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.

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.

A Ky. guide to the Patient Protection and Affordable Care Act

By Molly Burchett
Kentucky Health News

Few laws have generated as much confusion, opposition or news coverage as the Patient Protection and Affordable Care Act. Despite the flood of news stories about the law widely known as Obamacare, there is still much confusion about it.

That's not surprising. The 906-page law is complex and is accompanied by 10,535 pages of regulations. This guide to the law is designed to clear up confusion and offer various perspectives about how the law may affect you, your family or your business.

What does the Affordable Care Act do?

The law is a set of reforms that impose many requirements on insurance companies and requires all Americans, with very few exceptions, to have health coverage or pay a penalty starting Jan. 1.

Kynect home page

In addition to those mandates, the law created online health-insurance marketplaces and encouraged states to expand the federally subsidized Medicaid program for the poor and disabled. Gov. Steve Beshear expanded Medicaid and decided the state would run its own marketplace or exchange, Kynect, which launched Oct. 1.

Why did Congress pass the law?

The law is designed to extend health coverage, either through private insurance or Medicaid, to Americans without health insurance. More than 47 million Americans were uninsured in 2012, says the Kaiser Family Foundation, and about 640,000 of them were Kentuckians.

The law's rules for insurance will increase costs for many, so it provides Medicaid or subsidized coverage to help qualifying individuals pay for coverage. Those with incomes under 138 percent of the federal poverty threshold qualify for Medicaid, and those with incomes up to 400 percent of the poverty line get premium subsidies. The line for a family of four is $23,550, so such a family would qualify for subsidies if it makes less than $94,200 a year.

Who will be affected by the law?

Obamacare will affect almost everyone, but it will have less impact on people 65 and up because they're eligible for Medicare. Virtually everyone must have health insurance coverage by 2014 or pay a penalty. Beginning in 2015, employers of 50 or more full-time workers (defined as working at least 30 hours a week) must provide coverage for their employees.

Insurance companies can no longer deny coverage because of pre-existing conditions such as a disability, pregnancy, or chronic disease. Under one part of the law that took effect early, parents are able to keep their children on their insurance until the children turn 26.

The law aims to help people who can't get affordable insurance through an employer or who aren't ineligible for public coverage through Medicare or Medicaid. It also affects the self-employed, small businesses and employees of businesses that don't provide coverage.

Because the law is making fundamental changes in the health-insurance system, "In the long run, pretty much every American will be affected by Obamacare," reports Abby Hayes of The Dough Roller, a financial-advice site. "Next year, employer-sponsored insurance premiums are likely to fluctuate as insurance companies adjust their offerings."

Will the law lower health costs?

It's too soon to tell what impact the law will have on costs. Remember, there are two types of health costs: the country's overall cost and the cost that you feel in your pocketbook from the money your household spends on health services.

If you buy an insurance policy through the state exchange, www.kynect.ky.gov, your cost will depend on your individual situation, such as the size of your household and the number of smokers in it, and your income, which will determine your eligibility for subsidies or Medicaid.

Most people who buy coverage in the individual market will pay higher premiums in 2014, mainly because companies are required to cover people with pre-existing conditions and a broader range of services, such as prescriptions, than many people have been paying for.

Rates in the individual market will change yearly, as explained in a report from the Kaiser Family Foundation. It says the broader coverage, and limiting surcharges due to age, will spread the overall cost of care across the insurance marketplace, tending to lower premiums for people who are older and sicker and raise them for people who are younger and healthier. Thus, the trade-off for pre-existing coverage is the individual mandate, which requires everyone to purchase coverage to spread the cost.

Think of it this way: When you go out to eat with two grade-school children, they can order off the kids' menu, so you pay less for their smaller portions. The total bill is $30. Your kids' chicken finger platters are $5 each, and you and your spouse both have $10 items. However, if the restaurant must charge all patrons equally for the same meal, the $30 cost would be assessed differently. The cost for each individuals would be $7.50; the cost of your kids' meals would be higher and you and your spouse's meal would cost less.

Many Kentucky businesses have expressed concern about rising premiums for employee coverage. Some are moving to high-deductible plans that require employees to pay a larger share of their costs, and some may drop coverage, letting employees obtain insurance and subsidies through the government exchanges.

How do I get coverage from the exchange?

The Kynect website will determine your eligibility for Medicaid or subsidies, allow you compare plans and process the insurance application. If you don't have a computer, you can call toll-free to 1-855-459-6328 to apply or locate a local "Kynector."

Unless you qualify for a special enrollment period, you must enroll in a health plan by March 31, 2014. A "life-changing event," such as moving to a new state, major changes in income and changes in family size, can make you eligible for a special enrollment period, says Healthcare.gov, the federal website. (Kentuckians do not use the federal site because the state has its own site, Kynect.)

The date coverage starts depends on when you buy it. If you enroll before Dec. 15 and pay your first premium, your coverage starts Jan. 1. Likewise, in succeeding months, if you enroll between the 1st and 15th, your coverage starts on the 1st of the next month. If you enroll after the 15th, coverage starts the month after the next one.

What do the health plans cover?

Regardless of which plan you chose, the law requires all plans offered by any insurance company to cover these essential health benefits:

1. Ambulatory patient services (outpatient care)
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance abuse services (including behavioral health treatment)
6. Prescription drugs
7. Rehabilitative and habilitative services/devices
8. Laboratory services
9. Preventative, wellness, and chronic disease management services
10. Pediatric services (including oral and vision care) 

What will I pay for a plan?

Premiums depend on individual circumstances, such as income and the level of coverage, such as the amounts of deductibles and co-payments. Kynect is connected to federal databases — including Internal Revenue Service databases — to determine whether you qualify for assistance in paying a premium. People on Medicaid do not pay premiums.

Plans on Kynect vary widely. In addition to comparing premiums, it is important to consider deductibles, co-payments and other plan details. Kynect offers four basic types, labeled bronze, silver, gold and platinum. Bronze plans have the lowest premiums but have a $6,300 deductible. As you move up the plan spectrum to platinum, your premiums increase and your deductibles decrease. The exchange also offers people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy.

Let's consider a basic example. A 45-year-old Floyd Countian named John Smith earns $36,000 a year, which means he is eligible to buy subsidized insurance through Kynect.

The individual market in Floyd County is limited to two companies, Anthem Blue Cross and the non-profit Kentucky Health Cooperative; Humana Inc. isn't offering individual coverage there. Depending on the type of plan John chooses, his premiums will range from $182 (bronze) to $421 (platinum), with deductibles ranging from $6,300 (bronze) to $500 (platinum).

Kynect shows selected plans' ranges of premiums, 
deductibles and out-of-pocket limts.

John has several options. Let's say he decides that he needs to keep his premium payments below $250 per month because he just bought a house and is on a tight budget. He doesn't expect to have many doctor visits because he's pretty healthy, but he doesn't have enough money saved to afford a $6,300 deductible if things went south.

Considering his obligations, John decides to set aside 15 percent of his monthly income for health care. Based on this budget, he narrows his options down to three plans. The Kynect website displays them.

After eliminating the gold plan, John decides he would prefer to pay an additional $40 per month to reduce his deductible to $2,000, so he purchases the cooperative's PPO Silver plan. About 7 percent of his income each month will go toward the premium. He will save the other 8 percent ($240) to apply to his deductible, prescription drug costs and co-pays for office visits.

A $2,000 deductible means that John must pay all of his medical costs, excluding certain preventive services like immunizations and screening, until he reaches this threshold. Co-payments and premiums cannot count toward the deductible.

John really likes his family doctor, whom he's been seeing for 20 years, and the doctor is in the cooperative's network. This plan has a $30 co-pay for primary care and mental health services, and he feels comfortable paying this amount for an office visit. If he were to see an out-of-network doctor, he would pay co-insurance: 60 percent of the doctor's full charge for the visit. For prescription drugs, there is a $500 deductible, and John will pay $20 per prescription for generic drugs after reaching this amount.

John has peace of mind knowing that he's covered if he were to have an accident. The total amount he may have to pay each year is his out-of-pocket limit of $6,350, and since he has purchased this plan during the enrollment period, he will not face a penalty for not having coverage.

As he navigates the site, John sees that he qualifies for a payment assistance in the form of a tax credit that will either reduce the amount John will pay in taxes or increase his refund, depending on his personal situation; or it will reduce his monthly premiums, if he so chooses.

What happens if I don't get covered?

The penalty for 2014 will be the larger of either $95 per adult and $47.50 per child under 18, up to a total of $285 per family or 1 percent of household income in excess of $10,000 for an individual or $20,000 for a family.

For example, let's say an individual making $40,000 per year doesn't buy health insurance in 2013. This person would would pay 1 percent of $30,000, or $300, in 2014. What about a family with a $50,000 household income? It would pay a penalty of 1 percent of $50,000, or $500.

The initial penalties are much less than the cost of health insurance, but will go up each year. The minimum penalty may increase to as much as $695 per person by 2016.

What if I'm on Medicare or Medicaid?

Almost nothing will change if you have coverage through Medicaid, but there are some changes for Medicare beneficiaries. The law doesn't require Medicare beneficiaries to buy more insurance and won't force beneficiaries to see different doctors, reports Andrea Adleman of U.S. News.

Obamacare does, however, increase premiums or prescription-drug costs for some Medicare beneficiaries, and it mandates $716 billion in Medicare payment reductions over the next 10 years. These cuts are made by changing payment formulas for hospitals, nursing homes, home-health agencies, hospice agencies and Medicare Advantage plans, says the Congressional Budget Office.

The law already affects higher-income Medicare beneficiaries. Those who earn more than $85,000 ($170,000 for a couple) are paying higher Part B premiums, which cover physician and outpatient services, and for Part D, which covers prescription drugs, says Kaiser Health News. As a result of this sliding scale, about 5 percent of Medicare beneficiaries are paying more for premiums and prescription drugs.

It is projected that by 2019, 7.8 million beneficiaries will be paying the higher Part B premiums and of that group, 4.2 million will pay the higher Part D premiums. Kaiser estimated the combined premium in 2019 would be $299 to $683 a month, depending on income.

However, typical Medicare beneficiaries, those below the $85,000/$170,000 income threshold, will pay less for their premiums since the the law closes the "doughnut hole," the coverage gap in prescription benefits, by 2020. The National Council on Aging estimates the savings could reach $1,800 for some beneficiaries.

Also, both Medicaid and Medicare beneficiaries will qualify for more free preventive care, such as a yearly wellness visit, vaccinations and colorectal screenings, starting Jan. 1.

What if my employer covers me?

About 57 percent of Americans have health insurance through an employer with fewer than 200 employees, and those who are covered do not have to purchase a new plan on Kynect. If your employer’s plan covers less than 60 percent of allowed medical expenses, or costs you more than 9.5 percent of your household income, you can shop on the exchange.

Over the past 10 years, employers have been shifting more health costs to employees. Worker contributions increased 89 percent during the decade, and are 14 percent higher than in 2009, Kaiser Health News reports. So, while the nature of your work plan may be changing, this is not a direct result of the health law.

If you aren't covered by your employer or if your employer decides to drop your coverage, you must obtain coverage or face a penalty. Religious conscience and hardship exemptions to this mandated coverage exist, and you will need to complete an application to request such an exemption.

What if I'm an employer?

Steve Wilson, senior vice president of Benefit Insurance Marketing in Lexington, said in an email that employers with fewer than 50 employees are facing 2014 premium increases that may lead them to drop coverage for their employees.

Wilson said unless companies act quickly to renew early based on 2013 underwriting rules, the average 2014 renewal for his company's small business clients will increase 63 percent. He said his clients represent a broad range of industries that will, on average, pay $3,508 more per employee for coverage next year.

On the other hand, a study by the RAND Corp. says Obamacare could alleviate some of the difficulties for small employers by putting their employees into a single risk pool. The study predicts that the number of workers offered coverage will increase after the reform, mainly because more small businesses will offer coverage.

If you have a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance.

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.

Kentucky's Obamacare website's success resulted from careful and early testing, unlike the federal website, writers say

While Kynect, Kentucky's online health insurance marketplace, is being hailed as the country's best Obamacare website, the federal government's $634 million Healthcare.gov website continues to marred by technological glitches and bad press.

"The Kentucky Kynect likely takes the award for most written-about Obamacare marketplace -- and for good reason," reports Sarah Kliff of The Washington Post. "It had one of the most flawless launches of any state marketplace, posting robust application numbers on Oct. 1. So far, the state reports that 26,174 people have enrolled in private insurance or Medicaid." That figure was through Oct. 24.

Kentucky's success resulted from the creation and careful testing of a pared-down website before the Oct. 1 deadline, writes Dylan Scott on Talking Points Memo. Beshear officially created the marketplace, Kynect, without approval from the General Assembly on July 17, 2012, a few weeks after the U.S. Supreme Court upheld the law. In October 2012, the state hired software developers to build the technological infrastructure behind the marketplace.

Testing was undertaken throughout every step of the process, Carrie Banahan, Kynect's executive director, told Scott. The system was developed from January to March of these year, was developed by June, and began testing in July, he reports.

On the other hand, testing for the federal website began just two weeks before the launch. Private contractors in charge of building the federal online health insurance marketplace said that the administration went ahead with the Oct. 1 launch of HealthCare.gov despite warnings of insufficient testing, reports The Washington Post.

“This system just wasn’t tested enough,” said Julie Bataille, communications director for the federal Centers for Medicare and Medicaid Services. 

Frustration with the federal rollout continues to grow, but Sunday on NBC's "Meet the Press" Gov. Beshear defended Health and Human Services Secretary Kathleen Sebelius and President Obama and told Obamacare critics to take it easy.

“Look, this is going to take some time to get done, but everybody needs to chill out because it is going to work,” said Beshear.

Kentucky received $252 million from the federal government to set up Kynect, and about $23.8 million of that was applied to contracts and outside vendor payments. Although startup costs for the exchange are being covered by federal grants, the state will be responsible for all funding beginning in 2015. It plans to get the money with assessments on insurance companies using the exchange, but that may prompt a battle in the 2014 General Assembly.

In its colorful Kynect costume, Obamacare hits the streets in Kentucky and attracts national news coverage

By Molly Burchett
Kentucky Health News

When the Patient Protection and Affordable Care Act takes effect Jan. 1, many Kentuckians may have signed up for the health coverage it mandates without ever associating it with its political label, Obamacare.

This could be a planned marketing strategy or just the result of the state's effort to provide health care coverage to uninsured Kentuckians, but there's no need to anxiously await for Obamacare's arrival in Kentucky; the state's part of the health-reform law has hit the airwaves with a commercial, and the streets with tote bags and flyers in hand. And national news coverage has followed.

Huffington Post’s Jason Cherkis spent a day at the Kentucky State Fair and the next day in Laurel County with workers from Kynect, the state’s online health-insurance marketplace, and while learning much about the Kynect outreach efforts, he reports little about Obamacare. That's because it's not being called Obamacare, a label Republicans devised and the White House eventually accepted.

At the reform law's core is the implementation of health-insurance exchanges and subsidies in each state, which is provided through Kynect in Kentucky, "but little or none of these operations will have the words 'Affordable Care Act,' much less 'Obamacare,' attached to them," writes Jonathan Bernstein of The American Prospect. 

The Kynect website, where Kentuckians can go to sign up for insurance coverage and determine their eligibility for it, doesn't mention the federal government, reports Kevin Drum of Mother Jones in an article titled "Here's Hoping That Obamacare Is Better Than That Appalling Obamacare."

The state site describes the long-awaited (for some) and highly controversial (for more) law: without referring to it directly: "Starting next year, most Americans will be required to have health insurance. By using Kynect, you may receive payment assistance, special discounts or tax credits to help cover the costs of coverage for you, your family or your employees,"it says.

Most Kentuckians probably don't know that the insurance exchange exists, let alone that the exchanges are part of Obamacare. In an August Kaiser Family Foundation health reform poll, only 22 percent of respondents nationwide said they’ve heard “a lot” or “some” about the state-by-state exchanges, which are set to begin selling policies and signing up people for expanded Medicaid on Oct. 1.

Half of those polled (51 percent) said they didn’t know enough about Obamacare to understand how it will affect them and their family, and the number was even higher (62 percent) among the uninsured, the reform law's target population.

The uninsured and newly eligible Medicaid recipients, an estimated 600,000 Kentuckians, are also the target of Kynect's outreach efforts, although they may not be the ones receiving the tote bags at fairs and community events.

Furthermore, the Kaiser survey results show a vast majority of Americans don't know that the health law is actually a law; about 44 percent said they were “unaware” of the current status of the law, with 31 percent of that number  (14 percent of the total) saying they simply didn’t know if the Affordable Care Act was law or not.

This all suggests the possibility that, even as people start signing up for Obamacare in a few weeks, public opinion about the health law won't change, writes Sarah Kliff of The Washington Post. Thus, while public opinion of Obamacare leans to the negative, that may not keep some of its ostensible opponents from becoming users of it.

Kliff writes that the following three paragraphs written by Cherkis say everything you need to know about Obamacare:

Reina Diaz-Dempsey

A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare.
The man is impressed. “This beats Obamacare I hope,” he mutters to one of the workers.
“Do I burst his bubble?” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn’t. If he signs up, it’s a win-win, whether he knows he’s been ensnared by Obamacare or not.

With millions of dollars from the federal government, the state conducted "market research that included holding a dozen focus groups in Louisville, Paducah and London, according to Gwenda Bond, assistant communications director with the Cabinet for Health and Family Services," Cherkis reports. The tote bags are popular, but Diaz-Dempsey doesn't hand one over until the would-be recipient hears her simple pitch, which does mention the law, but without its political label:
We are Kynect -- part of the new health care law.
Do you know anyone who doesn’t have health insurance?
You may qualify for Medicaid or a tax credit based on your income.

"The crush of people don't greet Diaz-Dempsey with tea party dogma or amateur constitutional scholarship," Cherkins writes. "No one is there to complain about the individual mandate or heckle about death panels. They have questions. They wonder if they could get coverage despite having a pre-existing medical condition, how much it will cost them. . . . Could they just enroll their child? They talk about their sons and daughters, neighbors going without health care, and ask about the subsidies. The vast majority are relieved to learn about the health exchange."

Erin Hoben

But the next day in London, in a heavily Republican area, Cherkis encountered many skeptics and outright opponents of Obamacare. He reports that Erin Hoben, an outreach worker with Kentucky Voices for Health, an association of pro-Obamacare groups, told him that a Hazard woman she had been working with "called her recently to tell her that the Tea Party had urged her not to enroll because the exchange wasn’t happening."

Democratic Gov. Steve Beshear, who expanded Medicaid and defended Obamacare in a speech to the fair's Kentucky Farm Bureau Country Ham Breakfast, told Cherkis, “Most people don’t really understand it yet. I do not find that most people have any kind of negative feeling about it. It’s just that most people don’t quite understand the act or what they’re supposed to do yet.”

But the feds like what Kentucky is doing, and the state's only Democratic congressman, John Yarmuth of Louisville, told Cherkis: “I know that the administration believes that Kentucky and Vermont are the two best exchanges that were created, that are models for the country. They’ve said that numerous times to the Democratic caucus.” (Read more)

So, as the Kynect website says, "It’s a new day for health-care coverage in Kentucky. Thanks to Kynect, the power to manage your own care is finally in your hands," regardless if you know it or not.

Click here to view a Kynect factsheet to learn more about the health-insurance exchange.

Obamacare hearing highlights employers' worry and uncertainty; Yarmuth says repeal and defunding bids block needed changes

Three of Kentucky's congressmen agreement at a field hearing in Lexington Tuesday that the Patient Protection and Affordable Care Act needs changing, but had no a consensus on how it should be fixed.


From left, U.S. Reps. John Yarmuth, D-3rd District; Andy Barr, R-6th District; and Brett
Guthrie, R-2nd District, listen to Rep. Phil Roe, R-Tennessee, who chaired the hearing.

Business leaders at the hearing also called for a fix, saying the law creates challenges for employees, workers and the economy.

Republican Reps. Brett Guthrie of Bowling Green and Andy Barr of Lexington said the law should be repealed. Democratic Congressman John Yarmuth of Louisville said efforts to change the law are hindered by efforts to repeal or defund it, reports Ryan Alessi of cn|2's "Pure Politics."

Yarmuth supports changes to the law's definition of a full-time employee as one that averages 30 hours of work a week, which he says has led to unintended consequences. Many of the 130 hearing attendees also expressed concern about the 30-hour employees, Alessi reports.

The law includes a mandate that companies 50 or more full-time employees must provide those workers with health insurance or pay a $2,000 penalty per employee. Although this mandate has been delayed a year by the Obama administration, the employee mandate and complex regulations of the law has created "massive uncertainty" for U.S. employers, said Barr.

Several business owners complained about the looming mandate and uncertainty as well as the harmful financial consequences of Obamacare at the hearing, which was held by the U.S. House's Subcommittee on Health, Employment, Labor and Pension. Six of the eight speakers were Republicans expressing opposition to the law.

"What we know is what the administration is now admitting — that this massive piece of legislation is unworkable,” said Barr, who also said that the law should be permanently delayed, reports Alessi.

A majority of Americans (57 percent) disapprove of "defunding" Obamacare as a way to stop the law from being implemented, says an August poll from the Kaiser Family Foundation.  Almost 70 percent of respondents said defunding would be "using the budget process to stop a law is not the way our government should work."

Long-time Lexington restaurant owner Joe Bologna said he is concerned that Obamacare will impact people's ability to eat out.  To prepare for this and rising health costs faced by the business, he has reduced his staff from 54 to 47 and is closed on Mondays, reports Jack Brammer of the Lexington Herald-Leader. Other business people shared similar stories about the law's negative consequences.

On the other hand, Carrie Banahan, executive director of the Kentucky Health Benefits Exchange, the state's online insurance marketplace, said the law will improve Kentucky's health. There were many supporters of the law at the hearing, and some even hissed at critics of the law, reports Alessi.

“If we could get a bipartisan agreement to actually work on tweaks legislatively, I think we could dramatically improve the law and eliminate a lot of uncertainty,” said Yarmuth. Click here to read more about testimonies form the hearing or to watch cn|2 videos.

New survey shows physicians feel need to limit health-care costs but make that secondary to the interests of their patients

A new survey about health-care costs reveals that 85 percent of U.S. physicians feel a responsibility to address costs but say other professionals have more of a responsibility to do that, because physicians' obligation toward patients' interests is more important than cost reductions.

While 36 percent of physicians said they have a "major responsibility" to reduce costs, other major players in health care, such as lawyers, insurance companies, hospitals and drug companies, bear that major responsibility, says the study published in this week’s Journal of the American Medical Association.

“Physicians feel stuck in a difficult position,” lead author Dr. Jon Tilburt says in a Mayo Clinic release. “Despite their sense of responsibility to address health care costs, physicians consistently express a commitment to the best interests of patients even when it is expensive. Given this finding, we recommend that cost-containment strategies aimed at physician behavior should focus on innovations that not only promote savings but also preserve physicians’ commitment to individual patients.”

Physicians expressed general agreement with quality initiatives that may also reduce health costs, but were less enthusiastic about cost-containment measures involving changes to payment models, says an American Medical Association release. For example, physicians opposed the idea of cuts in Medicare fees for hospital readmissions and eliminating fee-for-service models.

A strong majority of physicians (69 percent) were enthusiastic about promoting chronic disease care coordination and limiting corporate influence on physician behavior (63 percent). The survey also found that 76 percent of physicians are aware of the costs of tests or treatments they recommend, says the Mayo release.

Physicians said costs can be reduced by improving quality, efficiency and continuity of of care through evidence-based initiatives and cost transparency, says the AMA release. Results of the random survey of 2,500 U.S. physicians indicate ways in which policymakers can collaborate with physicians to address rising health care costs.

“Moving toward cost-conscious care in the current environment in which physicians practice starts with strategies for which there is widespread physician support might create momentum for such efforts...," writes the study's authors in the journal article. Tilburt says physicians want to do the right thing, but when push comes to shove, they will do what's best for patients. Let's start with win win strategies that physicians support and that will cut costs and improve care, he said in a MedPage Today video interview. Click here to watch that video.

Health Watch USA hosts chief medical director of Center for Medicare and Medicaid Services in Lexington and online July 31

Dr. Patrick Conway, chief medical director of the federal Center for Medicare and Medicaid Services, will be presenting to Kentucky-based Health Watch USA on July 31 at 5 p.m., and with a few clicks on the computer, you can attend virtually.

Conway will be discussing CMS goals and the results of its value-based quality improvement programs, physician fee schedule quality proposals and future opportunities for CMS collaboration aimed to drive health-care quality.

Using your computer, you can attend and participate in the discussion through an online chat while listening to Conway's presentation and viewing the slides. Just click here to log into the conference's webpage and Adobe Connect will download to your computer free of charge.

The online login will be active 15 minutes before the presentation on July 31, and the presentation slides will be available to download as a PDF from the conference page. You can also attend the presentation at the Northside Library in Lexington. Click here for more information.

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website.

Kentucky picks up on federal Medicaid funding for inmates, which will expand when health reform takes full effect

Medicaid now covers care for inmates outside
prisons and jails, and health reform will extend
coverage to most former prisoners upon release.

By Molly Burchett
Kentucky Health News

Kentucky has missed out on millions of dollars from the federal government by not having it help pay for institutional health care of prison inmates outside prisons and jails. When the Affordable Care Act takes full effect Jan. 1, most Kentucky inmates will be eligible for expanded Medicaid coverage of hospitalizations and nursing-home stays, and the state is planning to have the feds pay almost all the cost. That should have benefits beyond saving state and local tax money.

Only a dozen states have taken advantage of the 16-year-old option to stick the federal government with 50 to 84 percent of such costs, and Kentucky is not among them, reports Christine Vestal of Stateline. The option stems from a 1997 ruling by the Department of Health and Human Services that Medicaid could cover care for Medicaid-eligible inmates who leave correctional facilities for at least 24 hours for treatment in qualified hospitals or nursing homes.

State and local governments have legal obligations to provide adequate health care to prisoners; those tapping the federal funds (Arkansas, California, Colorado, Delaware, Louisiana, Michigan, Mississippi, Nebraska, North Carolina, Oklahoma, Pennsylvania and Washington), and some scattered local governments use Medicaid to pay for hospital and nursing-home care for those prisoners qualifying for Medicaid, reports Vestal.

Kentucky has mostly been paying for such care out of the state's General Fund rather than utilizing its ability to spread the cost via Medicaid. For most states and localities, not bothering to seek Medicaid reimbursement for prisoners is an omission "that deprives them of millions of dollars in potential federal reimbursement," writes Vestal.

Fourteen years after the ruling, in September 2011, Kentucky's Cabinet for Health and Services began picking up on the deal, and Medicaid paid for the first hospital stay for a Kentucky prisoner. "Since then, improvements have been made in the processing and coordination with the State Department of Corrections," said Jill Midkiff, the cabinet's director of communications.

Expanded Medicaid makes most inmates eligible

Ever since the 1997 ruling, it has made fiscal sense to get inmates who needed outside medical attention enrolled in Medicaid, which has historically been used for inmates who are pregnant or disabled. Midkiff said Kentucky's program has mostly covered pregnant inmates.  “But in 2014 it really becomes a no-brainer,” Aaron Edwards, a legislative analyst in California who helped get the state’s program started, told Vestal.

That’s when the major elements of the Affordable Care Act take effect, and Medicaid expands in Kentucky to cover individuals at 138 percent of the poverty line -- now $15,856 for an individual or $32,499 for a family of four. Most prisoners will then qualify for Medicaid, said Midkiff. "As a result, all state prisoners requiring a hospital stay who meet requirements for Medicaid eligibility should be covered," she said.

The federal government will pay all the cost of newly eligible Medicaid patients from 2014 to 2017, when Kentucky will increasingly pick up part of the tab, rising to 10 percent by 2020. One of the big changes involves the process to enroll Medicaid eligible inmates, which wasn't standardized before, and the Kentucky Health Benefits Exchange will make that process easier.

The state has projected General Fund cost savings from Medicaid coverage of inmates at $7 million to $8.4 million a year. Local governments will save money, too; the cabinet says it is working to ensure Medicaid enrollment is part of a standardized processes for jails around the state. For county-specific data about Medicaid expansion, click here for information prepared by the cabinet, which includes information about the benefit for county jails.

Prisoners' enrollment in Medicaid impacts the community in other ways. The health law requires coverage of behavioral health services, such as substance-abuse treatment and mental-health services. Upon release from prison, most inmates will have Medicaid coverage and access to these services, and studies have shown that access to services like substance abuse and mental health treatment reduces an inmate’s chances for recidivism, reports Mary Flynn of the California Health Report.

Most prisoners don't have health insurance upon release from prison, and studies show they do not receive treatment for chronic conditions but use expensive emergency rooms instead of primary-care doctors. Now, most will be covered by Medicaid and will have access to preventive services, reports Michael Ollove of Stateline.

Republican lawmaker says state should switch to block-grant system for Medicaid

Democratic Gov. Steve Beshear has argued that his expansion of Medicaid under federal health reform will improve Kentucky's health, but a freshman Republican legislator with experience in state health policy says a whole new approach would do much more for less money, providing funds that could be used to help Kentucky's mental-health agencies or to provide education, public protection and other services.

Rep. Robert Benvenuti

Rep. Robert Benvenuti of Lexington, former inspector general of the state Cabinet for Health and Family Services, told Ryan Alessi of cn|2 that the state could improve Medicaid with a block-grant system, which  could be implemented through a federal waiver. It would effectively end the open-ended approach to Medicaid, meaning that rather than paying a set amount per enrollee, states would be provided with annual lump sums and be free to run the program as they wanted, reports Kaiser Health News.

Republican governors have long lobbied for this flexibility, saying that it would result in a cheaper, more effective program, but the Democratic governor of New York, the independent governor of Rhode Island (who will run for re-election as a Democrat) and the Republican governor of Indiana have been granted waivers to implement a block-grant system, and their results suggest such system could improve Medicaid. Indiana used its waiver to introduce subsidized health savings accounts, which increased satisfaction rates for Medicaid enrollees to 94 percent by granting them more control over their own health dollars, reports Avik Roy of Forbes magazine, writing that Rhode Island saved $1.34 billion from 2008 to 2010, "an astounding figure for such a small state."

Benvenuti said Kentucky's current blanket-coverage system "doesn't provide any incentive with co-pays and deductibles to get the person with diabetes to be more careful about their weight, to manage their diabetic condition better. . . . The more we say we are simply going to blanket our commonwealth with Medicaid recipients, then the less we'll have to target what ultimate will be the solutions: education and true management of health."

A block-grant system provides flexibility to address Kentucky's specific needs, says Benvenuti. “You would then have money to say ‘In Kentucky, what are our health issues?’ And we could drive centers of excellence in cardiac care, in drug addiction and mental health much deeper into our commonwealth, much more at a grassroots level and provide that care,” he told Alessi. The cabinet declined to comment.

Throughout his career as a health-care attorney and work with numerous health systems, Benvenuti has focused on fraud and abuse as well as other operational and regulatory issues facing health-care providers. As the cabinet's inspector general, he led "investigations involving more than 3,000 health care facilities and services" across the state, says his website. Here's his interview with Alessi:

Lexington internist, Dr. Ardis Hoven, becomes president of the AMA, the nation's largest physician organization

Ardis Dee Hoven, M.D., an internal medicine and infectious disease specialist in Lexington, was installed as president of the American Medical Association at its annual meeting Tuesday night in Chicago. The AMA is the nation's largest physician organization.

Dr. Hoven is a graduate of the University of Kentucky medical school, and she has served in numerous leadership position for the AMA, including her first presidential term in 1993-94. Hoven has also served at the UK’s Bluegrass Care Clinic, which treats infectious diseases including HIV/AIDS, reports Business Lexington.

The AMA is headquartered in Chicago, and since 1847 it has aimed "to promote the art and science of medicine and the betterment of public health," says its website. Furthermore, the organization's strategic focus is aligned with many of the health care issues now facing Kentucky, which are improving health outcomes, accelerating change in medical education and enhancing the sustainability of medical practice.

Doctor shortage news: Residencies are filling the pond with primary care doctors, but U.S. and Ky. need an ocean of them

Despite a critical shortage of primary care in the country, only 25 percent of newly educated doctors go into this field, and even worse for the mostly-rural Kentucky, less than 5 percent go on to practice in rural areas, says a study by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

The report, which was just released in the “Published Ahead-of-Print” section in Academic Medicine,  suggests that not only are we facing a primary care shortage, but also that the problem is not likely to be solved soon. There's been a lot of talk about the need to get primary care doctors to practice in Kentucky, specifically in the state's rural areas, without mention of the underlying issue that the study makes clear: there are not even close to enough doctors being trained as primary care physicians in the first place.

In addition to finding that just 4.8 percent of the graduate medical education system practiced in rural areas, 198 institutions (26 percent) produced no rural physicians and 283 institutions (37 percent) produced no Federally Qualified Health Center or Rural Health Clinic physicians, which were created to enhance the provision of primary care services in underserved communities.

“If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse,” said lead study author Dr. Candice Chen, a professor at SPHHS. “The study’s findings raise questions about whether federally funded graduate medical education institutions are meeting the nation’s need for more primary care physicians.”

Currently, the U.S. is producing primary care physicians at rates that are “abysmally low” and unless changes are made to the system, the nation will have an even greater shortfall of primary care doctors just as the Affordable Care Act ramps up demand for these services, said Chen in a Newswise release. And in Kentucky, the additional need for primary care doctors as a result Medicaid expansion is piled onto the heap of issues.

The study's authors said policymakers should take a hard look at the skewed incentives and other factors that have led to the current primary care crisis and develop a more accountable graduate medical education system. It is critical to find a better balance in medical specialties and more primary care physicians to build an effective, affordable health system.

UK Board of Trustees OKs $31 million plan to outfit another floor of new hospital with eye toward federal certification for heart work

The University of Kentucky Board of Trustees has given UK HealthCare the green light for its $31 million plan to outfit the eighth floor of Pavilion A at UK Chandler Hospital over the next few months to make room for a growing cardiovascular program and to clear the way for a federal "Center of Excellence" certification.

After the project is complete, the floor will hold 64 beds, including 24 intensive-care beds for the cardiovascular program that offers heart transplantation, artificial hearts and ventricular devices, reflecting UK's focus on receiving the federal certification.

In the near future, such a designation will be necessary to get enough referrals from doctors and smaller hospitals to maintain important services, including cardiovascular services, and to guarantee that Kentuckians can get the care they need inside the state, Dr. Michael Karpf, executive vice president for health affairs, said in an interview with Kentucky Health News this spring.

Karpf and other UK HealthCare officials are also recommending a $30 million cost-reduction program for their system because Medicare and Medicaid reimbursements are expected to decline as competition stiffens over the next few years, reports Linda Blackford of the Lexington Herald-Leader.

In response to these forces, UK has a goal to secure half the available business from out-of-state competitive areas over the next 10 years to remain viable in a highly competitive market. And, focusing on complex care should drive revenue for the hospital because UK makes money on the complex stuff, Karpf told KHN.

Read more here: http://www.kentucky.com/2013/06/10/2673382/uk-healthcare-using-30-million.html#storylink=cpy

The $592 million, 12-floor patient tower has remained half-empty since 2010, and when the estimated $530 million project to fully occupy the tower is added to the initial cost of constructing Pavilion A, the total price tag will top $1 billion over 20 years, reports Blackford.

The overall construction and expansion is expected to support patient care for the next 100 years, says a recent UK press release. Once it's fully occupied, the the 1.2 million-square-foot facility will include 512 private patient rooms.

Read more here: http://www.kentucky.com/2013/06/10/2673382/uk-healthcare-using-30-million.html#storylink=cp

Religious business owners and corporations have filed half the lawsuits over health reform mandate to cover contraception

By Molly Burchett
Kentucky Health News

Some religious business owners are filing suit against the government, saying the health-reform law violates the constitutional freedom of religion by mandating employee contraceptive and abortion-inducing drug coverage; the lawsuits are expected to land in the U.S. Supreme Court, and a case filed by Hobby Lobby is the first of this kind to be heard by a federal appeals court.

Challenges to the mandate that will require businesses with more than 50 employees to provide no-cost coverage of all contraceptives, sterilization procedures, plus education and counseling, are not just coming from Catholic entities with a religious, moral objection to contraception. About half of the cases have been filed by corporations, reports Robert Barnes of The Washington Post.

There are now 60 cases involving 190 individuals representing hospitals, universities, businesses, schools and people opposed to the mandate, says the Becket Fund for Religious Liberty. The Becket Fund maps the cases, as shown below; for the interactive version, click here.

Since the law mandates contraceptive coverage, groups such as Catholic bishops have accused the Obama administration of waging war on religious liberty, reports Barnes. In February, the administration announced an exemption for faith-based organizations from covering employees' contraception costs because the conceptions would be covered by a third party. Self-insured organizations like Catholic schools sued, arguing that the accommodation would not apply to them because there is no third-party insurer to cover contraception. But those cases have been dismissed in court because such organizations are given a one-year grace period to comply with the mandate, reports Laura Bassett of the Huffington Post.

Businesses don't qualify for faith-based exemption from mandates

Hobby Lobby's David and Barbara Green

Business do not meet the new exemption either, because they are not religious organizations. However, some businesses like Hobby Lobby, which was founded and is still owned by an evangelical Christian family that believes life begins at conception and already covers contraceptives through existing employee health coverage, are fighting the law's mandate to cover abortion-inducing drugs or devices, like morning-after and week-after pills.

"They ought to be able — just like a church, just like a charity — to have the right to opt out of a provision that infringes on their religious beliefs," said Kyle Duncan, who argued the case Thursday before the 10th Circuit Court of Appeals on behalf of the Green family, and a sister company, Christian booksellers Mardel Inc, reports The Associated Press.

Other suits have been filed by religious business owners of diverse enterprises, from a company that makes wooden cabinets to owners of Panera Bread restaurants, reports Barnes, but all the cases base their arguments on the First Amendment guarantee of free exercise of religion and on the Religious Freedom Restoration Act of 1993. The Hobby Lobby case also specifies that the mandate violates freedom of speech and the Administrative Procedure Act because it was imposed without prior notice or sufficient time for public comment.

In the early stages of litigation, lower courts have split on the issue. Some have rejected Hobby Lobby's request for an exemption to the mandate, and requests by other businesses for a temporary injunction, saying for-profit businesses aren't covered by the faith-based exemption. However, courts in St. Louis and the Seventh Circuit have granted temporary injunctions. (Read more)

Health insurers could exclude one in four Americans from coverage because they don't have bank accounts

By Molly Burchett
Kentucky Health News

Federal Deposit Insurance Corp. graphic

A new study says if corrective action isn't taken, health-insurance companies could exclude 27 percent of qualifying Americans now eligible for premium-assistance tax credits under the health-reform law because they plan to require customers to pay premiums automatically through a bank account. More than 1 in 4 of these people do not have a bank account.

If insurance companies won't do business with them, that will undermine efforts to expand health coverage and equalize access to health care, denying coverage to the more than 8 million "unbanked" Americans, says the report from tax firm Jackson Hewitt.

Unbanked households are those that lack any kind of deposit account, checking or savings, at an insured depository institution, so requiring a checking account for coverage could also worsen the existing disparities in both health-care access and health status of minority groups. African Americans and Hispanics are over 40 percent more likely than whites to be "unbanked," says the report.

Most health plans accept a credit card for the first month’s premium payment and thereafter require monthly payment from a checking account. An estimated 30 percent of U.S. households are "unbanked" or underbanked, with the highest rates among non-Asian minorities and lower-income, younger and unemployed households; underbanked households hold a bank account but also rely on alternative financial services, and one in five households use such check-cashing stores and money lenders instead of a traditional bank, says the Federal Deposit Insurance Corp.

This all goes against the basic ideals behind the health care law's "comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care," says the White House website.

Law doesn't protect Americans from discrimination

Federal officials are wary taking action that may discourage insurance companies from participating in the exchanges, current and former state health officers who have pressed the U.S Department of Health and Human Services for a ruling told Varney.

“I think there is a dawning awareness that this is a large problem,” Brian Haile told Varney; Haile is senior vice president for health policy at Jackson Hewitt Tax Service and has called on federal official to set a uniform standard requiring all insurers to accept all forms of payment.

Neither the health law nor other laws require insurance companies to accept all forms of payment, says Sarah Varney of Kaiser Health News. Alternative forms of payment include credit cards or pre-paid debit cards that people without bank accounts often use, and although health insurance companies are evaluating these options, they are not required to do so, reports Varney.

“I’ve not seen any specific guidance that says you have to be able to accept these types of payments,” Ray Smithberger, Cigna’s general manager of individual and family plans, told Sarah Kliff of The Washington Post.

Insurance carriers take a risk by accepting credit cards and pre-paid debit cards because transaction fees can run as high as 4 percent and pre-paid cards are popular among low-wage workers, Haile told Varney. 

“If you accept re-loadable debit cards, are you in fact getting folks with lower health status?” Haile told Varney. “That’s a real risk when you’re in the insurance business. So you can’t be the only one picking up those risks.”

The Jackson Hewitt report calls for immediate action by federal policy makers to ensure insurers cannot discriminate against the 'unbanked' through their payment acceptance policies by creating a system-wide rule requiring all forms of payment must be accepted.

"Given the dilemma presented to insurance companies by the strong financial incentives to discourage non-bank payment mechanisms, insurers are unlikely to resolve this issue without federal action," says the report.

Baucus sees a health-reform 'train wreck,' fearing insurance exchanges won't be ready

Max Baucus (J. Scott Applewhite, AP)

Senator Max Baucus, who as Senate Finance Committee chair helped write the health-care reform law, has become the highest-ranking Democrat to publicly voice concerns about its implementation, saying he thinks it’s headed for a collision with itself.

“I just see a huge train wreck coming down,” the Montanan told Health and Human Services Secretary Kathleen Sebelius during a budget hearing.

Matt Gouras of The Associated Press notes that polls show that Americans are confused by the complex law, which is designed to cover about 30 million uninsured people through a mix of government programs and tax credits. Baucus told Sibelius he’s “very concerned” that new health insurance exchanges will not open on time in every state and residents will not have enough information to make choices even if they do open on time, as Kentucky's seems likely to do.

"The administration’s public-information campaign on the benefits of the Affordable Care Act deserves a failing grade,” Baucus lectured. “You need to fix this.” Baucus’ office later told Gouras that the senator still thinks the Affordable Care Act is a good law, but questions its roll-out.

Sebelius said that the administration is on track to fully implement exchanges in January, and to be open for open enrollment on Oct. 1, 2013, reports Gouras. Kentucky is among the states that have chosen to build a fully state-based exchange. Others have chosen a state-federal partnership exchange, or defaulted into a federally facilitated exchange. The map below shows the lay of the land about that decision. Yellow states have defaulted to a federal exchange, light blue states are planning for a partnership and blue states have chosen a state-based exchange.

Map provided by the Kaiser Family Foundation

Confused or concerned about the impact of health reform on Kentucky businesses? There's a seminar for that.

To address possible confusion or concern of business people and the public about the Patient Protection and Affordable Care Act, or "Obamacare," health-care reform experts will address its impact on small and large companies across Kentucky at half-day seminars in Lexington and Louisville on May 8 and 9.

The Kentucky Health Care Reform Seminar will include specific discussions about expected cost increases and tax implications for businesses once reform is implemented, including the role of the health insurance exchange and the changing ways that coverage premiums will be determined. The seminar will be presented by The Iasis Group Inc., The Lane Report and the Kentucky Chamber of Commerce, says a chamber release.  

Guidance to employers will be provided on complying with the new rules surrounding insurance reforms and insight to whether Kentucky companies can truly afford it. The seminar is part of a statewide partnership that includes Commerce Lexington, Greater Louisville Inc., the Kentucky Society for Human Resource Management and the Northern Kentucky Chamber of Commerce (Click here for more details or to advance register)

Feds letting Arkansas privatize Medicaid expansion; idea could spread like wildfire, as in Florida, but cost questions remain

Arkansas has turned heads nationally with its preliminary plan to expand Medicaid using the private insurance market, showing that the Obama administration is willing to give states more flexibility than expected in expanding the program.

Health and Human Services Secretary Kathleen Sebelius has agreed to a proposal by Arkansas Gov. Mike Beebe to reject the Medicaid expansion but use federal money to buy private health insurance for the 200,000 people who would have been covered under ordinary expansion, reports Sandhya Somashekhar of The Washington Post.

States that have come down on either sides of the Medicaid-expansion issue may reconsider their decision in light of the Arkansas proposal, said Sara Rosenbaum, a health law professor at George Washington University. "If Arkansas is allowed to do this, I expect it to spread like wildfire," Rosenbaum told the Post.

The first place could be Florida, where a state Senate committee rejected Republican Gov. Rick Scott's expansion plan and proposed a privatization plan like that in Arkansas. Last week, a House committee voted to reject any expansion of the program. Scott "made it clear he was not going to lobby the Legislature on Medicaid," preferring to emphasize other issues, The New York Times' Lizette Alvarez reports. For coverage from the Tampa Bay Times and The Miami Herald, click here.

Could the wildfire spread all the way up to Kentucky?

Gov. Steve Beshear has said he wants to expand Medicaid in Kentucky if the state can afford it, but many Republican lawmakers oppose the idea, saying it would not be fiscally responsible. On the national level, 26 states and the District of Columbia have expressed a desire to expand Medicaid, 17 have said they reject it and seven are undecided, according to the nonpartisan Kaiser Family Foundation.

A more flexibile arrangement could be a game changer because it makes expansion more appealing, especially for states where expanding Medicaid has been politically unpopular and polarizing. in Arkansas, which has a Democratic governor and a Republicna legislature, officials say that from an ideological standpoint, using private insurance appeals to lawmakers from both parties, reports Somashekhar. She reports that even Democratic-led states might prefer this arrangement because it gets rid of some bureaucratic hurdles.

However, there are questions about cost. The Congressional Budget Office estimates that private insurance plans cost $3,000 more per person than Medicaid, reports Somashekhar. On the other hand, Arkansas officials say the move could ultimately save money in administrative charges along with other cost-control measures.

Although the Arkansas proposal is not concrete, it provides proof that the Department for Health and Human Services encourages innovative, state-based approaches to promote expansion. Many states may develop a new route best suited to their specific needs, without having to leave federal money on the table. (Read more)

Beshear will expand Medicaid, Democrat and Republican say; D says governor believes the state can opt out if it's not affordable

State legislators in both parties say they expect Gov. Steve Beshear to expand Medicaid to cover several hundred thousand more Kentuckians who earn up to 138 percent of the federal poverty rate.

Rep. Tom Burch, chairman of the House Health and Welfare Committee, told Ryan Alessi of cn|2’s "Pure Politics" that the governor told him exactly that last week. And Sen. Tom Buford, R-Nicholasville, told Kentucky Health News that he expects Beshear to do the deed.

Burch told Alessi that Beshear has decided to move forward with the expansion because he believes the state would be able to opt out if state officials discover that Kentucky can’t afford it after 2017.

Beshear didn’t mention expansion in his State of the Commonwealth Address last week, and the governor’s office said the official decision hadn’t been made yet but didn’t dispute Burch’s statement, Alessi reports. Here is the salient part of his interview with Burch:



Buford said Beshear will be under much political pressure to expand Medicaid because it is President Obama's signature program and expansion will create jobs. However, Republican legislators generally  have opposed the expansion of Medicaid because the state can’t afford it. The federal government will cover the cost of covering the extra people from 2014 through 2016. Kentucky would have to kick in 5 percent of the costs starting in 2017 and 10 percent by 2020.  

The federal government covers roughly 70 percent of Kentucky’s $6 billion Medicaid program. It covers more than 800,000 Kentuckians and with the expansion, that number could grow to more than 1 million — or roughly a quarter of all Kentuckians, reports Alessi.

“I think it’s critical that we take a look at those to see how we achieve that. I’m not sure that this would be the way that would be best-suited to Kentucky and be fiscally responsible for the state of Kentucky,” Sen. Julie Denton, R-Louisville and chairman of the Senate Health and Welfare Committee, told Alessi in December (at 4:10 of the interview below). “Frankly, I don’t think we can afford to do it,” she said.

Kasich of Ohio is fifth Republican governor to accept Medicaid expansion; he and others cite need to protect rural hospitals, poor

Several Republican governors have decided to expand Medicaid under federal health-care reform, saying their conservative principles were outweighed by a need to protect their state's rural hospitals and low-income people. Yesterday, the governor of one of the biggest states got on the bandwagon.

John Kasich of Ohio joined Jan Brewer of Arizona, Brian Sandoval of Nevada, Susana Martinez of New Mexico and Jack Dalrymple of North Dakota in saying they will take heavy federal subsidies to expand the program to households with incomes up to 138 percent of the federal poverty threshold.

Democratic Gov. Steve Beshear of Kentucky has said he wants to expand Medicaid if Kentucky can afford it, and he expects to get cost estimates around the end of March.

While Kasich is not an "Obamacare" supporter, he said expanding Medicaid “makes great sense for Ohio” because it would save $235 million over the next two years and free about $100 million in local funds for mental-health and addiction services, reports The Columbus Dispatch.

Kasich said the decision could extend health coverage to as many as 578,000 uninsured Ohio residents, and could keep everyone else’s health insurance premiums down because there won’t be so many uninsured people going to emergency rooms for their medical care, reports David Nather of Politico.

Kasich emphasized that he would like to see the 2010 law repealed, but the federal money it would pump into the state — about $13 billion over the next seven years — was too much to pass up, reports Stateline. The federal government will pay the full cost of expansion through 2016; then  states will have to pitch in, rising to a limit of 10 percent by 2020.

Brewer likewise said it doesn't make sense for Arizona to pass up federal dollars, reports Howard Fischer of the Arizona Daily Sun. "We will protect rural and safety-net hospitals from being pushed to the brink by growing their cost in caring for the uninsured," Brewer said. She also said the expansion will create enormous economic benefit, inject $2 billion into the Arizona economy, save and create thousands of jobs and provide health care to hundreds of thousands of low-income individuals, reports Fischer.

Brewer said going along with expansion will save Arizona money because the costs of providing care to the uninsured are not simply absorbed by hospitals but passed along through increased insurance premiums. Supporters of the expansion hope the five Republicans' decisions will prompt more GOP governors to follow suit. Twenty governors from both political parties are still undecided. (Read more)