Survey finds that 93 percent of hospital executives think Obamacare will improve systems and save costs

While there has been much grumbling about federal health reform, at least one very affected group of people think it's a great idea. A survey by Health Affairs found that 93 percent of hospital executives believe the Patient Protection and Affordable Care Act will make health care better, and cheaper, Ezra Klein reports for The Washington Post.

The magazine surveyed 74 senior executives at hospitals that had an average of 8,520 employees, and annual revenues of $1.5 billion, Klein reports. The survey found that 65 percent felt that by 2020 "the healthcare system as a whole will be somewhat or significantly better than it is today," and "93 percent predicted that the quality of care provided by their own health system would improve. This is probably related to efforts to diminish hospital acquired conditions, medication errors, and unnecessary re-admissions, as encouraged by financial penalties in the ACA." (Health Affairs graphic)

Executives also responded to favorably to other questions about reform, with 91 percent forecasting "improvements on metrics of cost within their own health system" and "85 percent expected their organization to have reduced its per patient operating costs" by 2020, Klein writes. "Overall, the average operating cost reduction expected was 11.7 percent, with a range from 0 percent to 30 percent. Most executives believed they could save an even higher percentage if Congress enacted legislation to accelerate the shift away from fee-for-service payment toward models like bundled payments. In such a case, the executives projected average annual savings of 16.0 percent, which, if applied across the healthcare system, would amount to savings of nearly $100 billion per year."

Respondents said savings can be achieved "through a combination of greater administrative efficiency, price reductions, and reduced reliance on hospital services," Klein reports. About 54 percent said this can be done by reducing the number of hospitalizations, 49 percent by reducing, re-admissions, 39 percent by reducing emergency room visits, 36 percent by reducing costs for medical devices, 27 percent by reducing costs for drugs, and 23 percent by improving office efficiency.

About 31 percent of respondents said another goal is to set "a specified timeline for transitioning Medicare reimbursement off of the fee-for-service payment system as a policy change that would facilitate cost control," Klein writes. "Another 30 percent supported aligning payment policies between Medicare and private insurers, and 28 percent supported separating funds for training and research from Medicare payment and maintaining current funding levels." (Read more)

As Obamacare spreads in Kentucky, the state remains conflicted about it and other forms of government help

By Al Cross
Kentucky Health News

Even as Obamacare coverage spreads in Kentucky, more widely than in almost any other state, the commonwealth remains conflicted about it and other forms of government aid -- creating a political battle that is likely to continue at least until the November 2014 elections, and perhaps into the governor's race in 2015.

The federal health-reform law and its presidential namesake have been the centerpiece of the U.S. Senate race, with Republican Sen. Mitch McConnell railing against it, primary challenger Matt Bevin saying McConnell hasn't done enough to dismantle it, and likely Democratic nominee Alison Lundergan Grimes keeping mostly mum as she waits for the political landscape to settle.

McConnell's Kentucky strategy is part of a national game plan, in which "Republicans are launching a class war with racial undertones—and hurting the poor whites they'll need to win in 2014," the respected, non-partisan National Journal said in a cover story in its weekly magazine over the weekend, reported from Louisville by political writer Beth Reinhard. It is titled "Return of the Welfare Queen," a trope popularized by Ronald Reagan.

Reinhard first looks beyond Kentucky, noting that "25 Republican-led states have — astoundingly" rejected expansion of Medicaid under the law. "To justify this unprecedented rejection of federal relief, these governors and state lawmakers say they just do not believe Washington will keep its promise to pick up the tab. Republicans in Congress are egging them on, denouncing Obamacare's disastrous launch as proof of the arrogance and folly of big government."

"The chances of the federal government picking up the tab for the newly eligible Medicaid people long term is zero, which means that the next governor, whoever that may be, is going to be stuck with a huge, huge problem," McConnell said at a Nov. 12 press conference which he limited to the subject of Obamacare. "The Medicaid expansion that we have already experienced, the Medicaid increases that we've already experienced, is the principal reason your kids' college tuition is going up. . . . So we're paying for it already."

National Journal's coverage has a video, the middle frame of which
shows Gov. Steve Beshear and House Minority Leader Nancy Pelosi.

Thus did McConnell conflate recent increases in Medicaid spending with Democratic Gov. Steve Beshear's expansion of the program to households earning up to 138 percent of the poverty line, from the current 69 percent. That will cost the state nothing for three years, because the federal government will pay the entire cost of care for the newly eligible. In 2017, the state will begin to hep out, hitting the law's 10 percent cap in 2020.

Reinhard notes that Republican "tirades" also target food-stamp recipients, and "Pitting makers against takers is simply smart, hardball politics for some Republicans whose "primaries that will be largely decided by a mostly white conservative base that hates the welfare state. . . . Class warfare can work in a primary. But, ultimately, Republicans' scorn for antipoverty programs hinders the party's efforts to expand beyond its conservative base."

Reinhard writes, "This opposition carries an unmistakable undertone of class warfare, a theme easy to exploit in states such as Kentucky, packed with low-income white voters who have a strong distaste for the federal government. To hear the rhetoric coming from Capitol Hill and the campaign trail, Medicaid and food-stamp recipients are a bunch of shiftless freeloaders living high on king crab legs and free health care, all on the backs of hardworking Americans."

But sometimes people who hold those opinions are relying on the government, too. Reinhard writes about Terry Rupe of Louisville, whose "household's $13,000 yearly income comes exclusively from Washington," and whom she met at a clinic where he was signing up for Medicaid: "The 63-year-old widower can't remember the last time he voted for a Democrat, and he's got nothing nice to say about President Obama. He's also never had health insurance, although he started working at age 9. Since his wife's death four years ago, he's been taking care of their 40-year-old, severely disabled daughter full time. She gets Medicaid and Medicare assistance."

Nevertheless, Rupe told Reinhard, "I don't have any use for the federal government. It's a bunch of liars, crooks, and thieves, and they've never done anything for me. I'm not ungrateful, but I don't have much faith in this health care law. Do I think it's going to work? No. Do I think it's going to bankrupt the country? Yes." Reinhard cites a poll which found that "A majority of whites believe the health-care law will make things worse for them and their families."

Next Reinhard introduces us to Adele Anderson, a white, middle-aged woman who gets $10 an hour for child care and $86 a month in food stamps, and was also signing up for Medicaid. She told Reinhard, "Democrats are too liberal. They just want to give handouts."

Reinhard observes, "The disdain she and Rupe show toward living on the government dole at the very moment they are doing just that is typical in a state that distrusts Washington as much as it needs federal help. . . . Still, Obamacare is so politically toxic that McConnell continues to flog the law that appears to be working in his own state. What's more, he's disqualifying its fledgling success by inciting class warfare."

At his Nov. 12 press conference, McConnell noted that more than 80 percent of Obamacare signups in Kentucky had been for Medicaid, and said, "You know, if I went out here on the street and said, ‘Hey, you guys want free health care?’ I expect I’d get a lot of sign-ups. The most successful part of it has been if you’re talking about getting people signed up is people who are signing up for something that’s free."

In response, the Grimes campaign issued a written statement: "It's unfortunate that Sen. McConnell chooses to look down on Kentuckians who need health care, instead of working to fix the problems. He ought to help those Kentuckians, not attack them."

Reinhard notes that Grimes has yet to say whether she supports the Medicaid expansion, but concludes: "Because Kentucky did take the cash, 308,000 poor people are now eligible for health insurance in the Bluegrass State. Over the 11 months leading up to the election, McConnell and other Republicans opposing Medicaid expansion will be hard-pressed to explain why they want to take health insurance away from needy constituents who belong to their own party." (Read more)

McConnell shares excerpts from letters he received from Kentuckians who are frustrated by health-reform law

By Melissa Patrick
Kentucky Health News

Continuing his attack on Obamacare, Senate Republican Leader Mitch McConnell took to the floor last week to read excerpts from letters he received from Kentuckians who are angry about the Patient Protection and Affordable Health Care Act. UPDATE, Dec. 17: He did so again today; video is here.

Generally, the main issues cited by McConnell are frustration with President Obama's promise that people happy with their health insurance could keep it; anger that their premiums and deductibles had increased under new policies that meet the law's requirements; and dissatisfaction with their inability to choose and pay for only the services they wanted. For example, several constituents said they did not have children, but were required to pay for pediatric dental care and maternity care.

A 35-year-old college graduate and married father of two from Bowling Green told McConnell that his plan, which he said best met his family's needs, had been canceled. As he sought a new plan that met the requirements, he was told it would cost 124 percent more. He noted that Vice President Joe Biden said Sept. 27 that a family of four with $50,000 income could get health insurance for "as little as $106 per month." McConnell said the Bowling Green man was quoted a price eight times that amount and asked him, "Why should the price of a product be based on my ability to pay?" The law provides subsidies for insurance coverage based on income and the type of plan purchased through the state insurance exchange, Kynect, up to $94,000 for a family of four.

Sherry Harris of Nicholasville told McConnell she was concerned that Lake Cumberland Hospital in Somerset was not on the Anthem network, "which means anybody in Pulaski and surrounding counties that qualify for a subsidy and want to use it will have to drive to London, Corbin or Lexington to get care" if they have an Anthem policy. Insurance companies are being more selective about their care networks in an effort to reduce costs; for details, click here.

A "Mr. and Mrs. Spears" of Louisville told McConnell that when they signed her up for the Kentucky Health Cooperative plan on Kynect, they did not sign up for a subsidy and thus were told no income verification was necessary.  Since then, they have received mailings from the insurance exchange declining coverage unless they sent income verification.

Exchange spokeswoman Gwenda Bond told Kentucky Health News in an email, "A request for additional documentation related to income verification might be generated, if they are likely to qualify for a subsidy based on the information provided on the application. Everyone is eligible to purchase a qualified health plan at sticker price at any time." The sticker price is the amount before the subsidy is subtracted.

Mrs. Spears also questioned the exchange's request for her voter-registration information. Bond said the federal "motor voter" law requires public-assistance agencies to ask applicants if they would like to register to vote. "Because Kentucky’s exchange is a single streamlined system for both Medicaid and subsidies, applicants are asked if they would like to register to vote," she said. "A voter registration form is mailed to them if they request one. There is no follow-up related to whether an individual registers or not, and it does not have an impact on coverage."

Mike Conn of Prestonsburg was upset that a policy with similar coverage to his previous policy would cost double.  He told McConnell that he was informed by the individual who helped him find coverage that it was because he lived in Eastern Kentucky and his old insurance company was "apparently not available there." Humana Inc. chose not to offer plans in all parts of the state.

Newspaper in Alabama, a similar state in many ways, gives its readers a look at Kentucky's embrace of Obamacare

The latest newspaper to look at Kentucky's embrace of Obamacare is in Alabama, a state that offers almost a mirror image of Kentucky: another Southern state with a very high poverty rate and very low health outcomes.

"Politically, both are deeply conservative, and both are home to wide expanses of rural poverty," writes Tim Lockette of The Anniston Star. But Alabama's approach to Obamacare "couldn't be more different," because it has rejected Medicaid expansion and a state-run insurance exchange.

The difference in Obamacare outcomes really is as stark as it looks, Douglas Scutchfield, a professor of health services research at the University of Kentucky, told Lockette. Scutchfield, who taught in Alabama for years, said that in demographic terms, "The only real difference is that most of your uninsured folks are black, and most of our uninsured folks are white. We have the Appalachians, you have the Black Belt." In politics, the states' governors have made a big difference.

While Democratic Gov. Steve Beshear expanded Medicaid and set up an exchange, Republican Gov. Robert Bentley and other state officials rejected both the Medicaid expansion and an exchange, citing costs.

Bentley cited the state's struggle to even cover the new enrollees that had been added since the Great Recession. Some Kentuckians are concerned about how the state will pay for its expansion. The federal government will pay all the cost of care for the newly eligible from 2014 through 2016, when the state will increasingly pick up part of the tab, rising to 10 percent by 2020. Beshear, citing a study, has said the expansion will expand the state's health-care industry enough to pay for it, and make the state more attractive to employers in the long run.

Bentley told Lockette that Alabama could not have had success with its own exchange because there is basically one major insurance company in Alabama, Blue Cross Blue Shield. But Alabama could have had more competition if the state had set up a nonprofit, cooperative insurance company, which Kentucky did.

"In Kentucky, everybody has an option," Cara Stewart, a fellow at the Kentucky Equal Justice Center, told Lockette. "Unless you're undocumented or in jail, there's something for you," she said.

Still, Stewart "said she’s run into difficulty working with people who already have employer-provided insurance, but want to switch to the exchanges to cover family members," Lockette report. Also, "The Kentucky system has refused to recognize some enrollees because they don’t have a credit history, health care advocates say." (Read more)

Humana allows policyholders to keep old plans without paying more; Anthem is still deciding

Humana, one of the three insurance companies offering individual health policies on the state's insurance exchange, will allow Kentuckians to keep their insurance coverage for another year without charging them more for it.

The other two companies on the individual market are Anthem and the Kentucky Health Cooperative. Anthem hasn't responded to recent inquiries about the old policies; it said last week that it was still deciding whether or not it would extend policies that don't comply with federal health reform. Since the non-profit cooperative is a new insurance organization, it is only offering policies that comply with the law.

A Humana spokeswoman told Kentucky Health News Monday that the company communicated premium amounts to individual policyholders in October when presenting policy owners with coverage options for 2014, including the option to continue their current plan. Those premium amounts for individual policies have not changed since the most recent changes to the Affordable Care Act, she said.

Some insurance experts have warned that consumers renewing noncompliant plans will be predominantly younger and healthier, while older and sicker people will migrate to the subsidized marketplaces, which could drive up costs for plans. Some states aren't allowing insurers to renew policies. For example, Washington Insurance Commissioner Mike Kreidler said he would not allow insurers to extend the policies “in the interest of keeping the consumer protections we have enacted,” reports Kaiser Health News.

In Kentucky, at least for Humana policyholders, this is not the case. President Obama said people whose policies were being canceled because they didn't comply with the law could renew them for another year if state regulators allow it. Gov. Steve Beshear gave insurers the green light to decide whether or not to renew these policies. Humana has decided to do so without charging additional premiums short-term.

Meanwhile, Anthem is deciding what to do and some existing policy owners in other states face as much as a 24 percent increase in their premiums. Obama's extension allows non-compliant policies to stay in place only for a year. This time next year, the transition must be made to plans that are qualified under the law.

Physicians say they dislike regulations on use of electronic health records, but they don't want to go back to paper records

Doctors say use of electronic health records is one factor contributing to physician dissatisfaction because it interferes with patient care, says a new study.

Surveyed physicians blame EHRs for reduced quality of care, saying that their daily interaction with "clunky" EHR systems contributes to their dissatisfaction, which is closely linked with their ability to provide quality care, reports Chris Kaiser of MedPage Today. The results were published in a study by the RAND Corp. and commissioned by the American Medical Association.

Physicians said the cumulative burden of rules and regulations affecting clinical practice, including “meaningful-use” rules for EHRs, also detracted from professional satisfaction, says the report brief. These rules were created by the federal Centers for Medicare & Medicaid Services; providers must certify that they are “meaningfully using” their EHRs by meeting established thresholds in order to qualify for the program's financial incentives. If providers accepting Medicare do not qualify by 2015, their Medicare payments will be reduced by 1 percent each year, says HealthIT.gov.

Despite their dissatisfaction with the regulations, physicians said they approved of the concept of EHRs, saying that their use has numerous benefits, including being able to remotely access patient information and improving in-practice communication, says the report. Only 20 percent of physicians said that practices should return to paper documentation.

“Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts,” said Dr. Mark Friedberg, a natural scientist at the RAND Corporation, in a news release. “But at the same time, they report that electronic systems are deeply problematic in several ways. Physicians are frustrated by systems that force them to do clerical work or distract them from paying close attention to their patients.”

The problem is that many EHR programs aren't user-friendly. This problem should be addressed, says the report, to ease physician workflow and free up time for the physician to spend with the patient. Here are some of the complaints physicians had about EHRs:

Time-consuming data entry 

User interfaces that do not match clinical workflow 

Interference with face-to-face patient care 

Information overload 

Lack of health information exchange between EHRs 

EHRs are expensive, threatening practice finances

Understanding physicians' professional satisfaction is important because better patient care is a potential "downstream" benefit of satisfaction. The researchers said knowing reasons for dissatisfaction can lead to targeted interventions to address the issues,says the news release.

"Aside from viewing better patient care as a potential consequence of better physician professional satisfaction, it may be useful to think of physician dissatisfaction, when it is caused by perceived quality problems, as an indicator of potential delivery system dysfunction," says the report.

Nationwide, eyes on are Ky.'s implementation and debate about Obamacare, and thousands of Kentuckians are signing up for it

By Molly Burchett
Kentucky Health News

The good, the bad and the ugly about health reform in Kentucky are showing up on national news as the state's two Republican senators stand vehemently against Obamacare and the state's Democratic governor ardently roots for it. Meanwhile, state officials say their health-insurance website, which is working much better than the federal site, is getting much more traffic than they expected.

The Republican senators from Kentucky, Rand Paul and Minority Leader Mitch McConnell, declared last week that their constituents didn’t want any part of the Affordable Care Act. “Obamacare might sell in New York, but Kentuckians aren’t buying it,” McConnell and Paul wrote in a column sent to newspapers.

This came after Democratic Gov. Steve Beshear, who decided to build the insurance exchange without asking for approval from the politically divided General Assembly, wrote a New York Times op-ed in support of the reform law. He jabbed at “naysayers” who “pour time, money and energy into overturning or defunding the Affordable Care Act.”

The problem for McConnell and Paul is that Kentuckians are buying into Obamacare, writes John Tozzi of Bloomberg Businessweek. "In fact, the Kentucky exchange has, so far, enrolled more patients than any other." Kentuckians are enrolling in droves, at a rate of more than 1,000 people per day, and Beshear has become more pointed in his criticism of McConnell and Paul.

“Our state’s U.S. senators are simply ignoring the facts when they continue to insist that ‘no one’ in Kentucky wants the Affordable Care Act,” Beshear told MSNBC.

Carrie Banahan, executive director of Kynect, the state's insurance exchange, told Jane Timm of MSNBC that enrollements are far beyond state officials' expectations. “We had thought that maybe we might receive a couple of hundred applications during the month of October. We had no idea it would be thousands of applications.”

Kynect's Carrie Banahan (left) and Gov. Steve Beshear

There were concerns that people in rural areas might not get the word about the program or have difficulty signing up because they lack Internet access, but Teresa Fleming, chief financial officer of Mountain Comprehensive Health in Eastern Kentucky, told Timm her lobbies had been flooded with people signing up for the plans. Her primary-care facilities were among the numerous Kentucky clinics that received part of $2.83 million in federal money for Kynect outreach and enrollment iniatives.“The response has shocked us,” Fleming said, “We think it’s due to a lot of word of mouth."

Kentucky's success is getting much national attention. Beshear discussed it with MSNBC’s Chris Matthews and keynoted a meeting in Washington. President Obama praised Beshear’s implementation during a private meeting with House Democrats Wednesday, said Rep. John Yarmuth, D-Louisville, who was at the meeting.

“The president said (the Affordable Care Act) got really good rollouts in some places you wouldn’t expect it, and he said the place that has done best is Kentucky,” Yarmuth told James R. Carroll of The Courier-Journal. He said Obama noted the irony that McConnell and Paul have been two of Obamacare's most vocal critics.

Republican efforts to defund or delay Obamacare led to the shutdown of the federal government, which has proven highly unpopular. It may have also improved public opinion of the law; an NBC/Wall Street Journal poll last week found a 7-percentage-point increase in its popularity. The survey also found the Republican Party registering its worst approval ratings in the poll's history, with just 24 percent having a favorable opinion of the GOP, and 21 percent viewing the Tea Party favorably.

"There is little question that the GOP is bearing the brunt of blame in the standoff over re-opening the government and the debate over the debt ceiling as 53 percent of the public now places the blame on Congressional Republicans compared to 31 percent who view President Obama as being the guilty party," Rick Ungar of Forbes reports.

Health reform law is debated and explained on KET

By Molly Burchett
Kentucky Health News

Two Kentucky Educational Television programs addressed the federal health-reform law Monday night, providing opportunities for Kentuckians to debate the Patient Protection and Affordable Care Act and ask questions about how "Obamacare" would affect them.

First, "Kentucky Tonight" host Bill Goodman sat down with a bipartsan panel to discuss the law, which went into effect Oct. 1 with the roll-out of Kynect, the state's online insurance marketplace. Then Renee Shaw hosted state officials who answered questions from callers.

The panelists were Dr. Peter Thurman, medical director of Family Health Centers in Louisville; Democratic state Rep. Mary Lou Marzian of Louisville, who was a nurse for 35 years ; Rep. Robert Benvenuti, ranking Republican on the House Health and Welfare Committee, and Dr. Ralph Alvarado, a Winchester internist and pediatrician who has run for the General Assembly three times and is planning a fourth race for the legislature.

Goodman began by asking the panelists to rank Obamacare's roll-out as an overwhelming success, an abysmal failure or somewhere in between.

Thurman, an Obamacare supporter, gave it a C even though Kynect has had many fewer problems than the federal system. He said Obamacare may not solve the huge issue of health care costs, but will those who can't afford health care access to it.

Alvarado called the roll-out a disaster, noted that not all physicians are accepting Kynect plans, and said people at the Kynect call center are getting minute-by-minute changes about the plans.

"That's not accurate," Marzian said. "You've talked to two people who had problems." She said the rollout has been a success and Kentuckians are hungry for insurance coverage, which is access to health care, and such access should be a right for all Kentuckians. "I would have been happy if we put everyone in the country on Medicare," she said.

Benvenuti said the premise of Obamacare is a failure. He said that it took $252 million of federal seed money to start Kynect, which has a $39 million annual operating budget, and that if the state could have taken the money in a block grant and used it in ways that work best for the state, a much more sustainable system could have been created.

Benvenuiti said many Kentuckians won't be able to afford the large deductibles in the Kynect plans, so the state and country are creating a dependency that can't be afforded. "Over $3 trillion will be spent over 10 years and over 35 million Americans will still be uninsured," he said.

Thurman said there has been a trend toward high deductible plans for years to shift costs to employees. Marzian said that while some deductibles are high, insurance coverage prevents you from going bankrupt if you have a serious accident, and she said the law's free preventive care will ultimately save money.

"Nothing is free," Benvenuti replied. Alvarado said about 83 percent of private physicians oppose the law, and there won't be enough doctors to provide preventive care. He said the law will not fulfill its two main goals, to reduce costs and to provide coverage to all Americans.

Alvarado objected to Obamacare's requirement to buy insurance, but Marzian said the mandate is necessary for the law to be successful. So far, she said, it has been a success. The Kynect site has has 175,000 visitors, more than 22,000 people have started insurance applications, and almost 15,000 applications have been completed.

Jean Prowse, a caller from Muhlenberg County, complained about all the political rhetoric and asked where she could get reliable, non-partisan information. Marzian directed her to the Kynect website, where Kentuckians can learn if they are eligible for Medicaid or government subsidies to help buy insurance.

Questions about Obamacare enrollment

The second show must have been more to Prowse's liking. It featured Cabinet for Health and Family Services Secretary Audrey Haynes, Kentucky Health Benefits Exchange Executive Director Carrie Banahan and Medicaid Commissioner Lawrence Kissner, who answered questions from Kentuckians about buying insurance through Kynect -- after a little bragging.

Haynes and Banahan said Kentucky's implementation of the law has exceeded expectations. In addition to the over 22,000 Kentuckians who have started applications on Kynect, more than 209,000 small businesses have started applications, Haynes said, adding, "In Kentucky, when we're trying to reach over 640,000 uninsureds, this is success."

The questions and answers on the second show were practical, not political, touching on many basic facts and a few unknown details of the law.

Regarding income limits for subsidies through Kynect, Haynes said it is important for people to call or to go online because this process is very individual. "That's why we didn't publish an individual insurance rate," she said, because there is no average.

All plans will offer the 10 essential health benefits required by the law, said Banahan.  There are four tiers of plans, with the bronze plans offering the lowest premiums and highest deductibles, and the platinum plans offering the highest premiums and lower deductibles. A catastrophic-only plan is avaialble to people under 30.

One Kentuckian with a $14,000 annual income called to ask about Medicaid eligibility, and Kissner said she would be eligible.

On the website, there is a calculator where you can enter preliminary information to determine eligibility. You can anonymously browse the website to view the "sticker price" of the plans based on this information before you register and apply, said Banahan.

If you already receive coverage from your employer or from a state program, you are only eligible for subsidies if the employer's premium that you have to pay for single coverage is more than 9.5 percent of your family income.  More than likely, you would not qualify for premium assistance, said Banahan, and you would have to pay full price for coverage through Kynect.

What if you have veteran's benefits?  Banahan said you may want to check out your coverage eligibility on Kynect.

What if you don't have a computer?  You can call the toll-free Kynect number at 1-855-459-6328 to apply or locate a local "Kynector." Kissner said the public library in your county may provide access to a computer and the Internet services.

When will the fines for not getting covered begin and how much will they be? The fines will begin in 2015. If you don't have insurance for at least nine months in 2014, the fine is $95 per household member or 1 percent of your income, whichever is greater, said Banahan. If your income is below 100 percent of the poverty line, you are not required to have health insurance. People with incomes up to 138 percent of the poverty level are now eligible for Medicaid.

If you are planning to buy insurance or sign up for Medicaid through Kynect, you must be enrolled by Dec. 15 to get coverage starting Jan. 1, said Haynes. If you want premium assistance or a tax credit, you need to purchase insurance through the exchange, but otherwise, insurance can be purchased outside of the exchange.

To explore your eligibility for premium assistance or coverage through Medicaid, visit the Kynect website.  All three experts stressed the importance of visiting the website or calling the Kynect toll-free number with any additional questions and for information specific to your needs.

Beware of identity thieves exploiting the Patient Protection and Affordable Care Act to get personal information

As if buying health insurance isn't confusing enough, the Better Business Bureau has sent out a series of releases warning people to beware of scam artists posing as callers claiming to be from the federal government. The scam is mostly targeting small business owners, and people who are 65 and older or have disabilities.

The caller informs you that you've been selected to receive insurance cards through the Patient Protection and Affordable Care Act, but before the card can be mailed, they need your personal information, such as a credit card, Social Security number or Medicare ID. The callers may seem credible, often possessing personal information, such as a bank account number or routing number.

If someone gets such a call, they should immediately hang up, the BBB says. Don't press any buttons and don't return voice mails. The government usually communicates through mail, but if they call, they will already have all the necessary personal information. (Read more)

Here are tools and resources to help you understand how the health reform law impacts you, your family and your business

By Molly Burchett
Kentucky Health News

The rollout of the insurance-buying section of the Patient Protection Affordable Care Act started Oct. 1, and regardless of where you stand on the law, it's important to be informed about what will happen Jan. 1 when the law's major provisions are set to go into effect. To help you understand how the health law impacts you, your family or your business, the Foundation for a Healthy Kentucky has compiled a list of links to information about the health law.

The law, informally known as Obamacare, is a set of health care reforms signed into law by President Obama on March 23, 2010. The law includes insurance mandates and requires everyone to have health insurance or pay a penalty starting Jan. 1.  In addition to insurance mandates, both the establishment of online health-insurance exchanges and expansion of Medicaid are two essential elements of the law.

In June 2012, the Supreme Court upheld the health law in a 5-4 vote, saying its requirement that most Americans obtain insurance or pay a penalty was authorized by Congress’s power to levy taxes. The Internal Revenue Service will administer that provision of the law. The court ruling limited the law’s blanket expansion of Medicaid, which attempted to require all states to expand the program in order to receive federal funding, saying that each state could make its own decision.

The Kentucky Health Benefit Exchange, Kynect, was established in July 2012 and opened for enrollment Tuesday. Calling it “the single-most important decision in our lifetime for improving the health of Kentuckians,” Gov. Steve Beshear announced his decision to expand Medicaid in Kentucky in May. As a result of this decision, Medicaid has expanded to provide coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level—currently $15,856 for an individual or $32,499 for a family of four.

About 640,000 Kentuckians are uninsured, and 308,000 of them qualify for expanded Medicaid because their incomes are less than 138 percent of the federal poverty threshold. The remaining 332,000 Kentuckians must purchase private insurance through Kynect. Of those purchasing private plans, an estimated 83 percent will be eligible for at least some tax credit to do so, reports Kentucky Voices for Health, a group of health-reform advocates.

Currently, the federal government pays 71 percent of Medicaid costs, and the state covers 29 percent of the costs. Under Medicaid expansion, the federal government will cover 100 percent of the costs of the newly eligible people for the first three years. Starting in 2017, the federal government will cover 95 percent of the costs for this expanded population, and federal funding will phase down to 90 percent by 2020.

The Kentucky Voices for Health presentation, found here, gives more details about the overall purpose of the Affordable Care Act and its implementation in Kentucky. Get Covered Kentucky, a coalition spearheaded by Kentucky Voices for Health, compiled additional information about Medicaid expansion. Click here for these tools and resources.

Beshear says Medicaid expansion is the right choice for Kentucky, providing numerous reasons and county-level data to explain why not expanding the program would hurt both Kentucky’s health, which already ranks poorly in many health categories, and taxpayers’ bottom line. Click here to see the impact of health reform on your local community.

You may be eligible for coverage through Medicaid or tax subsidies to help you purchase private insurance. Go the the Kynect website to determine your eligibility for Medicaid coverage or private insurance subsidies and to enroll Medicaid, the Kentucky Children’s Health Insurance Program or private plans. "It’s easy to apply, with just one application to fill out. When you apply online, you get enrolled quickly. We also have insurance agents and Kynectors who will help you apply using computers," says the website. If you want to apply by mail or fax, click here for paper applications.

The law does not require small employers (businesses with 50 or fewer employees) to provide insurance coverage. If you own a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance. Since the mandate to cover employees has been delayed for a year, businesses with more than 50 employees will not face penalties in 2014 for not providing health insurance, but they may face penalties starting in 2015.

The foundation resource page includes additional resources to help you understand health reform efforts at the federal level, including those from the Kaiser Family Foundation, which includes a subsidy calculator, the Robert Wood Johnson Foundation and a fact page from the U.S. Department of Health and Human Services. In addition, a foundation report outlines how the health law creates opportunities to address public health issues, decrease health disparities and reform care delivery.

Kentucky Health Cooperative partners with UK HealthCare, extending coverage to all 120 Kentucky counties

As a result of an exclusive partnership with UK HealthCare, the Kentucky Health Cooperative, the state's new non-profit insurance carrier, expanded its coverage Wednesday to the University of Kentucky's network of over 1,000 clinicians across Kentucky.

For Kentucky residents who enroll in a Kentucky Health Cooperative insurance plan, the agreement is bringing a statewide network of high-level, accessible clinicians to all 120 Kentucky counties, Janie Miller, chief executive officer of the organization, said in a news release.

The cooperative is Kentucky's non-profit, or Consumer Operated and Oriented Plan under the federal health reform law. The co-op offers coverage to individuals and families and to employees of businesses employing two to 50 full-time equivalent employees, which can be purchased on the state health-benefits exchange, branded as Kynect, directly from the co-op website and from many brokers and agents in Kentucky.

Both Anthem and the co-op offer plans throughout the state, while Humana is offering a limited service area. Since the co-op is a new insurance carrier, forging this type of partnership with UK is an important step; UK HealthCare hass multiple locations across Kentucky, including hospitals, clinics, outreach locations and patient care services, says the release. In addition, it ensures that co-op coverage will be accepted by the more than 1,000 clinicians affiliated with the UK health system.

Part of UK HealthCare's mission is to provide Kentuckians with advanced subspecialty care, while collaborating closely with community providers, says its website. Miller said the co-op's collaboration with UK will significantly benefit both Kentuckians who seek advanced medicine and those who require rural health care, the co-op says in the release.

“We look forward to teaming up with some of the nation’s top clinicians and researchers as well as with community providers dedicated to the delivery of well-integrated health services at the community level,” Miller said. (Read more)

Beshear to speak in Washington Thursday about health care's next era; session to be videostreamed

Gov. Steve Beshear will deliver the keynote address to the National Journal forum "Countdown to Transformation: A Roadmap to Health Care's Next Era—90 Days Out" tomorrow at 12:15 p.m. Eastern time. The event will take place in the Ronald Reagan Building and International Trade Center in Atrium Hall at 1300 Pennsylvania Ave. NW in Washington, D.C. It will also be live-streamed on the magazine's website, a press release from Beshear's office said.

The American health care system is about to enter a new era, the National Journal says: "Countdown to Transformation will examine the complex political, medical and business ramifications of the implementation of Affordable Care Act." Beshear has taken a high profile in the rollout of federal health reform because Kentucky is the only Southern state to expand Medicaid and run its own health-insurance exchange.

Federal shutdown won't stop Obamacare, Ky. insurance exchange

By Molly Burchett
Kentucky Health News

The federal government is on the brink of shutdown after House Republicans refused to pass a budget unless it involved a delay in the health reform law, and both Senate Democrats and the White House have said they will block any such budget resolution. In the event that Congress doesn't reach a compromise, which would lead to a shutdown on 12:01 a.m. on Tuesday, enrollment for Kentucky's online health insurance exchange, Kynect, will still begin as scheduled.

The shutdown drama is heightened since Tuesday is both the start of the federal fiscal year and the first health insurance can be bought on the online exchanges created by the reform law, often called Obamacare. Kynect won't be affected because it is funded by a "permanent appropriation," that isn't subject to annual appropriation, Paul Van de Water, a policy analyst at the Center on Budget and Policy Priorities, told Sharon Begley of Reuters.

The Department of Health and Human Services' contingency plan for a government shutdown makes clear that Obamacare will continue, along with other mandatory programs like Medicaid and Medicare, programs that do not rely on annual appropriations and involve the human life and safety, Cunningham and Nather report. "And that means the staff that carry out mandatory programs like those in the health law can keep working — even if their positions are funded through the annual spending bills."

However, uncertainty about the shutdown could add more confusion to America's lack of understanding of the health law. Many may not realize they can sign up for coverage through the state exchanges even if the federal government is shut down.

The Kaiser Family Foundation's August 2013 Health Tracking Poll showed that roughly four in 10 Americans, 44 percent, either think the law has been repealed by Congress or overturned by the Supreme Court. A recent Pew Research Center poll last week found 53 percent of Americans disapprove of the law, and 42 percent approve.

But most Americans oppose defunding the new law if it means shutting down the government and defaulting on debt, says CNBC's third quarter All-American Economic Survey.

President Obama has said he will not negotiate on his signature legislative accomplishment, and most Senate Republicans have disavowed the House Republican strategy of risking a government shutdown.

The stakes are high for both political parties, writes Noam Levey of the Los Angeles Times. For Democrats, a meltdown of the new system would be politically damaging. For Republicans, "A relatively drama-free rollout of the law this fall could shatter what has been a key pillar of the Republican agenda."

Opinions about Obamacare will not change overnight and the law's effectiveness won't be determined by the first few weeks of the exchanges. The Congressional Budget Office estimates that only about 7 million people will enroll in 2014, but that the number will rise to 25 million by 2018.

There are currently 640,000 uninsured Kentuckians, which 14.9 percent of the state's population, says the Kynect website. About 332,000 will be able get insurance through the exchange, and 276,000 of them can get subsidies to buy insurance coverage through the exchange.  An additional 308,000 Kentuckians will be newly eligible Medicaid, with expansion of the program to people earning up to 138 percent of the federal poverty level.

It is expected that about 147,000 Kentuckians who are newly eligible for Medicaid in 2014 will find coverage through Kynect. That number is projected to increase to about 188,000 by 2021, says a Medicaid expansion report. Open enrollment for coverage runs through March 31, 2014. Beginning Jan. 1, coverage purchased on the exchange will take effect, and most Americans will be required to have health insurance or pay a penalty. Click here for more information about Kynect.

Gov. Steve Beshear and Lt. Gov. Jerry Abramson are appearing at events across the state this week to promote the exchange and enrollment, starting Tuesday morning in Louisville and that afternoon in Hazard. They will visit Ashland, Lexington, Covington and Bowling Green on Wednesday; and Mayfield and Owensboro on Thursday. For details, click here.

Workers, employers blame Obamacare for higher premiums, but experts say the causes are a lot more complicated than that

By Molly Burchett
Kentucky Health News

While the main provisions of the federal health-reform law are only now taking effect, some Americans are already saying it doesn't work and are blaming it for higher insurance premiums and deductibles. But the cause and effect are uncertain.

"The connection between the new benefit plans and the new law isn’t as clear as it might seem . . . because many of the coming benefit changes have been talked about and embraced by companies for years, long before Obamacare became an emotional and political lightning rod," reports Dan Horn of The Kentucky Enquirer.

As they renew or enroll in employer health plans, workers are taking note of unwelcome changes, including new fees and surcharges, more high-deductible plans, bigger penalties for not participating in wellness programs, and the elimination of benefits for spouses, Horn writes.

"The law represents the most profound change to the nation’s health care system in decades, and uncertainty over its provisions has made both businesses and individuals nervous," Horn reports. "With the [employer] mandate on hold, most companies get another year before the Affordable Care Act changes the game."

Nearly one in five Americans believe their health insurance costs have gone up because of Obamacare, says CNBC's third quarter All-America Economic Survey.

Actual health-insurance premiums to cover working Americans rose 4 percent this year, less than in the previous two years, says the Kaiser report. Slow premium growth indicates a slowdown in health benefit costs for U.S. companies, which economists attribute to an overall economic slowdown. And, the tepid economic recovery and decline in personal wealth continues to impact the health sector, says a recent Price Waterhouse Cooper Health Research Institute report.

Shifting costs to employees

While premiums may be rising more slowly for employers, they could be rising more rapidly for workers because employers' insurance plans are shifting more costs to workers. Many companies are moving to high-deductible plans that require employees to pay a larger share of their costs.

The Pricewaterhouse Coopers report said in 2013 that the number of employers offering only high-deductible plans increased 31 percent over 2012, and another 44 percent of employers are considering the move for 2014. Transitions to high-deductible plans can affect health care costs; when consumers pay more for their health care, they often make more cost-conscious choices.

"Businesses have been shifting more of the costs of health insurance to workers through premiums, deductibles and other cost-sharing,” said Drew Altman, Kaiser Family Foundation CEO. “From a consumer perspective, the cost of health insurance just keeps going up faster than wages.”

Over the last decade, premiums have risen almost three times as fast as wages or inflation. The average premium for family coverage has increased 80 percent, and worker contribution has increased 89 percent over the past decade and 14 percent more than in 2009, says the Kaiser report.

A new study by the Kaiser foundation says the economy has had the biggest influence on health care utilization and spending.

It says adjustments to health benefit plans have been slowly occurring over the past decade, well before Obamacare became policy, and economic conditions may influence workers' perception of health insurance costs. “We’re seeing that the continued economic downturn is leading to more burden for employees,” said Gary Claxton, vice president of the foundation.

The economic decline has put pressure on companies to reduce overall costs and pass along the expense of health insurance to the employees, said Claxton. Companies have been trimming benefits and implementing cost-saving and cost-control measures for some time, but many still blame these unpopular measures on Obamacare. “Why wouldn’t you?” he asked.

Proponents of Obamacare say it's actually helping control costs. Even if it isn't now, it will eventually, Claxton told Drew Armstrong of Bloomberg in a conference call. His boss agrees.

"Historically, we have always seen the health-care marketplace respond by lowering costs when there is the threat of impending health reform legislation or government action on costs," Altman wrote in a recent column for Politico. "Now we have not only the threat but the reality,"

Big changes are on the way

The health law builds on employer-sponsored insurance, but since it makes such big changes to the system, some are questioning how it will impact the employers' role in providing insurance. A study by the RAND Corp. says that through state insurance exchanges' putting employees of small firms into a single risk pool, Obamacare could alleviate some of the difficulties faced by small firms that want to offer insurance.

Many people are concerned that the law may cause employers to stop offering health insurance. The RAND study predicts the opposite, saying that the number of workers offered coverage will increase from 115.1 million (84.6 percent of the approximately 136.0 million U.S. workers) to 128.7 million (94.6 percent ) after the reform.

The large increase in coverage will stem from small business coverage, which will be driven by a greater demand for coverage by workers due to individual penalties for being uninsured and the availability lower-cost insurance options, says the RAND study.

However, health plans may look different than those before the health law passed. The state exchanges allow an employer to provide employees with more plan options. The Kaiser report notes that the exchanges encourage employers to deliver health benefits in a lump sum that employees can use to buy insurance through the exchange.

Another trend tied to the law is the proliferation of employee wellness programs. New federal rules for such programs allow employers to have larger financial rewards for employees who participate in them, and allow employers to penalize employees for specific behaviors, such as smoking.

Horn, writing in the Enquirer, says companies have embraced wellness programs as a way to offset costs: "No matter where they stand with the law, companies are constantly looking for new ways to save on health care."

These health-benefit approaches, just like the premiums paid for the plans, will vary with each exchange. Kaiser says the common theme is to give employees choices, along with financial responsibility for those choices. The fact is, as a result of the health law, some Americans will pay more for health insurance and some will pay less.

"Whether this new way of purchasing coverage works for employers and their employees, and how it affects benefits and plan costs, will be among the more important stories for the employer health insurance market over the next few years," says the Kaiser report.

Delaying individual mandate, as GOP now proposes, would wreck exchanges and Obamacare, Democratic aide warns; McConnell says Republicans can't get Democratic votes they need in Senate

The key piece of the latest House Republican legislation to keep the federal government running – a one-year delay of the federal health-reform law and its requirement for individuals to make sure they are covered – "would have serious consequences" for the online health-insurance marketplaces set to open Tuesday, writes the spokesman for the only Democrat in Kentucky's congressional delegation.

"If you require insurance companies to cover everyone regardless of pre-existing conditions and don't require everyone to have insurance, the insurance companies will leave the market," writes Stephen George, communications director for Rep. John Yarmuth of Louisville. "Kentucky tried that in 1994, and the results were devastating: 40 insurance companies left the state, leaving just one private plan and one state-run plan." Supreme Court Justice Ruth Bader Ginsburg noted that in her concurrence to the decision upholding the law, George notes.

Senate Republican Leader Mitch McConnell told Newsmax.com that the House plan "would be a very appealing vote to all Senate Republicans," but they despair of getting any Democrats to join them. "It would require at least five Senate Democrats to agree with that. We’re not going to be able to do anything Republicans-only in the Senate because we have a math problem."

Hinting that the game is about at an end, or at least that he wishes it to be, McConnell said Republicans would target four Democratic senators who are seeking re-election next year in states President Obama lost twice: Mark Begich of Alaska, Mark Pryor of Arkansas, Mary Landrieu of Louisiana, and Kay Hagan of North Carolina.

"There are four Democratic senators who are running for re-election who will have to explain to their constituents why they didn't take the opportunity today to defund, and therefore stop, this overwhelmingly unpopular law," McConnell said. "Our ability to have achieved the defunding is not there, because we don't have enough Republican senators to achieve the goal — and until we have at least four or five Democrats to support us, we can't get that job done." (Read more)

Beshear, writing in The New York Times, defends Obamacare

Ever since he decided to expand Medicaid with money from the federal health-reform law, Democratic Gov. Steve Beshear has been telling opponents of Obamacare to "Get over it." Now, as Republicans have made the law the sticking point in talks to keep the government open and cover the national debt, Beshear has taken that argument to a national audience.

"Get over it, and get out of the way, so I can help my people. Here in Kentucky, we cannot afford to waste another day or another life," Beshear concluded in an op-ed piece in The New York Times on Friday. While not naming Sens. Mitch McConnell and Rand Paul, he took some swings at them.

"Sunday morning news programs identify Kentucky as the red state with two high-profile Republican senators who claim their rhetoric represents an electorate that gave President Obama only about a third of its presidential vote in 2012," Beshear wrote. "So why then is Kentucky — more quickly than almost any other state — moving to implement the Affordable Care Act?"

The real answer is that Beshear is a Democrat and Kentucky law allowed him to expand Medicaid and create a state-based health-insurance marketplace without approval of the legislature, which is divided between the parties. But the governor answered his question another way: "Because there’s a huge disconnect between the rank partisanship of national politics and the outlook of governors whose job it is to help beleaguered families, strengthen work forces, attract companies and create a balanced budget."

Beshear noted that several Republican governors have expanded Medicaid and/or created insurance exchanges, saying they "see the Affordable Care Act not as a referendum on President Obama but as a tool for historic change. That is especially true in Kentucky, a state where residents’ collective health has long been horrendous."

Beshear said health insurance will now be available to the 640,000 uninsured Kentuckians. "Lack of health coverage puts their health and financial security at risk. They roll the dice and pray they don’t get sick. They choose between food and medicine. They ignore checkups that would catch serious conditions early. They put off doctor’s appointments, hoping a condition turns out to be nothing. And they live knowing that bankruptcy is just one bad diagnosis away. Furthermore, their children go long periods without checkups that focus on immunizations, preventive care and vision and hearing tests. If they have diabetes, asthma or infected gums, their conditions remain untreated and unchecked. For Kentucky as a whole, the negative impact is similar but larger — jacked-up costs, decreased worker productivity, lower quality of life, depressed school attendance and a poor image. . . . Frankly, we can’t implement the Affordable Care Act fast enough." (Read more) 

Ky. Health Cooperative, a new kind of insurer, could help hold down rates and reshape the health-care system

By Molly Burchett
Kentucky Health News

FRANKFORT, Ky. -- A little-known but key part of federal health reform created a new kind of health insurance -- a cooperative that is neither public, like Medicare and Medicaid, or run for profit, like traditional insurance companies. And the Kentucky Health Cooperative is offering coverage this week, with the opening of the state health-insurance exchange.

Kentucky is one of 23 states with plans the law designated as Consumer Operated and Oriented, or "co-ops," designed to give for-profit companies more competition and hold down rates. The plans have received more than $2 billion in federal loans to build themselves from scratch, but have been operating largely under the radar.

Janie Miller (Associated Press photo)

"The co-op program is an extremely little known part of the Affordable Care Act," Kentucky Health Cooperative CEO Janie Miller said in an interview with Kentucky Health News. "It's been very difficult to get people to understand what the co-op is and why they should care."

The Co-Op provision was a political compromise in the Affordable Care Act, developed as an alternative to the "public option" of a government-run plan. "It's the closest thing you can probably get to a public option," said Miller. “We [cooperatives] are created to be the non-profit options in most states… specifically for the uninsured and under-insured. ”

But the co-op could also help all insurance buyers, by pushing private insurers to set premiums lower than they would without non-profit competition. "Since we are non-profit, we don’t have to add a profit margin to our products, so our price should be competitive," Miller said. 

"We believe the addition of the Kentucky Health Cooperative will be positive for Kentucky consumers by bringing more competition to the market," said Ronda Sloan, spokesperson for the state Department of Insurance, which approves premium rates. "While Humana is offering a limited service area, both Anthem and the Kentucky Health Cooperative are offering plans statewide."

Development of the co-op

The creation of this new type of insurance began in Kentucky when Joe Smith of the Kentucky Primary Care Association, a lobby for primary-care clinics, got a call from Beam Partners of Atlanta, a consultant to health plans and cooperatives, offering to help create a co-op. Smith, who spent five years organizing health cooperatives in Alaska before becoming executive director of the Kentucky group, recruited other board members and Miller, who was recently secretary of the state Cabinet for Health and Family Services.

The cooperative was the only applicant in Kentucky for the federal loans. It received $11.9 million in start-up loans and is in line for $46.8 million of reserves from the federal government. The reserve money allows the co-op to meet state requirements for solvency and enter the insurance market.

Miller said the application process was community-driven and required a business plan and an extensive feasibility study estimating how many people the co-op would likely insure. It estimates 31,000 in the first year and 65,000 after 20 years.

"That's about 10 percent of the uninsured market that would be eligible for the exchange and not the Medicaid expansion" under the reform law, to people with incomes up to 138 percent of the federal poverty level. The exchange offers tax credits to make its coverage more affordable.

In return for the federal money, and to promote sustainability and accountability, the co-op must reach specific milestone requirements to receive all of the money from the Center for Consumer Information and Insurance Oversight in the Centers for Medicare and Medicaid Services.

"Is it an uphill battle? Absolutely," Miller said.

The co-op has some limits

The law bars the cooperative from using federal loan funds to for marketing and advertising, but it is required to do education and outreach, such as press releases and community presentations, and it has hired a Louisville public-relations firm, New West, to raise its profile.

"We are finding that a lot of people, especially people who did not have insurance, don't necessarily value having health insurance every month like we do," Miller said. "But they see the value when they need health services . . . so we are doing a lot of education about what the patient protections are and about the new affordability programs" in the law, including the cooperative. Insurance from the co-op can be bought on the state health-benefits exchange, branded as Kynect, directly from the co-op website and from many brokers and agents in Kentucky..

Kentucky Health Cooperative is modeled after other successful cooperatives, such as the Group Health Cooperative of Seattle, which was founded in 1947 and has evolved from a single clinic to an organization that delivers higher-quality, affordable coverage and care to more than 650,000 members, the group's executive director of public policy said at a Co-Op Federal Advisory Board public hearing.

In preparing to launch plans on the Kentucky exchange, Miller said, the cooperative's biggest challenge has been time constraints.  The co-op has outsourced its claims processing and call center, but will have 55 employees when fully staffed by Dec. 1, Miller said. It has partnered with ProCare Rx for prescription benefits.

Since the cooperatuve is new, it had no historical data about specific claims and collections, so it contracted with Milliman, an actuary with access to millions of claims for new carriers entering the market, to ensure that health plans were adjusted for a pool of members whose risks might be higher than usual.

The cooperative's business plan projects that about 75 percent of its sales will cover individuals directly, and 25 percent will cover employees of small businesses.

What's really different?

The cooperative is a non-profit, consumer-governed health plan, where consumers can become engaged and have a say in the health plan's affairs, says Miller. "There's something about health care that says it shouldn't all be for profit."

Smith said the co-op "provides an opportunity for a value-based system that goes beyond the bottom line."

The co-op will be directly responsible to its policyholder-members because it they will govern it. By January 2016, all of its board members will have been elected by co-op members, said Miller. “Not only that, but if we collect revenues above expenses, that money goes back to our members in the form of better benefits or lower premiums,” she said.

Miller said there's another inherent possibility in the co-op's consumer governance design to engage consumers and educate them. If the ownership is truly educated, the whole design of health care can be shifted from "treat them and street them" to a focus on quality care. Members "can start putting demands on the institution that they own to start being a true health care system. That's the dream, that's the goal," said Smith.

Kentucky, Louisiana, South Carolina and Tennessee are the southern states with cooperatives. Click here for the complete list and funding totals.

Watch out for specious claims about health-reform law in highly politicized debate; Sen. Paul among those found off base

The biggest story in the state and nation is about to be Tuesday's opening of online health-insurance marketplaces, or exchanges, under the federal health reform law. "Obamacare" has been politicized from the start, and the current debate has featured several specious claims that journalists should be on the lookout for as they report, edit, present and choose commentary (including letters to the editor and person-on-the-street interviews) on the subject.

"There’s plenty of fodder for fact-checkers in Sen. Ted Cruz’s looong attack on Obamacare, and in President Obama’s defense of it," says FactCheck.org, the oldest of the nonpartisan political fact-checking services. It says the Texas Republican falsely claimed that spouses of United Parcel Service employees will be “left without health insurance” and forced into “an exchange with no employer subsidy.” UPS is dropping coverage only for who can get insurance with their own employer.

Conversely, "Obama greatly exaggerated when he credited the health care law for bending the cost curve on health care spending," FactCheck says. "Experts say the down economy is the overwhelming reason that national health care spending has been growing at historically slow rates in recent years."

FactCheck also took on Cruz ally Sen. Rand Paul (R-Ky.) for saying “everybody is going to pay more” for health insurance under the Patient Protection and Affordable Care Act. "The fact is, some will pay more and some will pay less," the service says. "Some currently uninsured Americans will pay little or nothing because of the law’s expansion of Medicaid."

As usual, FactCheck has a detailed accounting for its analyses, with plenty of references, here.

Kentucky poverty rate is fifth highest in U.S., but a larger share of Kentuckians had health insurance in 2012 than in 2011

By Molly Burchett
Kentucky Health News

In 2012, as U.S. incomes remained lower and poverty rates higher than in 2007, the year before the recession, Kentucky poverty rates increased and one in four Kentucky children were living in poverty, according to estimates released Thursday by the U.S. Census Bureau. However, the percentage of Kentuckians with health insurance increased.

Kentucky had the fifth highest percentage of residents living in poverty (19.4 percent) in 2012, up from 18.8 percent in 2011. It ranked behind Mississippi (24.2 percent), New Mexico (20.8), Louisiana (19.9) and Arkansas (19.8). However, it was statistically tied with the last two states for third place because the error margin for the estimates is plus or minus 0.5 percentage points. Nationally, 2012 was the second straight year that the U.S. poverty rate had failed to improve. It remained at 15 percent, with 46.5 million people earning at or below the federal poverty line. Click here for an interactive poverty rate map from Stateline.

These findings highlight the challenges that Kentuckians face regarding economic security relative to the rest of the country. The high poverty rate should also act as a warning since it presages troubles with education, health and other areas, Terry Brooks, director of Kentucky Youth Advocates, told Chris Kenning of The Courier-Journal.

The figures are three-year rolling averages from the American Community Survey, a continuing poll of Americans. It estimated that 595,260 Kentuckians were uninsured in 2012, indicating an uninsured rate decline to 13.9 percent, from 14.7 percent. Overall, the U.S. uninsured rate dropped from 15.7 in 2011 to 15.4 percent in 2012, with the number of the uninsured statistically unchanged at 48 million. Insured rates tend to rise as employment rises.

Among the estimated 1 million Kentucky households earning less than $25,000 a year, 22.6 percent do not have health coverage. Kentuckians aged 19 to 25 had the highest percentage of unisureds for a specific age group; about 400,000 Kentuckians are in that group, and 28.1 percent of them are uninsured.

The national decline in the uninsured rate was modest compared to a bigger drop in 2011 that resulted from the federal health reform law that allowed people 26 or younger to be covered on their parents' plans. The slight dip in the national uninsured rate for 2012 was due mostly to increases in government coverage, such as Medicaid and Medicare.

Nationally, the coverage by employer-provided health insurance for people under 65 remained stable. Kentucky, Michigan and Vermont were the only states to see a statistically significant increase in the rate of private health insurance coverage from 2010 to 2012.

The Census Bureau's American FactFinder report generator provides specific information about health insurance coverage.  For example, the chart below comes from a report about the types of health insurance coverage for specific age groups, and it shows estimates of the types of coverage for Kentuckians ages from 35 through 64.

When the main provisions of the health law take effect in 2014, expansion of the state Medicaid program with federal money is expected to provide free health care to as many as 308,000 Kentuckians at up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four.

The state will also offer federal tax credits for Kentuckians who lack job-based health insurance and buy private coverage through the new state health insurance exchange, Kynect, which opens for enrollment on Oct 1. Click here to read more about Kynect or to check your eligibility for coverage or subsidies.

Earlier, the Census Bureau reported there were 46.5 million people in the U.S. living in poverty median household income remained steady from the year before and was $51,017. Kentucky had a median household income of $46,362 in 2012, compared to the U.S. median of $51,371.  Click here for an interactive median income map from Stateline.

Beshear announces rates in health-insurance exchange, says Kentuckians will like them, especially the federal 'discounts'

By Al Cross
Kentucky Health News

Tossing out the first examples of what Kentuckians will pay for required health coverage through the state health insurance exchange that opens Oct. 1, Gov. Steve Beshear predicted yesterday, "The vast majority of people are going to be very excited about what they find. . . . When they check it out, they’re gonna sign up."

Beshear said there has been much speculation about premiums, but little talk about the federal subsidies (he called them "discounts") that the exchange will offer to individuals and households with incomes up to 400 percent of the federal poverty level. He said subsidies will be available to individuals earning as much as $45,960 a year, and to families of four with income as high as $94,200 a year.

Beshear notes that 15 percent of Kentuckians are uninsured (light green in pie chart); at left is
Kynect Director Carrie Banahan; at right is Health and Family Services Secretary Audrey Haynes.

Tea Party activist David Adams, who recently lost the first round of his court battle to stop the exchange and Medicaid expansion, has said some consumers will have to pay almost double for their current coverage, and he told The Courier-Journal that the subsidies won't make up for that.

About 15 percent of Kentuckians, more than 640,000, have no health coverage. About 308,000 will become eligible for the Medicaid program, which is being expanded under federal health reform to include people with incomes up to 138 percent of the poverty level. Among the other 332,000, 85 percent of those people will qualify for subsidies, Beshear said, and in some cases the subsidy will be 100 percent.

The subsidies are available only through the insurance exchange, which the state has branded Kynect. The exchange will offer five plans, with premiums based only on age, income, geography, number of people on the plan and how many of them use tobacco.

State's example of bronze plan for a smoker earning $30,000

The ceiling for the tobacco surcharge is 40 percent, which has drawn criticism, but the state Department of Insurance said that is the most common surcharge in the state's health-insurance industry. Beshear said a 50-year-old man who smokes and earns $30,000 a year would still pay only $160 a month for coverage under the "bronze" plan, the one with the lowest premiums and highest deductibles and other out-of-pocket costs. Under the plan with the lowest deductibles, he would pay $279.

The bronze plan has a very large $6,300 deductible. The other standard plans are silver, gold and platinum; their deductibles are 20 percent (called "co-insurance") plus $4,600, $2,500 and $1,000, respectively. The exchange will also offer people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy, Beshear said.

Among other examples in the bronze plan, which has a $6,300 annual deductible: A nonsmoking farmer in his mid-50s earning $34,000 a year would pay $47; a family of four with no smokers and $70,000 annual income would pay $403; a 32-year-old single mother with two children and $40,000 income would pay $133.

Beshear offered no average cost, saying “There are too many factors to create an average that would be useful. . .. The bottom line is that families must do some research,” which the Kynect website and call center can help them with starting Oct. 1. He said the plans shouldn't be compared to individual plans offered in commercial market, because “the coverages are so much different.”

One big difference is that under the federal health reform law, all plans must cover prescription drugs, hospital care, maternity and newborn services, mental health and substance abuse services, emergency care, rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management and pediatric services. Also, they are not allowed to have any dollar limits on coverage.

The law also bans insurance companies from denying or dropping coverage because of someone's health condition, meaning that "For the first time we’re gonna be able to provide affordable health insurance of every single Kentuckian. . . . This is a historic event in the commonwealth." The federal law requires practically every American to have health insurance.

The plans' geography is based on the state's eight Medicaid regions. Beshear said at least two insurance companies will be offering plans in each region, unlike some states. He said four companies have proposed to offer dental insurance, but those plans are still under review by Kynect and the Department of Insurance, which evaluates them for actuarial soundness.

Humana Inc., Anthem Blue Cross and the new Kentucky Health Cooperative will offer policies for individuals, while Anthem, the co-op, Bluegrass Family Health and United Healthcare will provide employee coverage for businesses. Employers with fewer than 50 workers are not required to insure them, and those with fewer than 25 employees can get tax credits for doing so.

The rates are for 2014. Beshear said companies were “understandably cautious” in setting premiums without any experience on which to base them, so he expects rates to decrease in 2015.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.