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)

Health reform should make Medicaid and Medicare more interested in preventing chronic diseases in young, expert says

Dr. Wayne Myers

While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Hazard and Perry County, where he once worked. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers, who headed the federal and Kentucky rural-health offices, said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (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)

Kentucky's health-insurance exchange has covered a greater share of population than any other state-based exchange

Kentucky has registered more people for Medicaid and private health insurance than any other state with its own exchange created under the federal health-reform law, Christine Vestal reports for Stateline, in a story explaining why Kynect and some other state exchanges are working well.

“Our system doesn’t have a lot of bells and whistles,” Carrie Banahan, executive director of the Kentucky Health Benefits Exchange (the formal name of Kynect), told Vestal. “There aren’t a lot of graphics that would take a lot of bandwidth.”

"Kentucky and other top-performing states enable consumers to browse the various plans available on the exchange without first having to set up a password-protected account," Vestal notes. "That step alone spared those exchanges a lot of error messages and screen freezes experienced by people using the federal site," Healthcare.gov.

"Successful states also devoted months, not weeks, to exhaustive, round-the-clock testing," Vestal writes. "Kentucky tested for three months, while the U.S. Department of Health and Human Services reportedly devoted only the last two weeks of September to testing Healthcare.gov before its Oct. 1 launch."

The four most successful states – Connecticut, Kentucky, Rhode Island and Washington – all contracted with the consulting firm Deloitte "to manage and develop their sites," using federal funds, Vestal reports. Kentucky's expenses for its exchange were higher than average. (Stateline chart)

UPDATE: As of 7 p.m. Thursday, Dec. 5, after 10 days of increased traffic and enrollments, the exchange said it had enrolled 71,955 people, 56,437 of them in Medicaid and 15,518 in private plans. Most of the 28,307 who had been found eligible for a subsidy to buy a private plan had not chosen a plan yet. Dental plans had 5,074 enrollees.

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)

Book chronicles Hall's 40-year battle for health, against poverty

By Molly Burchett
Kentucky Health News

Eula Hall has been called an angel, dynamite, a force to be reckoned with, and a living legend. She has dedicated her life to combating poverty in Appalachia and providing health care to those in need. Some say that she has done more for health care in Eastern Kentucky than any other single person.

Even at age 86, Hall continues to fight against poverty, providing health care to those who need it. Hall’s story will be told in a new biography, Mud Creek Medicine: The Life of Eula Hall and the Fight for Appalachia, written by Pikeville native Kiran Bhatraju.

Hall grew up in Pike County and moved to the Mud Creek community in adjoining Floyd County at the age of 16. She witnessed the devastating impact of poverty, including lack of health care, and became a staple in the Mud Creek community, someone to whom people would turn when they were sick or hungry.

In 1973, at age 46, Hall opened the doors to The Mud Creek Clinic in Grethel, Ky., a rural community in Floyd County, with a $1,400 donation and the help of two local doctors. The clinic rented space at first, but Hall quickly moved her family out of a nice home in Mud Creek so the home could be converted into a clinic to provide health care regardless of patients' ability to pay.

For 40 years, Hall’s clinic has weathered hard times, reports Jonathan Meador of WKMS in Murray. But, with resiliency and the help of the community, the clinic now operates in five locations and continues its mission: To provide Appalachia’s poorest residents with health care and dental services they can afford.

Hall says things have improved in Appalachia in the last 40 years, but she is still concerned that growing income inequality in America is leaving too many of her patients behind, reports Meador. Appalachians still face numerous economic and health disparities that are deeply rooted in poverty.

"We still have people who don't have enough to meet their needs," Hall told Meador. "These are good people; these are honest people, hard workin' people, when they were able. But you know, they're disadvantaged now, and they just don't have the means to meet their needs and stuff, and somebody has to be concerned; somebody has to look out for 'em."

Bhatraju says that proceeds of his book will go toward funding the clinic. Click here to purchase a copy of the book.

Obama, fighting to regain traction, calls out McConnell on health care; Kentucky senator replies, and president does it again

White House file photo

President Obama called out U.S. Sen. Mitch McConnell two days in a row in speeches defending the Patient Protection and Affordable Care Act as an example of the administration's efforts to help the middle class in a time of increasing economic inequality.

“As people in states as different as California and Kentucky sign up every single day for health insurance, signing up in droves, they’re proving they want that economic security,” Obama said in a speech Wednesday. “If the Senate Republican leader still thinks he is going to be able to repeal this someday, he might want to check with the more than 60,000 people in his home state who are already set to finally have coverage that frees them from the fear of financial ruin.”

Washington Post columnist and Georgetown University professor E.J. Dionne Jr. used the quote in a column he wrote from Louisville after interviewing journalist-author Chris Matthews Tuesday night at the latest Kentucky Author Forum sponsored by the University of Louisville. Dionne said the issue of inequality "could be joined in a particularly stark way" in Kentucky because Democratic Gov. Steve Beshear "has turned his state into a national model for how the law can be made to work — and because polls suggest that McConnell is facing a serious Democratic challenge next year from Alison Grimes, the secretary of state." McConnell also faces a primary challenge from more conservative Republican Matt Bevin, a Louisville businessman.

Dionne called up Audrey Haynes, secretary of the state's Cabinet for Health and Family Services, and got some "figures suggesting how expanding health coverage can dent inequality: Among Kentucky’s uninsured, 61 percent have a high-school education or less; only 7 percent are college graduates. Underscoring Obama’s point in his address that inequality is not simply a matter of race, 88 percent of the state’s uninsured are white."

Obama's first call-out of McConnell came Tuesday, as the president began a concerted effort to defend and sell the health-reform law in the wake of its troubled website and insurance companies' cancellation of millions of policies, putting the lie to Obama's promise that people who liked their plans could keep them. That has put him at "a new low in his presidency," the Post's Chris Cillizza wrote.

Obama said, "Just the other day, the Republican leader in the Senate was asked what benefits people without health care might see from this law. And he refused to answer, even though there are dozens in this room and tens of thousands in his own state who are already on track to benefit from it. He just repeated 'repeal' over and over and over again. And obviously we’ve heard that from a lot of folks on that side of the aisle. Look, I’ve always said I will work with anybody to implement and improve this law effectively. If you’ve got good ideas, bring them to me. Let’s go. But we’re not repealing it as long as I’m President and I want everybody to be clear about that. We will make it work for all Americans. . . . If, despite all the millions of people who are benefiting from it, you still think this law is a bad idea, then you’ve got to tell us specifically what you’d do differently to cut costs, cover more people, make insurance more secure. You can’t just say that the system was working with 41 million people without health insurance."

In reply, McConnell issued this statement: “Another campaign-style event won’t solve the myriad problems facing consumers under Obamacare. Consumers didn’t need another 20,000 pages of regulations and higher premiums and deductibles to let a 25-year old stay on his parents’ plan — and they really didn’t need Obamacare’s cancellation of millions of plans that people already have and like in order to provide help to those with pre-existing conditions. The American people have been learning about the impact Obamacare will have on individuals and families in the form of higher premiums, disrupted insurance, and lost jobs—more broken promises from the administration. And they’re becoming increasingly aware of the fact Obamacare is broken beyond repair. The only ‘fix’ is full repeal followed by step-by-step, patient-centered reforms that drive down costs and that Americans actually want.”

Websites that misled Kentuckians seeking health insurance are taken down, blocked or corrected

Three websites that were misleading Kentuckians about the Patient Protection and Affordable Care Act and about the state's health-insurance exchange have either been taken down, corrected or blocked by the state attorney general's Office of Consumer Protection, the office said.

Kentucky consumers who are attempting to obtain insurance under the federal health-reform law need to make sure they are connected with the official health insurance exchange website kynect.ky.gov, the office advised.

A "copycat website," Kynect101.com, was removed after the office complained that it was "deceptively similar" to Kynect.ky.gov. Search engines steered customers to this site and provided false information about their options under the Act, according to the release. This site has now been taken down and no longer appears on Google, which had ranked the copycat site first and worked with the office to block access to the site.

Google has also removed healthcaregov.net from its search engine because it created the misleading impression that it was a government health exchange and did not offer clear information for consumers on how to access the official Kentucky exchange, the release said. A third site, healthcare.com, has made corrections to its site to make sure Kentuckians will be able to link to the state's official site Kynect.ky.gov.

The Office of Consumer Protection offers these tips to protect yourself from misleading websites:
• Make sure you're working with a registered insurance agent or certified kynector, a person paid by the state to help users with the exchange. A list of approved agents and kynectors maintained by the Cabinet for Health and Family Services can be found online or by calling 1-855-4kynect (459-6328).
• Protect your personal information. Only a registered insurance agent, a certified kynector, or contact center customer service representative should ask for your personal information to help you apply.
• Do not pay for help. Insurance agents and kynectors will not solicit money.
• Remember that you can only get tax credits through Kynect, and there is no charge to apply for the credits.
• Beware of phishing scams online. Consumers should be cautious of any email claiming to be connected to the Affordable Care Act, including any emails claiming to be affiliated with kynect and asking for personal information.
• Ask questions. Don't sign anything you don't fully understand, and verify the answers you get with trained kynect representatives.

Consumers who are aware of questionable practices are encouraged to contact the attorney general’s office at 888-432-9257 or consumer.protection@ag.ky.gov. If you think your personal information has been compromised, visit www.ag.ky.gov.

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.

Beshear's office says he is considering 'various ideas' for financing Ky. insurance exchange, not just a 1% fee on policies

"Gov. Steve Beshear’s administration is reconsidering how to pay for the Kentucky Health Benefit Exchange amid increased criticism from some Republicans in the legislature and a court case challenging a fee Beshear created through executive order," Ryan Alessi reports for cn|2's "Pure Politics," a service of Time Warner Cable.

“Various ideas for a sustainability plan for the exchange are being discussed, and such a plan will be finalized for implementation before current funding expires in 2015,” the governor's office told Alessi. Current funding comes from the federal government.

Beshear's plans have called for the exchange to be financed with a 1 percent fee on policies bought through the exchange, to be paid by insurance companies using it. "But in a statement in response to questions from Pure Politics, the governor’s office said it’s suddenly considering other ways to pay for the exchange," Alessi reports, adding that the office didn't respond to his follow-up question about whether legislative approval would be needed for whatever plan was adopted.

House Speaker Greg Stumbo, a Democrat from Prestonsburg, said during a Kentucky Hospital Association panel last month that the fee does not require approval of the General Assembly. Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, told Alessi that it does. Here's a video clip:

Beshear says Medicaid plan will transform Ky. in a generation; acknowledges it was easier because he wouldn't face voters

In a generation, Kentucky will be a very different state because the federal health-reform law and expansion of Medicaid has made health insurance available to all residents of the state, Gov. Steve Beshear told Los Angeles Times political reporter Mark Z. Barabak for a story the paper published on Thanksgiving Day. And he acknowledged that his Medicaid decision was easier because he can't seek re-election.

"I knew if I was going to make a huge difference in the health status of Kentucky, it was going to take some kind of transformational tool to do that, and that's what the Affordable Care Act is for me," Beshear told Barabak. "I think we've started something here that a generation from now you'll see a very different Kentucky than what you see today."

Beshear "conceded, with a small smile, that it was easier knowing he would never face voters again," Barabak writes. "Embracing Obamacare is not without political risk. Undaunted by the early success in Kentucky, Republicans plan to make the controversial program a major issue in 2014, when the GOP will be vying to take control of the state House for the first time in close to a century."

Politics aside, "The need for care in this pretty but hard-pressed state is unarguable," Barabak writes. "Kentucky leads the nation in cancer deaths and preventable hospitalizations and suffers some of the highest rates of diabetes, cardiovascular illness and premature death." But he says "Kentuckians may feel understandably whiplashed" because the state's Republican U.S. senators firmly oppose "Obamacare." (Read more)

Feds say reform law has saved Kentuckians on Medicare an average of $928 this year on prescription drugs

The federal health reform law has saved seniors and the disabled millions of dollars on their Medicare prescription-drug coverage, says the Centers for Medicare & Medicaid Services.

CMS said 65,040 Kentuckians have saved a total of $60.4 million in the first 10 months of 2013, an average of $928 per person in Medicare. CMS said Kentucky seniors have saved $180.9 million on the coverage, known as Part D, since the passage of the reform law.

Seniors will also be free to use more of their Social Security cost-of-living adjustment as they choose, because the Medicare Part B premium will not increase in 2014 as a result of the law’s cost restrictions, CMS noted. The deductible for standard Part D plans will decline by $15 in 2014, to $310.

The data also show that since the Patient Protection and Affordable Care Act took effect, more than 7.3 million seniors and people with disabilities who reached the prescription coverage gap, commonly known as the "donut hole," have saved $8.9 billion on their prescription drugs, an average of $1,209 per person.

The "donut hole" is the gap in coverage after the basic coverage and before the catastrophic coverage takes effect.  Without rebates authorized by the law, Medicare beneficiaries would have to pay out-of-pocket for the entire cost of prescription drugs once they hit the hole, until they incur enough expense to reach catastrophic coverage.

Next year, Medicare Part D participants in the donut hole will save about 53 percent on the cost of brand name drugs and 28 percent on the cost of generic drugs, CMS says. These savings and Medicare coverage are to gradually increase until 2020, when the donut hole will be closed.

Humana, United and Assurant allow non-compliant policies to be extended; Anthem and Bluegrass offer sort of half a loaf

Some health-insurance companies won't give Kentucky customers the opportunity to renew polices that don't comply with the federal health-reform law, under the conditional extension granted by President Obama, state Insurance Commissioner Sharon Clark told a legislative committee yesterday.

"Humana, United Healthcare and Assurant Health say they will go along with President Barack Obama’s healthcare fix and let thousands of their customers renew their canceled insurance policies for another year," The Courier-Journal reports. "Insurers such as Bluegrass Family Health and Anthem are offering an alternative, providing some consumers an early renewal option that essentially could allow them to keep existing coverage partly into 2014."

"Melissa Metzger, an attorney for Anthem, said the company has spent more than $150 million to beef up operational systems and develop products that would meet the ACA requirements, often in markets that Anthem has served for decades," C-J reporters Mike Wynn and Chris Kenning write.

"About 280,000 Kentuckians — 130,000 in individual plans and 150,000 in group plans — have or will receive discontinuation notices from insurance companies saying their current health plans would not be offered under the federal health care law," Kevin Wheatley reports for The State Journal in Frankfort. "About a third of Anthem’s more than 100,000 individual plan members and half of its 100,000 group plan members have accepted" the company's offer, which expires Dec. 15, "to change the effective date of their current policies to Dec. 1, meaning they could carry that plan through Dec. 1, 2014."

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)

Most Kentucky hospitals will pay Medicare penalties under health reform, one the country's largest; look them up here

More Kentucky hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive programs, one of the federal health reform law’s changes designed to create financial rewards for doctors and hospitals to provide better care. Pineville Community Hospital is being assessed the highest penalty in the country for its readmission rates.

Medicare has two quality-care incentive programs for hospitals. Value-based purchasing gives bonuses and penalties based on 24 quality measures, and the other program levies penalties for readmissions. Thirty-one Kentucky hospitals were assessed a penalty while 26 were given a bonus for improved performance, says an analysis by Kaiser Health News. Here's a screen shot of the beginning of the list:

The law allows the federal government to withhold a portion of a hospital's Medicare reimbursement money, up to a 1.25 percent penalty or bonus for every bill paid between October 2013 and September 2014, based on assessments of these quality standards.

"The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently," reports Kaiser's Jordan Rau.

Large value-based bonuses are going to some major teaching hospitals and smaller institutions, such as Pikeville Medical Center. The state's average bonus is 0.25 percent, compared to the national average of 0.24 percent; Kentucky's penalties averaged minus 0.20 percent, for a total average of zero. It won't be known how much hospitals will receive or pay in dollar figures until next October since this depends on how much the hospital ends up billing Medicare, Kaiser reports.

However, as a result of the readmission program, Pineville Community Hospital is losing 2.57 percent of its reimbursements,the largest penalty in the country. Considering the impact of both the value-based program and readmissions program, Kaiser reports, two out of three hospitals are losing money starting last month.

Here's how the value-based score was figured: 45 percent on hospitals' use of clinical processes of care; 30 percent on patient experiences; and 25 percent on death rates. Hospitals were are also assessed by how they compared to other hospitals and how much they improved from two years ago, says Qualitynet.org.

Researchers are unsure whether the penalties are significant enough to trigger major improvements, writes Rau. And, some hospitals that have made improvements are still losing money because they haven't improved as much as other hospitals. On the other hand, some hospitals with subpar quality rankings are still getting more money because they showed improvement.

Nationwide, Medicare has raised payment rates to 1,231 hospitals and reduced payments to 1,451. Hospitals that are designated as critical access facilities and certain cancer hospitals were excluded from the program. But these facilities aren't immune to other portions of the health law, such as cuts in Disproportionate Share Hospital (DSH) program payments,for having a high percentage of Medicare and Medicaid patients.

New quality measures will be added to the value-based program for 2015, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps. In addition, the maximum readmission penalties grow to 3 percent next year, and a third incentive program will take an additional 1 percent of payments away from hospitals that have the most injuries or infections during patients' stays.

"Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October," reports Rau.

Dr. Patrick Conway, Medicare’s chief medical officer, says "We're moving away from volume and toward quality." Yet, to remain viable, some hospitals are being forced to make up for payment cuts by seeing more patients. Click here for the interactive chart.