Feds allow people whose health plans were canceled, and haven't gotten a new one, to keep old one or get catastrophic plan

If you were among the 280,000 or so Kentuckians whose health plan didn't meet the requirements of the federal health-reform law, and you haven't enrolled in a qualified plan, you will be able to keep your old plan for a while, or buy a cheap, catastrophic-coverage plan that has been available only to people under 30, the U.S. Department for Health and Human Services announced Friday.

The Obama administration acted under the law's "hardship" exemption  for people who "experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan."

"For these people, in other words, Obamacare itself is the hardship," writes Ezra Klein of The Washington Post. "The administration agreed with a group of senators, led by Mark Warner of Virginia, who argued that having your insurance plan canceled counted" as an unexpected human-caused event.

The White House estimates that only 500,000 people who had their plans canceled because of Obamacare have not yet obtained insurance. However, insurance companies "worry the White House is underestimating," Klein reports.

In Kentucky, 48,302 of the approximately 280,000 whose plans didn't qualify are in "grandfathered" plans that were extended in advance by insurance companies, according to the state Department of Insurance. Another 63,832 were offered transitional relief by their insurance company under President Obama’s request to states, which Kentucky approved. "The remaining had the option to take early renewal to continue current health insurance policies through at least 12-1-14," department spokeswoman Ronda Sloan told Kentucky Health News in an email.

The move "puts the administration on some very difficult-to-defend ground," Klein writes. "Normally, the individual mandate applies to anyone who can purchase qualifying insurance for less than 8 percent of their income. Either that threshold is right or it's wrong. But it's hard to argue that it's right for the currently uninsured but wrong for people whose plans were canceled. Put more simply, Republicans will immediately begin calling for the uninsured to get this same exemption. What will the Obama administration say in response? Why are people who plans were canceled more deserving of help than people who couldn't afford a plan in the first place?" (Read more)

"Catastrophic plans generally have lower premiums than other plans but offer more limited benefits," writes Louise Radnofsky of The Wall Street Journal. "They typically cover three primary-care visits a year and some preventive benefits, but beyond that they only cover large medical costs after a high deductible. Carriers offering them for the coming year already have cleared the plans with state regulators and set prices in the expectation that few people over the age of 30 would be purchasing them."

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)

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)

Beshear says other governors will follow his lead on Medicaid

Associated Press file photo

Gov. Steve Beshear says states that have not expanded the Medicaid program under the federal health-reform law, as he did, will do so in the next few years because their voters will demand it.

“I believe the pressure will be so great over the next three or four or five years, on the states that haven’t gone in this direction, that they will end up just where Kentucky is,” Beshear told Alexander Burns of Politico, in the governor's latest appearance in a national publication.

Burns writes, "It’s precisely the message national Democrats are aching to hear, even – or perhaps especially – from a source as unexpected as a pro-gun, pro-coal, red-state governor who once endorsed using state tax incentives to build a creationist theme park."

The story, headlined "Kentucky's unlikely health care heartthrob," focuses on Beshear's high national profile stemming from his expansion of Medicaid to people earning up to 138 percent of the federal poverty line and the state's successful rollout of a website that is enrolling about 1,000 people a day in Medicaid or private insurance -- unlike the federal government's site, which seems to be getting in order after a disastrous rollout that made many Democrats nervous. He is the only Southern governor to take both steps.

"For anxious national Democrats who have pined for a white knight in the health-care reform debate, Steve Beshear is starting to look like the one they’ve been waiting for – implausible as that development may be," Burns writes. "Amid a torrent of negative national headlines about the Affordable Care Act, the 69-year-old Kentucky governor – a canny Southern operator who’s spent his career at arm’s length from the [national] Democratic base – has charged out of Frankfort as a kind of ambassador-by-default for the controversial law."

Burns says the verdicts on the state and national programs are "far from decided, but Beshear says his mind is entirely made up on both the merits and the politics of health care. From his perspective, voters’ opposition to the ACA is driven largely by a sense of anxiety about how the program may change their lives. If they find a year from now that the law has left their personal care unchanged, or even improved it, public opinion could shift quickly."

State Senate Republican Floor Leader Damon Thayer, "a leading Obamacare critic in the state, said Democrats would pay a price for Beshear’s decision to 'channel his inner liberal Democrat with no election ever facing him again in the future'," Burns writes, quoting Thayer: “While it appears that Kentucky has done a competent job implementing a website, it’s still a bad policy. . . . The people of Kentucky don’t like the fact that he has unilaterally implemented Obamacare without legislative approval, and they don’t like Obamcare.” (Read more)

Anthem says Kynect has delivered inaccurate enrollment forms, but is nevertheless a model for insurance exchanges

Some health-insurance companies say Kentucky's Kynect exchange for acquiring coverage is giving them inaccurate or incomplete enrollment forms, and that is also a problem in other state-operated exchanges, Kyle Cheney and Jason Millman reported for Politico Dec. 4.

"It’s a new twist in the unfolding saga of so-called 834 forms — industry jargon for the application files that insurers receive when someone signs up for coverage through an exchange," the reporters write. "Insurers in Kentucky and New York, for example, say they’ve received flawed 834 enrollment forms from their local exchanges, though the extent of the errors is unclear. Washington state has already had to correct thousands of 834s with faulty information about federal tax credits. . . . It’s uncertain how deep the problems go, in part, because the states themselves aren’t sure — and are reluctant to divulge much about their technical challenges."

As for Kentucky specifically, "Although a Kynect spokeswoman said the exchange has dealt with only 'minor issues' since it started sending enrollment files to insurers a month ago, she didn’t indicate whether those issues had resulted in flawed forms or if they’d been resolved."

Tony Felts, a Kentucky spokesman for Anthem Blue Cross and Blue Shield, told Politico that it's too early to say if the problems have been solved: “In general, the situation is the same for the state-run exchanges as it is for the federally facilitated exchanges. As far as the quality of the data that’s coming in, I can’t say that everything has been completely accurate.” Still, he told Kentucky Health News Dec. 9, "There is no question that Kentucky's exchange is performing substantially better and is a model for how the exchanges could be running."

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, a lobbying group, told Politico, “While there is significant variation from state to state, health plans in many state-based exchanges are seeing similar problems with enrollment files.” (Read more)

Beshear says Ky. is 'gold standard' for implementing Obamacare, trades shots with McConnell in Washington

"Kentucky has become the gold standard when it comes to implementing the Affordable Care Act, and I'm very proud of that," Gov. Steve Beshear said Thursday morning at a press conference in Washington with Democrats in the U.S. House.

"There is a tremendous pent-up demand in Kentucky for affordable health care," Beshear said. "People are hungry for it." Citing studies that led him to expand the Medicaid program under the reform law, he said that "will generate $15 billion for Kentucky's economy and create 17,000 new jobs," Jennifer Bendery reports for The Huffington Post.

Beshear also took a shot at Republican Sen. Mitch McConnell, who calls for repeal of the law: "I have a U.S. senator who keeps saying Kentuckians don't want this. Well, the facts don't prove that out." He said more than 550,000 people have visited the state's health-insurance exchange website since it launched on Oct. 1, and about 69,000 have signed up for coverage, 41 percent of them under 35.

"Asked if he thinks Obamacare will be a factor in McConnell's reelection campaign in 2014, Beshear said 'It may well be,' but perhaps not in the way McConnell hopes," Bendery reports. The governor said, "I predict it will be an issue where people start looking at the critics and say, 'What was all that yelling and screaming about? I think you must have misinformed us about the Affordable Care Act.'"

Wednesday night, McConnell called the law a "catastrophic failure" for people everywhere," Bendery notes. "This is beyond fixing. It needs to be pulled out root and branch and we need to start over," the Senate minority leader said on Fox News Channel's "On The Record With Greta Van Susteren."

"McConnell spokesman Don Stewart responded by citing an article about 280,000 Kentuckians being forced to give up their current insurance policies as a result of Obamacare requiring stricter guidelines for coverage," Bendery reports. McConnell later issued a statement saying in part, "The things my constituents now have to put up with as a result of this law are simply unacceptable." (Read more)

Webinar on health-reform coverage to be held Thursday

A one-hour webinar, "Covering Health Care Reform: How to Inform Your Readers," is being offered from 2 to 3 p.m. ET Thursday at a cost of $45. (The earlybird fee of $35 has expired.) The sponsors are the Kentucky Press Association, the Southern Newspaper Publishers Association and Online Media Campus. For registration and more information, click here.

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.

Haynes asks hospitals for a truce as they and state work through problems with managed-care Medicaid

Health and Family Services Secretary Audrey Haynes won a smattering of applause from Kentucky hospital officials Thursday as she called for "not a surrender, but a truce" as her cabinet continues to address the hospitals' complaints about the state's managed-care system for Medicaid, which recently entered its third year.

Haynes drew the ire of hospitals last month when she said some needed to change their business models to emphasize prevention and wellness, not cashing in on Medicaid payments for emergency-room care. Thursday, she said in a speech to the Kentucky Hospital Association in Louisville that she wants "to work more closely together, not only to improve your business practices," but to improve the health of Kentucky.

Haynes also called on the hospitals to join Appalachian Regional Healthcare and the University of Kentucky hospital in contacting past patients who lacked insurance and urge them to sign up for expanded Medicaid or private insurance on the state's Kynect website, under federal health reform. "I need your help," she said. "we're very excited about the opportunity for dramatic improvements in Kentucky's health status."

Also at the meeting, state Rep. Jimmie Lee, D-Elizabethtown, the House's health-care budget subcommittee chair, said he thought Haynes and the administration of Gov. Steve Beshear had largely resolved the "prompt pay" problems of hospitals not getting money they are owed by insurance companies. But Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, called for more action on the subject, such as an independent review panel to review disputed claims.

Beshear and two other Democratic governors say Obamacare is working in their states, and cite examples

Gov. Steve Beshear continues to be a major national cheerleader for the federal health-reform law, citing Kentucky examples in an op-ed piece he and the Democratic governors of Connecticut and Washington circulated to newspapers this week.

"People keep asking us why our states have been successful," they write. "Here’s a hint: It’s not about our websites. Sure, having functioning websites for our health-care exchanges makes the job of meeting the enormous demand for affordable coverage much easier, but each of our state websites has had its share of technical glitches. As we have demonstrated on a near-daily basis, Web sites can continually be improved to meet consumers’ needs. The [Patient Protection and] Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football."

All three governors expanded the Medicaid program to include people with incomes up to 138 percent of the federal poverty line. Beshear cites two independent studies that showed Kentucky "couldn’t afford not to expand Medicaid. Expansion offered huge savings in the state budget and is expected to create 17,000 jobs." The state will have to start helping pay for the expansion in 2017, but Beshear has argued that the economic activity from more health care will cover that bill.

At least one of Beshear's co-authors, Washington Gov. Jay Inslee, is not allowing insurance companies to renew policies that don't comply with the law, as President Obama allowed last week. But they wrote, "What we all agree with completely, though, is the president’s insistence that our country cannot go back to the dark days before health-care reform, when people were regularly dropped from coverage, and those with 'bare bones' plans ended up in medical bankruptcy when serious illness struck, many times because their insurance didn’t cover much of anything.
Thanks to health-care reform and the robust exchanges in our states, people are getting better coverage at a better price."

As an example, Beshear cited Howard Stovall, whose sign and graphics business in Lexington "has paid half the cost of health insurance for his eight employees" since it opened in 1998. "With the help of Stovall’s longtime insurance agent and Kentucky’s health exchange, Kynect, Stovall’s employees are saving 5 percent to 40 percent each on new health insurance plans with better benefits. Stovall can afford to provide additional employee benefits, including full disability coverage and part of the cost of vision and dental plans, while still saving the business 50 percent compared with the old plans." (Read more)

At least one insurance company will let Kentuckians keep their health insurance plan for another year if they like it

By Molly Burchett
Kentucky Health News

At least one insurance company, Humana, will be allowing Kentuckians to keep their insurance coverage for another year if they like it, even if the policies aren't compliant with the Patient Protection and Affordable Care Act.

Partially owning up to his reforms' rocky rollout last week, President Obama said people whose policies were being cancelled because they didn't comply with the law could renew their policies for another year -- if insurance companies are willing to do so and state regulators allow it. Kentucky is among the states allowing them to do so, and Humana is going along.

Humana -- and Anthem Blue Cross, if it follows suit -- will be required to tell such policyholders "what protections these renewed plans don't include" and that they have alternatives that may be better and cheaper on insurance exchanges, Obama said.

“Humana has been educating people about the full range of options, including the ability to retain their current coverage, in accordance and coordination with state law," a Humana spokesperson told Kentucky Health News. An Anthem spokesperson said the company is still reviewing its options.

About 280,000 Kentuckians -- almost all those in individual and small-group insurance market -- faced policy discontinuation, requiring them to get different insurance coverage.

Experts say there are a number of obstacles that could keep insurers from letting customers renew old policies, including the concern that the risk pools of the state's health-insurance exchange will be skewed. And, insurers will have to calculate how much they plan to charge for policies that were going to be discontinued.

“Changing the rules after health plans have already met the requirements of the law could destabilize the market and result in higher premiums for consumers,” Karen Ignagni, the president of America’s Health Insurance Plans, a lobbying group, told The New York Times.

Some insurers say the president's move is adding to the confusion that surrounds the health-care law and adding uncertainty to the insurance market. This may discourage participation from a key group, young and healthy people who are needed to make insurance exchanges sustainable, reports The Washington Post.

There is doubt that insurance companies can do all of this in less than a month to ensure coverage is in place by Jan. 1. It is unclear how, as a practical matter, the changes proposed by the president can be put into effect, National Association of Insurance Commissioners President Jim Donelon said last week. And, even if they do, the proposed changes only last a year.

National Rural Health Day to be held Nov. 21, including webinars on current topics

The third annual National Rural Health Day, which brings awareness to rural health issues and current efforts in addressing these issues, will be observed with events nationwide and special presentations in Sterling Heights, Mich., Nov. 21.

The National Organization of State Offices of Rural Health and all 50 state offices of rural health said in a news release that health concerns of the 60 million rural Americans include: a lack of health care providers; accessibility issues, particularly transportation and technology; and affordability, as the result of higher out-of-pocket costs and other factors.

"Meanwhile, rural hospitals and health systems face declining reimbursement rates and disproportionate funding levels that make it challenging to meet the physical, social and economic needs of their communities," organizers say.

The observance also focuses attention on state rural-health offices, which foster relationships, disseminate information and provide technical assistance that improves access to quality health care for rural citizens, according to the news release.

National Rural Health Day events include several free webinars. Topics, times, and speakers are:

• AgriSafe: Protecting the People Who Feed America (Noon EST) – Natalie Roy, executive director and Carolyn Sheridan, clinical director, AgriSafe Network(Registration: https://www3.gotomeeting.com/register/491563334)
• Rural 101: The Basics of Rural Health (1 p.m. EST) – Kristine Sande, program director, Rural Assistance Center(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=660990830) 
• Population Based Health and Health Promotion in Rural (2 p.m. EST) – Lynda Bergsma, program director, Arizona Center of Rural Health; Caroline Ford, former director, Nevada State Office of Rural Health(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=666479151)
• The Affordable Care Act in Rural America (3 p.m. EST) – Tom Morris, associate administrator; Deepti Loharikar, public health analyst, and Aaron Fischbach, public health analyst, federal Office of Rural Health Policy(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=666426441)
• Resources for Recruitment, Networking, and Telehealth (4 p.m. EST) – Mike Shimmens, executive director, National Rural Recruitment and Retention Network; Rebecca Davis, executive director, National Cooperative of Health Networks Association; Kathy Hsu Wibberly, director, Mid-Atlantic Telehealth Resource Center(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=664434416)

The rural health offices' national organization will have a National Rural Health Day press conference and celebration at the National Press Club in Washington at 10 a.m. EST Nov. 21. To learn more about the observance, visit http://celebratepowerofrural.org. Contacts: Bill Hessert at 814-360-1964, billh@nosorh.org; Teryl Eisinger at 586-850-5257, teryle@nosorh.org.

280,000 Kentuckians, almost all those with individual and small-group insurance policies, will have to change under Obamacare

By Molly Burchett
Kentucky Health News

About 280,000 Kentuckians will have to give up their current insurance policies, which are being discontinued because they don't comply with the Patient Protection and Affordable Care Act, according to the state Department of Insurance.

Department spokeswoman Ronda Sloan said individual policies for about 130,000 people and small-group policies for about 150,000 more will be discontinued. This means that almost all Kentuckians in the individual (134,086) and small group (153,943) private insurance market segments will face policy discontinuation, requiring them to get different insurance coverage even if they like their current coverage.

These Kentuckians join the millions of Americans who are getting or will get cancellation letters for their health insurance under Obamacare. An estimated 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive this type of letter over the next year because existing policies don’t meet the standards mandated by the health care law, reports NBC News.

NBC says the Obama administration has known this would happen for three years, despite President Obama's statement that people who liked their health insurance would be able to keep it under the health law.

The plans that are being discontinued do not meet the requirements of the law, which standardized policies and set minimum standards. "This is not a ‘cancellation’ or a ‘termination.’ No one is losing coverage,” Sloan  said in an email to The Associated Press. Discontinuation letters will offering a compliant plan that the consumer can switch to upon renewal, she said.

The consumer can also take this opportunity to shop around for other options through an insurance agent or on the state's Kynect website, where they may qualify for a subsidy or Medicaid coverage, Sloan noted.  Kentuckians should be sure to purchase a plan that is from a licensed Kentucky company and is a qualified health plan, she said.

The health law requires all plans to offer 10 essential benefits, such as mental health care, prescription drug coverage and maternity and newborn care. Plans that don't cover such services typically have lower premiums.

In the small-group market, businesses can shop for employee coverage in the same way that individuals shop for coverage, through an insurance company, agent or Kynect.

Small employers have expressed concern about being able to afford coverage for their employees, citing rising premiums, and Sloan says there is no way for the Insurance Department to know whether or not an employer is planning to continue offering coverage to employees whose policies are being discontinued. "If not, those employees could purchase coverage on the individual market," she said.

Humana's misleading letter to policyholders

After Humana Inc. sent discontinuation letters to 6,543 policyholders, the Insurance Department fined it $65,430 because the letters were misleading. They called for customers to renew their plans for 2014 within 30 days or choose a more expensive option that complies with the health law, and didn't clearly say that policyholders could compare and choose competing plans, for which they could possibly qualify for federal subsidies. In addition, they said that a customer could get the cheaper premium option by agreeing to changes not yet approved by the Insurance Department.

“The Department of Insurance fined Humana for providing members with a policy amendment form that was not approved. This was a clear-cut violation of Kentucky’s insurance code,” Insurance Commissioner Sharon Clark told Chris Kenning of The Courier-Journal.

State officials are also reviewing a letter sent by Anthem Blue Cross Blue Shield that asked people to "call now to lock in "today's affordable rates,", reports USA Today. The insurance department determined that the letter was marketing to potential customers, and thus did not violate the insurance code. "Humana’s letter, by contrast, went to current policyholders," Kenning reports.

Latest New York Times look at Obamacare in Kentucky examines highs and lows of enrollees and people helping them

 Navigator Kelli Cauley helps an applicant. (Luke Sharrett, NYT)

While many states have suffered through complications in signing up uninsured people for health insurance under the Affordable Care Act, Kentucky has been leading the way in efficiency, enrolling about 1,000 people per day. Abby Goodnough of The New York Times was already using Kentucky as a lens to view the rollout of health reform, and in her latest story looks at major players in the enrollment process -- including the navigators for the state's Kynect website, insurance agents, and the uninsured -- exploring the ups and downs of each group.

"Though people can sign up on their own, navigators can help those confused by the sea of insurance options," Goodnough writes. "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." One such navigator, or Kynector, is Kelli Cauley. The Louisville resident has put 1,000 miles on her car in the last month, and the stress of the high pressure job has caused her to lose 12 pounds. As part of her job, Cauley is one of eight Kynectors who have "to enroll 699 people per month in Medicaid or private plans through the exchange. They are required to hold educational events around the region, and the agency’s phones have been ringing nonstop with requests for enrollment help at health fairs, cultural festivals and other events that the uninsured might attend."

Cauley, a former home-economics teacher, said she "expects the job to get harder as she comes under pressure to help people who might be more reluctant to sign up than the early enrollees," Goodnough writes. "But she has some strategies: visiting small day-care centers, for example, where workers are likely to be uninsured. For now, just meeting the initial flood of requests is a strain." Cauley told Goodnough, "You do have to be on your A game constantly." The reward, though, is that she has been able to help dozens of people get coverage.

Insurance agents aren't getting the same warm feeling. Some agents "refuse to sell plans through the exchanges, which they see as a threat, and have instead focused on selling other insurance, like property and casualty," Goodnough writes. Some agents who are selling the plans, aren't seeing a silver lining in the results. Donald Mucci, who has been "an insurance agent for more than three decades, has yet to get comfortable with the new system and does not much like it. (He) resents that the health care law prompted insurance companies to cut commissions paid to agents. And he thinks the exchange website makes it hard for people to understand the pros and cons of various plans, such as which hospitals and doctors they cover. Yet Mucci, an affable man in monogrammed shirt cuffs, said he wants the system to work."

Mucci, whose firm, the Garrett-Stotz Co., has been in Louisville 82 years, has only enrolled a few customers in exchange programs. During a recent enrollment, his commission was $18, far less than what he normally gets, Goodnough writes. "The law requires insurers to spend at least 80 percent of money from premiums on medical care instead of on administrative costs, which include commissions to agents and brokers. Consequently, some insurers cut commissions, infuriating many agents and brokers."

Despite the long hours put in by navigators, and the concerns of insurance agents, the plan appears to be helping people in dire need of insurance. And in some instances, people are getting what they need, without feeling like they're being handed charity. One such case revolves around a woman Cauley helped, who would identify herself only as Kay. The well-dressed substitute teacher "learned that she would be eligible for Medicaid under the new law, but she was unwilling to enroll because of what she saw as a stigma attached to the program," Goodnough writes. She told Goodnough, “I don’t want to be a freeloader.”

But the cheapest option for Kay "through the exchange would be a plan with a $356 monthly premium and a $6,300 deductible," Goodnough writes. With that amount being too high, Cauley was able to find her an alternative. "Kay could sign up for Medicaid, but only use it in catastrophic events. For checkups and other routine care, Kay could pay her own way, perhaps negotiating a discount with her doctors." She summed up her situation, and perhaps the point of what health reform hopes to accomplish, saying, “You’re giving me an alternative I can live with." (Read more)

Uninsured young adults may qualify for high-deductible health coverage for $50 or less per month on state exchanges

Almost half of single young adults who are uninsured may qualify for coverage for $50 or less per month under federal health reform, according to a report from the U.S. Department of Health and Human Services.

HHS says young adults often qualify for lower costs on monthly premiums through tax credits based on family size and income. A single person's income must not be more than $45,960 to qualify for a tax credit, according to the Kynect website, and lower-income families receive the most assistance.

The federal report examined the 34 federally facilitated and state-partnership marketplaces and found that 46 percent of single young adults (ages 18-34) who may be eligible for coverage could purchase a "bronze" plan with high a deductible for $50 per month or less after tax credits, and 66 percent may be able to pay $100 or less for coverage. The report also found that "an additional 1 million eligible uninsured young adults may qualify for Medicaid in the states that have opted to expand the program in 2014."  (Read more)

Find out about your eligibility at Kynect, Kentucky's online insurance marketplace.

Weekly newspaper's editorial advises readers to ignore 'irresponsible rhetoric' about Obamacare and find out the facts

The Sentinel-News, a twice-weekly newspaper in Shelbyville, reminded Kentuckians to pay close attention to the "irresponsible rhetoric" surrounding the launch of the Patient Protection and Affordable Care Act.

Since registration opened Oct. 1, "misinformation and carefully constructed lies" abound, the paper said in an editorial. It reflects on how many people have "fallen victim" to exaggerated individual experiences posted on social media and "even worse, the acceptance and delivery of similar items by otherwise responsible broadcast news outlets."

The editorial says there is great disagreement about the viability of the law and both sides of the political aisle are producing statistic and "experience"-based arguments to sway you to their way of thinking.  It goes on to say that the Better Business Bureau has issued an alert about scammers trying to capitalize on the process, and it is easy for consumers to be "had" in this environment. Fact-checking organizations have called some of the information propaganda. Tragically, the editorial says, "the 'information' being distributed to validate their arguments appears to be flimsy and desperate and without sound base."

The message of this editorial is: Consumers, do your homework and check your facts. It recommends a visit to the website of KIPDA, a Louisville-region planning agency that is helping people navigate the new system; checking the website of the state health-insurance marketplace, Kynect, to see what insurance will cost you and your family; calling an information hot line; analyzing all of your options ; and doing the math: Are the new health care options more or less expensive, more or less restrictive than another option you may have?

And finally, the editorial reminds us to be patient: "All parties (need to) let it roll out, evaluate how it works and then adjust the law to ensure that it meets the needs of most Americans and provides the intended health care." (Read more)

Ky.'s successful rollout of health-insurance exchange prompts New York Times to profile Beshear as 'a man on a mission'

A weekend article in The New York Times describes Gov. Steve Beshear as a man determined to prove that the health-reform law works, and says Kentucky stands out in many ways while the federal government is struggling to fix its health-insurance website. While comparisons are difficult, Trip Gabriel reports that Kentucky's health insurance marketplace is "one of the most successful" in the country.

Kentucky is the only Southern state to operate its own insurance exchange as well as to expand Medicaid coverage. "It is an anomaly on the polarized political map, and a test — in a red state that has elected to the Senate Mitch McConnell, the Republican leader, and Rand Paul, a tea-party favorite — of whether bitterness over the law will dissolve if people decide it effectively provides affordable health care," Gabriel writes.

Gov. Steven L. Beshear, right, with employees at Kynect 
headquarters. He has said Kentuckians do not have to 
like President Obama or him to like the new health care law.

President Obama said last week that Kentucky may have had the most successful exchange launch. As of last week, some 34,000 Kentuckians had begun applications on Kynect, and more than 11,000 had signed up for plans.

At the federal level, exchanges have been plagued by technical "glitches" and to date, the Obama administration has failed to release official enrollment numbers. The Republican National Committee said Monday it was sending a Freedom of Information Act request to the Centers for Medicare and Medicaid Services, seeking Obamacare enrollment numbers, reports Caroline May of The Daily Caller.

About half a million people have started applications on the federal exchanges, administration officials said Saturday. The figure is only a snapshot of applications, and since the administration isn’t planning to release until next month the number of people who have actually enrolled in a health plan, much is left unsaid, writes Joanne Kenen of Politico. For now, it can only be said that Kentucky may have the most successful roll-out, and the governor is determined to make success a certainty.

Beshear told the Times his decision to embrace the law was not political. “To me this was a moral decision,” he said. “We’ve got 640,000 Kentuckians who don’t have access to any kind of affordable health care. The last ranking I saw, we’re 44th out of 50 in health status. You take any chronic disease or condition — heart disease, cancer, smoking, obesity, you name it — and we’re either the worst or close to the worst.”

In embracing the law, Beshear decided not to seek approval from the General Assembly for the exchange or the expansion of Medicaid, moves that brought a lawsuit and a circuit-court ruling supporting him. The state Supreme Court has been asked to hear the case, brought by tea-party activist David Adams of Nicholasville. Beshear said in a recent op-ed piece in the Times, "To those more worried about political power than Kentucky’s families, I say, 'Get over it.'"

“Steve Beshear is a man on a mission,” Al Cross, the director of the University of Kentucky's Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News, told Gabriel. “He no longer has to worry about politics.” Beshear, who is in his second term, cannot seek re-election in 2015.

While many Kentuckians are concerned about Obamacare's effect on their health insurance or the state budget, Beshear blamed the law’s unpopularity on Republicans who were "demonizing" it. "You don’t have to like the president; you don’t have to like me," he told Gabriel. "Because this isn’t about him, and it’s not about me. It’s about you, your family and your children. So do yourself a favor. Find what you can get for yourself. You’re going to like what you find."

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.