Understanding Obamacare

Hospitals May Help Pay ACA Premiums

Aug 14, 2014

Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital or United Way.

Some hospitals in Florida, New York and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care.

The clock is ticking for hundreds of thousands of people who have unresolved issues affecting their coverage under the new health care law. Florida has the most cases at 93,800.

The Obama administration said Tuesday that letters are going out to about 310,000 people whose citizenship or immigration details don't match what the government has on file. 

These consumers need to send in their documentation by Sept. 5. Otherwise their coverage will end Sept. 30.

Insurers: 2015 Exchange Rates Could Spike

Jul 31, 2014

State insurance officials are preparing to release figures next week on how much health plans will cost under the Affordable Care Act for 2015, and rate increases seem inevitable as insurers say their new consumers are older and sicker than anticipated.

Federal officials have capped the amount of money scofflaws will be forced to pay if they don’t buy insurance this year at $2,448 per person and $12,240 for a family of five.

The amount is equal to the national average annual premium for a bronze level health plan. But only those with an income above about a quarter of a million dollars would benefit from the cap. Those making less would still have to pay as much as 1 percent of their annual income.

Insurers must pay $41.7 million in rebates to Florida individuals and employers this summer, an amount that far exceeds refunds in any other state, according to a federal report released Thursday. 

Companies affiliated with Florida Blue in Jacksonville -- Blue Cross and Blue Shield of Florida and Health Options Inc. -- owe a total of $20 million, nearly half of the total.

FL Blue Signals Rate Hikes Ahead

Jul 21, 2014
Kaiser Health News

Florida Blue, the state’s dominant health insurer, snagged more than one in three consumers on the health law’s exchange this year, but many could face rate hikes as the carrier struggles with an influx of older and sicker enrollees, said the company’s top executive.

Several factors could drive up rates next year — including a paucity of younger and healthy enrollees and a greater-than-expected surge in people seeking expensive health services, CEO Patrick Geraghty said in an interview.

Wikimedia Commons

A court case challenging the Affordable Care Act's subsidies for plans sold on the federal marketplace could have an outsize effect on Florida, according to a new analysis.

A ruling is expected any day on Halbig v Burwell from a three-judge panel of the U.S. Court of Appeals in Washington, D.C. If the government loses and further legal maneuvers fail, the 34 states that rely on the federal exchange would see a $36-billion loss of subsidies, three Urban Institute researchers project.

Nearly 1 million Floridians have signed up for coverage via the Affordable Care Act (ACA), but some in South Florida are having to battle with doctors for treatment, the Miami Herald reports.

A lot more Floridians have health coverage compared to a year ago, but the state continues to have one of the nation’s highest uninsured rates, two new studies show.

An estimated 26 percent of working-age Floridians remain uninsured, according to a new Commonwealth Fund survey that looks at enrollment since the Affordable Care Act enrollment launched last October.

Obamacare Attracted Uninsured:Survey

Jun 20, 2014

Nearly six in 10 Americans who bought insurance for this year through the health law’s online marketplaces were previously uninsured—most for at least two years, according to a new survey that looks at the experiences of those most affected by the law.

That finding is higher than some earlier estimates, and counters arguments made by critics of the law that most of those who purchased the new policies were previously insured.

Ninety-three organizations in the state that are working in coalition under the title Health Care for Florida Now are asking Floridians to sign a petition calling for the state to accept federal funds to expand coverage to low-income adults who are in the so-called "Coverage Gap."

In 2013 the Florida House voted not to accept the $51 billion over 10 years in federal funds available for the program under the Affordable Care Act even though the Senate approved it and Gov. Rick Scott said he would sign it.

In 2014's session, the debate never occurred.

Floridians who bought health insurance on the Affordable Care Act marketplace and received tax credits got a pretty good deal, according to federal data.

They spent an average of $68 a month, considerably less than the national average of $82, the charts show. (See page 23 in the report)

Some people refuse to buy insurance that complies with the Affordable Care Act for political reasons. Others simply don't think it's really affordable.

The New York Times reports that a growing number of them have turned to the religious loophole in the health law. Two of those profiled are Florida women who are members of a faith-based nonprofit called Christian Healthcare Ministries.

"Welcome to Cigna," said the letter, dated May 16, on behalf of my new employer, the Kaiser Family Foundation. The letter also said the insurer was placing me on a one-year waiting period for any pre-existing conditions.

Seriously? Wasn't the health law supposed to end that?

"We have reviewed the evidence of prior creditable coverage provided by you and/or your prior carrier and have determined that you have 0 days of creditable coverage," the letter said.

Two health organizations filed a complaint with federal health officials Thursday alleging some Florida insurance companies are violating the Affordable Care Act by structuring their insurance plans in a way that discourage consumers with HIV and AIDS from choosing those plans.

The National Health Law Program and The AIDS Institute of Tampa said four insurance companies offering plans in Florida through the federal online exchange required HIV and AIDS patients to pay a percentage of their often expensive drugs instead of a flat co-pay.

Since being diagnosed with a heart condition, Mark Heath has lost his home, his boat and most of his possessions. As one of the 800,000 Floridians trapped in the state’s Medicaid gap, he told the Daytona Beach News-Journal he didn’t have the means or access to needed medical care.

When Marie Bien-Aime first enrolled in a Healthcare.gov plan, she picked one that avoided a monthly payment.

Then the 59-year-old cook at a Miami restaurant realized her longtime health clinic didn't take the plan. Shortly before the enrollment deadline, Bien-Aime upgraded to a plan that costs $37 per month.

"Paying $37 isn't good for me, but I had to do it because I wanted to keep my doctor because he's so good," said Bien-Aime, who was previously uninsured.

healthcare.gov

Nearly 1 million Floridians signed up for a health insurance plan through the federally-run Health Insurance Marketplace during the first open enrollment period, according to numbers from the U.S. Department of Health & Human Services.

Among the states using the federal government's exchange -- healthcare.gov -- Florida had the highest number, with 983,479 enrolled.

Humana

Doctors may diagnose ailments, but for most of us, an insurance company steers our health care decisions.

We hear a medical opinion, and think, '"Is it covered? Can we afford it?"

These days, insurers are asking similar, bottom-line questions. The Affordable Care Act is changing the way they make money.

Until recently, Mike Smith, 64, of Long Beach, Calif., worked 11 hours a day, Monday through Friday and then half a day on Saturday. He was a district manager for a national auto parts chain.

He dreamed of retiring early, but it wasn't an option for him because he and his wife relied on the health insurance tied to his job.

"At our age, with some pre-existing medical conditions, it would have been very costly to buy insurance on the open market — about $3,000 a month," he says.

Thousands of former foster youth are gaining health insurance under the Affordable Care Act.

The new law extends Medicaid coverage for former foster youth who have aged out of the system and are under the age of 26.

Florida officials say roughly 10,000 former foster youth are eligible. But they aren't automatically enrolled and need to apply for coverage. The provision is aimed at giving former foster youth the same opportunity for health insurance as their peers who are able to stay on their parent's insurance until they turn 26.

The cost of the Affordable Care Act is about $5 billion a year less than originally projected, mostly because insurance premiums were lower than expected, the Congressional Budget Office said Monday.

While 7 million Americans enrolled for health insurance before the March 31 Affordable Care Act deadline,  Charlene Dill wasn’t one of them.

The young mother of three collapsed and died from a treatable heart condition on March 21. She fell into  Florida’s health care gap; her income from part-time commission-based jobs was just $9,000, too poor for Affordable Care Act subsidies, the Orlando Weekly magazine reports.

It May Not Be Too Late to Enroll

Apr 2, 2014
Carol Gentry / WUSF

Enrollment in health insurance plans is continuing, and navigators in Florida are still working to help people pick plans.

Jodi Ray, who directs the USF grant program that contracts with navigator groups, said the contracts haven't expired so the navigators are still available at the same places they were before -- some community centers, health clinics, and so on.

(Go to this page and click on "find local help." You can type in your zip code and get a list.)

Carol Gentry / WUSF

Al Lopez Park in Tampa is normally an oasis of serenity on a Monday. But on the last day of open enrollment for health insurance under the Affordable Care Act, the community center was crowded, noisy and stressful. Hundreds of procrastinators came seeking help from navigators.

It was a microcosm of the nation, as 3 million Americans visited the HealthCare.gov website and another 1 million used the call-center line on the last official day to sign up for a 2014 health plan.

In a Florida Matters show first aired Tuesday night on WUSF 89.7 FM, a panel of experts answers reader and listener questions about the Affordable Care Act.

What's Next for Health Law?

Mar 31, 2014

Just because open enrollment for people who buy their own health insurance formally closes March 31 doesn't mean debate over the health law will take a hiatus.

After more than four years of strident rhetoric, evidence about how the law is actually working is starting to trickle in. Here are seven things to watch before the next enrollment period begins in November:

1) How many enrolled, really?

Rightly or wrongly, this figure has become a yardstick by which some are measuring the law's success. But no one can give an accurate accounting yet.

Monday is the deadline to sign up for private health insurance in the new online markets created by President Barack Obama’s health care law. So far, about 4 out of every 5 people enrolling have qualified for tax credits to reduce the cost of their premiums.

Here’s what you need to know:

* The deadline is Monday at midnight EDT for the states where the federal government is running the sign-up website, including Florida; states running their own exchanges set their own deadlines.

With this year's deadline to register for individual health insurance just a weekend away, much attention is being lavished on two numbers — the 6 million Americans who have signed up so far, and the percentage of those folks who are (or aren't) young.

But experts say the national numbers actually don't mean very much.

Lottie Watts

 In a Florida Matters show that first aired Tuesday night on WUSF 89.7 FM, a panel of experts answers reader and listener questions about the Affordable Care Act.

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