of Kaiser Health News joins Ray Suarez to answer some of your most frequently asked questions.

HEALTH INSURANCE EXCHANGES - Bronze, Silver, Gold, and Platinum Plans (Series Part 5)

REMINDER:  The exchanges are for people who DO NOT get health insurance through their employer.

"From Bronze to Platinum Plans, What Will New Insurance Exchange Premiums Cost?" PBS Newshour 9/25/2013

Excerpt

SUMMARY:  New details were released about coverage choices for consumers in the new health care exchanges.  What will their premiums cost?  Ray Suarez is joined by Louise Radnofsky of The Wall Street Journal to answer some of your most frequently asked questions.

GWEN IFILL (Newshour):  Now we take a deeper dive into the health care story with the first look at what premiums will cost as the new marketplaces known as exchanges come online.

Among the details released today: Customers will be able to choose from a variety of plans, ranging from lower-cost plans in a bronze or silver category with less coverage to higher-cost ones known as gold or platinum with greater coverage and benefits.

The average monthly premium for an individual buying insurance through one of the cheaper options will be $328 a month.  Then it gets complicated.

Ray Suarez picks it up from there.

RAY SUAREZ (Newshour):  It's not simply a matter of picking among these different categories like bronze or silver.  Each class of plans will have a number of options to choose from and, in many cases, people will also be able to get a subsidy to help purchase the insurance.

But the premiums will vary by age, health status, geography and other factors.  And there are additional costs, too.

We try to walk through this now with Louise Radnofsky of The Wall Street Journal.

HEALTH INSURANCE EXCHANGES - Financial Incentives and Disincentives (Series Part 4)

"How Do the Health Reform Law's Financial Incentives and Disincentives Work?" PBS Newshour 9/20/2013

Excerpt

SUMMARY:  Even as Republicans are trying to shut off funding for the law, the Obama administration and some states are preparing for implementation of the Affordable Care Act.  Julie Rovner of NPR joins Ray Suarez to answer some of your frequently asked questions on tax credits and subsidies, as well as penalties for not having insurance.

RAY SUAREZ (Newshour):  We have spent some time laying out some of the basics of the exchanges and the premiums consumers might payment, but we're also getting a number of questions on other related financial issues, such as tax credits, taxes, and penalties still to come.

And that's our focus tonight.

And, once again, Julie Rovner of NPR joins us.

And, Julie, to get people to do things and not do things, there are all kinds of incentives and disincentives baked into the law.  What about these subsidies and tax credits?  How do they work?
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RAY SUAREZ:  And in a country with a median family income in the low $50,000 range, that captures most American families, that 400 percent of poverty, doesn't it?

JULIE ROVNER, National Public Radio:  Yes.  Many of the people who go to the exchanges who don't have insurance will be able to get some kind of a subsidy, some kind of help to help them pay for insurance.  In many cases, it will be possibly almost equivalent to what they would get if they had help coming from an employer.  That's the idea.

RAY SUAREZ:  All week, we have been fielding questions from people who have asked us about things they still don't understand that's in the law.  Let's take a listen.

MICHELE TORO, Florida:  I'm Michele Toro from Pembroke Pines, Florida.

And my question is, how will the tax credits affect those uninsured?

RAY SUAREZ:  Is this different if you are not working right now?

JULIE ROVNER:  No.  Basically, it's the same.

If you go to the exchange, if you are uninsured or if you buy your own insurance -- again, it's important to remember that the exchanges are not really for people who have insurance at their jobs.  It's for people who are in what we call the individual market, people who buy their insurance on their own without the help of an employer, or people who are uninsured who don't have insurance, don't have access to employer-provided insurance.

And, again, all of those people who go to the exchange will be eligible for these subsidies, these tax credits if they are between 100 percent of poverty and 400 percent of poverty, their income.

HEALTH INSURANCE EXCHANGES - Lower Premiums, Fewer Choices?

Reminder, the for-profit health insurance industry is NOT in business to provide health care.  They exist ONLY to make a profit (a BIG profit) from customers who cannot really say no.

"Lower Health Insurance Premiums to Come at Cost of Fewer Choices" by ROBERT PEAR, New York Times 9/22/2013

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Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law.  But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.

From California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans.

When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount.  To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance.  And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.

Some consumer advocates and health care providers are increasingly concerned.  Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.

Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.

“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said.  “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”

Insurers say that with a smaller array of doctors and hospitals, they can offer lower-cost policies and have more control over the quality of health care providers.  They also say that having insurance with a limited network of providers is better than having no coverage at all.

HEALTH INSURANCE EXCHANGES - What Premiums Might Cost? (Series Part 3)

"How Does Health Care Reform Affect the Cost of Insurance Premiums?" PBS Newshour 9/19/2013

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SUMMARY:  Whether you already have health insurance or will soon be shopping for coverage through one of the insurance exchanges, what can you expect to happen to the cost of your premiums?  NewsHour analyst Susan Dentzer joins Ray Suarez to answer some of our most frequently asked questions about the new health care reform law.

RAY SUAREZ (Newshour):  We again focus on essential questions about the exchanges and insurance rates.  Tonight, what do we know about what premiums might cost?

We have received a lot of questions about this, and this time we're joined by "NewsHour" regular Susan Dentzer.

Susan, there's widespread either misunderstanding or confusion about what this is going to mean, even among people who are already insured.  They think something is coming to change their lives.  We got questions like this one.

BURTON CATLEDGE, Odenton, Md.:  My name is Burton Catledge.  I'm from Odenton, Maryland.

And my question for the Affordable Care Act is, will the premiums go up for those that currently have health insurance, and, if so, how much?

RAY SUAREZ:  Do we even know that yet?

HEALTH INSURANCE EXCHANGES - Who Can Sign Up and What's Covered? (Series Part 1)

"Navigating the October Launch of Health Insurance Exchanges for Americans" PBS Newshour 9/17/2013

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JUDY WOODRUFF (Newshour): .....the health care reform law and its impact on insurance coverage.

New insurance marketplaces, called exchanges, are getting set to open in October.  But there's still much frustration and confusion about the law.  A new poll finds 53 percent of the public is opposed to it.  Just 25 percent say they have a very good understanding of it.  And only about half of the uninsured Americans surveyed are supportive of it, with many questions about how it works.

We're starting a series tonight in which we will try to answer some of your more frequently asked questions.

Ray Suarez is in charge.

RAY SUAREZ (Newshour):  The exchanges are intended to provide new insurance options for those who are uninsured or in some cases need to change their coverage.

What we have heard online and from people we have interviewed are basic questions:  Who can sign up and what's covered?  That's where we start tonight.

Julie Rovner from NPR is with us again to help us walk through this.

And, Julie, we have been hearing about the exchanges for a really long time.  The window finally opens up on October 1.  What is an exchange and who are the customers?