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She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"},"lklivans":{"type":"authors","id":"8648","meta":{"index":"authors_1591205172","id":"8648","found":true},"name":"Laura Klivans","firstName":"Laura","lastName":"Klivans","slug":"lklivans","email":"lklivans@kqed.org","display_author_email":true,"staff_mastheads":["news","science"],"title":"Reporter and Host","bio":"Laura Klivans is a science reporter and the host of KQED's video series about tiny, amazing animals, \u003cem>Deep Look\u003c/em>. Her work can also be heard on NPR, \u003cem>Here & Now, \u003c/em>and PRI. Before working in audio, she taught, leading groups of students abroad. One of her favorite jobs was teaching on the Thai-Burmese border, working with immigrants and refugees.\r\n\r\nLaura has won three Northern California Area Emmys along with her Deep Look colleagues. She's won the North Gate Award for Excellence in Audio Reporting and the Gobind Behari Lal Award for a radio documentary about adults with imaginary friends. She's a fellowship junkie, completing the USC Center for Health Journalism's California Fellowship, UC Berkeley's Human Rights Fellowship and the Coro Fellowship in Public Affairs. Laura has a master’s in journalism from UC Berkeley and a master’s in education from Harvard.\r\n\r\nShe likes to eat chocolate for breakfast. She's also open to eating it all day long.","avatar":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twitter":"lauraklivans","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["editor"]},{"site":"stateofhealth","roles":["contributor","editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"Laura Klivans | KQED","description":"Reporter and Host","ogImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lklivans"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon 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Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_362982":{"type":"posts","id":"stateofhealth_362982","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362982","score":null,"sort":[1522082717000]},"guestAuthors":[],"slug":"a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","title":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks","publishDate":1522082717,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>While most of the recent debate around health care has been around cost -- especially the predictions about skyrocketing Obamacare premiums -- there are 100 pages in the Affordable Care Act devoted solely to improving the \u003ca href=\"https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/\" target=\"_blank\" rel=\"noopener\">\u003cem>quality \u003c/em>of the health care\u003c/a> Americans are paying so much for.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s Obamacare marketplace, is taking that mandate under the law seriously, and is now making a bold move to improve quality in a concrete way, and ultimately, ensure that California consumers get more value for their premium dollars.\u003c/p>\n\u003cp>In the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace.\u003c/p>\n\u003cp>“We’re saying ‘time’s up,’” said \u003ca href=\"https://www.bizjournals.com/sacramento/news/2015/05/22/covered-california-hires-chief-medical-officer.html\" target=\"_blank\" rel=\"noopener\">Lance Lang\u003c/a>, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”\u003c/p>\n\u003cp>Lang says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. The chosen targets require hospitals to perform fewer unnecessary C-sections, reduce hospital-acquired infections, improve patient experience, and reduce excessive costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For example, C-sections. Hospitals get paid more to do them, and they usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Although C-sections are often medically prudent when the mother or fetus has a high risk of complication, many women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section.\u003c/p>\n\u003cp>“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Lang.\u003c/p>\n\u003cp>Unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.\u003c/p>\n\u003cp>That’s not quality health care, said Lang, and that’s why Covered California is telling hospitals they need to reduce their C-section rates to 23.9 percent or lower, for low-risk births. \"Low risk\" is defined as a healthy, first-time mom carrying a single baby with its head down, all the way to full term (\u003ca href=\"https://www.nichd.nih.gov/news/resources/spotlight/102413-redefining-term\" target=\"_blank\" rel=\"noopener\">39 weeks gestation\u003c/a>).\u003c/p>\n\u003cp>Covered California is joined by \u003ca href=\"https://www.coveredca.com/medi-cal/\" target=\"_blank\" rel=\"noopener\">Medi-Cal\u003c/a>, the state health program for low-income residents, \u003ca href=\"https://www.calpers.ca.gov/\" target=\"_blank\" rel=\"noopener\">CalPERS\u003c/a>, the retirement program for state employees, and the \u003ca href=\"http://www.pbgh.org/\" target=\"_blank\" rel=\"noopener\">Pacific Business Group on Health\u003c/a>, which represents self-insured employers. Together, these groups pay for the health care of 16 million Californians, or 40 percent of the state, which gives them substantial leverage with hospitals.\u003c/p>\n\u003cp>But only Covered California is telling hospitals that if don’t play by the rules, they’ll be benched.\u003c/p>\n\u003cp>“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the \u003ca href=\"http://www.leapfroggroup.org/\" target=\"_blank\" rel=\"noopener\">Leapfrog Group\u003c/a>, a Washington, DC-based nonprofit that rates hospitals on quality.\u003c/p>\n\u003cp>Quality control for hospitals is a recent phenomenon, and still largely voluntary, she said.\u003c/p>\n\u003cp>“Back in the '80s and '90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said. “There’s never been a culture of accountability.”\u003c/p>\n\u003cp>Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach – 1.4 million people buy coverage through the marketplace, and they shop among plans offered by 11 state-approved insurance companies.\u003c/p>\n\u003cp>Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.\u003c/p>\n\u003cp>“The Northeast Business Group on Health, which covers New York and Massachusetts and Connecticut, they will definitely be watching this to see what could be done,” Binder said.\u003c/p>\n\u003cp>Overall, California’s hospitals are on board with the goal. Of the 243 maternity hospitals in the state, 40 percent have already met the target, Lang said, and another 40 percent have taken advantage of coaching and consulting, to help educate the doctors on how they can adjust their practice, and to educate patients who request C-sections about the risks.\u003c/p>\n\u003cp>“While many may prefer that, when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the \u003ca href=\"http://www.hqinstitute.org/\" target=\"_blank\" rel=\"noopener\">Hospital Quality Institute\u003c/a>, a subsidiary of the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>, both of which support the C-section reduction goals as “the right thing to do.”\u003c/p>\n\u003cp>The effort has raised some concerns among mothers who hear about the 23.9 percent target and worry about rationing.\u003c/p>\n\u003cp>“We don't just chase rates,” Morath said, in counter to that concern, “but rather look at what the clinical needs are and best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”\u003c/p>\n\u003cp>But the coaching, and the kind of system change and staffing levels that can be required to lower C-section rates, might be too costly for some hospitals. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.\u003c/p>\n\u003cp>The target rate may not be fair for these hospitals, said Malini Nijagal, an OB/GYN at Zuckerberg San Francisco General Hospital. Her hospital’s C-section rate is already below the target, but she said it won’t be easy for others with more diverse patients.\u003c/p>\n\u003cp>“So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a C-section is way higher than someone who is not all those things,” she said. “And so the problem is, how do you adjust for the patient population of a hospital?”\u003c/p>\n\u003cp>At Memorial Hospital of Gardena, the C-section rate is 45.2 percent. At East Los Angeles Doctors Hospital, the rate is 48.1 percent, according to publicly-available state data listed on \u003ca href=\"http://calhospitalcompare.org/\" target=\"_blank\" rel=\"noopener\">CalHospital Compare\u003c/a> and \u003ca href=\"https://www.kqed.org/stateofhealth/358760/yelp-adds-c-section-rates-and-childbirth-data-to-reviews-of-california-hospitals\" target=\"_blank\" rel=\"noopener\">Yelp\u003c/a>.\u003c/p>\n\u003cp>Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for \u003ca href=\"http://avantihospitals.com/\" target=\"_blank\" rel=\"noopener\">Avanti Hospitals\u003c/a>, which owns both hospitals.\u003c/p>\n\u003cp>She said the hospitals will meet the 23.9 percent benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay \"out-of-network\" fees to be seen there, or they would have to travel farther to another facility that was still in the network.\u003c/p>\n\u003cp>“We are in under-served, economically challenged urban neighborhoods and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.\u003c/p>\n\u003cp>Health plans can request exceptions to Covered California’s contract rules, in order to keep non-complying hospitals in their networks, as long as they document their reasoning.\u003c/p>\n\u003cp>“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener\">California Association of Health Plans\u003c/a>, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators, and health plans have to ensure that patients continue to receive services in a timely manner.”\u003c/p>\n\u003cp>So far, the prospect of exclusion, plus the coaching and education, have functioned as an effective motivator. By the 2020 deadline, Covered California’s Dr. Lang believes all hospitals will either have met the target or be on their way. While the consequences are real, and while it may take some awkward conversations to get there, he said the ultimate goal is to get hospitals to deliver better, safer care to patients.\u003c/p>\n\u003cp>“It's a quality improvement project,” Lang said, “but with a deadline.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CORRECTION: An earlier version of this story incorrectly listed the quality-care targets hospitals would have to meet to be included in Covered California insurance plans. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Covered California, the state's insurance marketplace, has been actively focused on cost control for years. Now the agency is demanding more on quality measures such as C-section rates and hospital-acquired infections. ","status":"publish","parent":0,"modified":1534298703,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1464},"headData":{"title":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks | KQED","description":"Covered California, the state's insurance marketplace, has been actively focused on cost control for years. Now the agency is demanding more on quality measures such as C-section rates and hospital-acquired infections. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362982 https://ww2.kqed.org/stateofhealth/?p=362982","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/03/26/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks/","disqusTitle":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/03/DemboskyHospitalQuality.mp3","audioTrackLength":214,"path":"/stateofhealth/362982/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>While most of the recent debate around health care has been around cost -- especially the predictions about skyrocketing Obamacare premiums -- there are 100 pages in the Affordable Care Act devoted solely to improving the \u003ca href=\"https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/\" target=\"_blank\" rel=\"noopener\">\u003cem>quality \u003c/em>of the health care\u003c/a> Americans are paying so much for.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s Obamacare marketplace, is taking that mandate under the law seriously, and is now making a bold move to improve quality in a concrete way, and ultimately, ensure that California consumers get more value for their premium dollars.\u003c/p>\n\u003cp>In the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace.\u003c/p>\n\u003cp>“We’re saying ‘time’s up,’” said \u003ca href=\"https://www.bizjournals.com/sacramento/news/2015/05/22/covered-california-hires-chief-medical-officer.html\" target=\"_blank\" rel=\"noopener\">Lance Lang\u003c/a>, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”\u003c/p>\n\u003cp>Lang says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. The chosen targets require hospitals to perform fewer unnecessary C-sections, reduce hospital-acquired infections, improve patient experience, and reduce excessive costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For example, C-sections. Hospitals get paid more to do them, and they usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Although C-sections are often medically prudent when the mother or fetus has a high risk of complication, many women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section.\u003c/p>\n\u003cp>“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Lang.\u003c/p>\n\u003cp>Unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.\u003c/p>\n\u003cp>That’s not quality health care, said Lang, and that’s why Covered California is telling hospitals they need to reduce their C-section rates to 23.9 percent or lower, for low-risk births. \"Low risk\" is defined as a healthy, first-time mom carrying a single baby with its head down, all the way to full term (\u003ca href=\"https://www.nichd.nih.gov/news/resources/spotlight/102413-redefining-term\" target=\"_blank\" rel=\"noopener\">39 weeks gestation\u003c/a>).\u003c/p>\n\u003cp>Covered California is joined by \u003ca href=\"https://www.coveredca.com/medi-cal/\" target=\"_blank\" rel=\"noopener\">Medi-Cal\u003c/a>, the state health program for low-income residents, \u003ca href=\"https://www.calpers.ca.gov/\" target=\"_blank\" rel=\"noopener\">CalPERS\u003c/a>, the retirement program for state employees, and the \u003ca href=\"http://www.pbgh.org/\" target=\"_blank\" rel=\"noopener\">Pacific Business Group on Health\u003c/a>, which represents self-insured employers. Together, these groups pay for the health care of 16 million Californians, or 40 percent of the state, which gives them substantial leverage with hospitals.\u003c/p>\n\u003cp>But only Covered California is telling hospitals that if don’t play by the rules, they’ll be benched.\u003c/p>\n\u003cp>“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the \u003ca href=\"http://www.leapfroggroup.org/\" target=\"_blank\" rel=\"noopener\">Leapfrog Group\u003c/a>, a Washington, DC-based nonprofit that rates hospitals on quality.\u003c/p>\n\u003cp>Quality control for hospitals is a recent phenomenon, and still largely voluntary, she said.\u003c/p>\n\u003cp>“Back in the '80s and '90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said. “There’s never been a culture of accountability.”\u003c/p>\n\u003cp>Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach – 1.4 million people buy coverage through the marketplace, and they shop among plans offered by 11 state-approved insurance companies.\u003c/p>\n\u003cp>Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.\u003c/p>\n\u003cp>“The Northeast Business Group on Health, which covers New York and Massachusetts and Connecticut, they will definitely be watching this to see what could be done,” Binder said.\u003c/p>\n\u003cp>Overall, California’s hospitals are on board with the goal. Of the 243 maternity hospitals in the state, 40 percent have already met the target, Lang said, and another 40 percent have taken advantage of coaching and consulting, to help educate the doctors on how they can adjust their practice, and to educate patients who request C-sections about the risks.\u003c/p>\n\u003cp>“While many may prefer that, when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the \u003ca href=\"http://www.hqinstitute.org/\" target=\"_blank\" rel=\"noopener\">Hospital Quality Institute\u003c/a>, a subsidiary of the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>, both of which support the C-section reduction goals as “the right thing to do.”\u003c/p>\n\u003cp>The effort has raised some concerns among mothers who hear about the 23.9 percent target and worry about rationing.\u003c/p>\n\u003cp>“We don't just chase rates,” Morath said, in counter to that concern, “but rather look at what the clinical needs are and best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”\u003c/p>\n\u003cp>But the coaching, and the kind of system change and staffing levels that can be required to lower C-section rates, might be too costly for some hospitals. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.\u003c/p>\n\u003cp>The target rate may not be fair for these hospitals, said Malini Nijagal, an OB/GYN at Zuckerberg San Francisco General Hospital. Her hospital’s C-section rate is already below the target, but she said it won’t be easy for others with more diverse patients.\u003c/p>\n\u003cp>“So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a C-section is way higher than someone who is not all those things,” she said. “And so the problem is, how do you adjust for the patient population of a hospital?”\u003c/p>\n\u003cp>At Memorial Hospital of Gardena, the C-section rate is 45.2 percent. At East Los Angeles Doctors Hospital, the rate is 48.1 percent, according to publicly-available state data listed on \u003ca href=\"http://calhospitalcompare.org/\" target=\"_blank\" rel=\"noopener\">CalHospital Compare\u003c/a> and \u003ca href=\"https://www.kqed.org/stateofhealth/358760/yelp-adds-c-section-rates-and-childbirth-data-to-reviews-of-california-hospitals\" target=\"_blank\" rel=\"noopener\">Yelp\u003c/a>.\u003c/p>\n\u003cp>Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for \u003ca href=\"http://avantihospitals.com/\" target=\"_blank\" rel=\"noopener\">Avanti Hospitals\u003c/a>, which owns both hospitals.\u003c/p>\n\u003cp>She said the hospitals will meet the 23.9 percent benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay \"out-of-network\" fees to be seen there, or they would have to travel farther to another facility that was still in the network.\u003c/p>\n\u003cp>“We are in under-served, economically challenged urban neighborhoods and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.\u003c/p>\n\u003cp>Health plans can request exceptions to Covered California’s contract rules, in order to keep non-complying hospitals in their networks, as long as they document their reasoning.\u003c/p>\n\u003cp>“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener\">California Association of Health Plans\u003c/a>, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators, and health plans have to ensure that patients continue to receive services in a timely manner.”\u003c/p>\n\u003cp>So far, the prospect of exclusion, plus the coaching and education, have functioned as an effective motivator. By the 2020 deadline, Covered California’s Dr. Lang believes all hospitals will either have met the target or be on their way. While the consequences are real, and while it may take some awkward conversations to get there, he said the ultimate goal is to get hospitals to deliver better, safer care to patients.\u003c/p>\n\u003cp>“It's a quality improvement project,” Lang said, “but with a deadline.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>CORRECTION: An earlier version of this story incorrectly listed the quality-care targets hospitals would have to meet to be included in Covered California insurance plans. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362982/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_15","stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_38","stateofhealth_3138","stateofhealth_368","stateofhealth_2808","stateofhealth_3231","stateofhealth_2519","stateofhealth_365"],"featImg":"stateofhealth_363029","label":"stateofhealth"},"stateofhealth_362498":{"type":"posts","id":"stateofhealth_362498","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362498","score":null,"sort":[1517027336000]},"guestAuthors":[],"slug":"despite-ongoing-threats-to-the-affordable-care-act-the-head-of-covered-california-says-its-here-for-the-long-haul","title":"Head of Covered California: State Exchange ‘Here for the Long Haul’","publishDate":1517027336,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cspan style=\"font-weight: 400\">Californians have until Jan. 31 to buy a health plan through the state’s health exchange, \u003ca href=\"http://www.coveredca.com/%E2%80%8E\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>.\u003c/span>\u003c/p>\n\u003cp>Despite ongoing uncertainty around the Affordable Care Act (ACA) on a national level, the state's insurance marketplace, Covered California, is recording higher enrollment numbers this year when compared to the same time last year. The instability around the ACA is due to several factors, including Republican attempts to repeal and replace the bill, a shortened, six-week enrollment period in other states (California decided to keep the standard three-month enrollment), and the recent passage in Congress of a \u003ca href=\"https://www.npr.org/2017/12/15/571258698/chart-how-the-new-version-of-the-republican-tax-bill-would-affect-you\" target=\"_blank\" rel=\"noopener\">tax reform bill\u003c/a>, which removed the law's penalty for people who failed to buy health coverage. That coverage \"mandate\" is still in effect this year, but will expire starting in 2019.\u003c/p>\n\u003cp>KQED spoke to Covered California's executive director, Peter V. Lee, who emphasized that despite these challenges, his program remains solid.\u003c/p>\n\u003cp>\u003cem>This interview has been edited for brevity and clarity.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Can people still sign up for health insurance through Covered California? \u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Peter V. Lee:\u003c/strong> We're in the very end of open enrollment. Many people are confused because in much of the country open enrollment ended Dec. 15. We’re open through Jan. 31 -- the end of the month. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Anyone that doesn't have insurance should come to our website and check it out. \u003c/span>Three-quarters of those eligible don't know (that they're eligible).\u003c/p>\n\u003cp>Click on “\u003ca href=\"https://www.coveredca.com/find-help/\" target=\"_blank\" rel=\"noopener\">find help near me\u003c/a>,” and you can find a local insurance agent. They're always going to be free. We have people that speak Cantonese, Spanish, and they all speak insurance.\u003c/p>\n\u003cp>\u003cstrong>Right, it feels like another language. You released numbers this past Monday showing how many people enrolled for the very first time, and those numbers are up from this time last year. Why do you think that is?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> This last year has been sort of crazy -- a lot of roller-coaster effects. We've done everything we can to have things be stable for consumers. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">One of the reasons we've seen more people sign up is it's cheaper for many people. About 1.1 million of California consumers get financial help, which lowers their premiums. For them, their health care costs went \u003cem>down\u003c/em> 10 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For those for whom it's not cheaper, which means they don't get a subsidy, it may be on average 10 percent more expensive than last year.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">We're out there pounding the pavement, we're running ads, we're getting the word out through social media, through radio and through TV. People are getting the word out. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">This is the fifth year for open enrollment, and at this point we've become a pretty well-known brand in California. People are used to hearing about us and they come back.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What percentage of people on Covered California get subsidies?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> There's two numbers. First, the individual market has about 2.5 million people. Half of them buy direct from their health plans. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">You can only get a subsidy if you buy from us. So at Covered California about 85 percent of the people that sign up with us get a subsidy. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>You released a report on Jan. 18 predicting that individual insurance markets in all states would see rate hikes in 2019 between 16 and 30 percent. And you called it a \"roller coaster for consumers.\" How will that impact California in 2019?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> First, that projection is for next year. I want to be really clear that for Californians shopping now that get subsidies, their rates went \u003cem>down\u003c/em> in 2018. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But nationally there's removal of the tax penalty [for not buying insurance]. Projections are that some healthier people will drop out of buying insurance. On average, that would increase premiums in California probably eigh,t percent on top of underlying health care costs. So we might see premiums go up next year by 15 percent in California. In other states, it could go up 30 percent or more. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What is your plan for keeping Covered California afloat in the future?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> Number one: Covered California is totally afloat. The worst case is, and this is bad, there might be a few hundred thousand fewer Californians with health insurance. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The penalty being there, or not being there, isn't the glue that holds the Affordable Care Act together. We're here for the long haul and we operate like a business. We've got hundreds of millions of dollars in reserves. We use zero state funds, and zero federal funds. So we're a going proposition. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The issue for 2019 is what this means for people that get no subsidies. They will be saying, “Holy mother of God, I got a 15 percent rate increase!\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What would you like to add?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> This last year, there were interminable attempts to repeal and replace [the Affordable Care Act]. Didn't happen.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> One of the things that I am most surprised by is how much the health care debate has changed from six years ago before the Affordable Care Act. People took for granted that we could be in a world where, if you had diabetes or asthma or cancer, you could be denied getting health care forever. No one wants to go back to those days. That's a huge change.\u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"Covered California Executive Director Peter V. Lee says premiums are down for people with subsidies and enrollment is up.","status":"publish","parent":0,"modified":1517088030,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":29,"wordCount":907},"headData":{"title":"Head of Covered California: State Exchange ‘Here for the Long Haul’ | KQED","description":"Covered California Executive Director Peter V. Lee says premiums are down for people with subsidies and enrollment is up.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362498 https://ww2.kqed.org/stateofhealth/?p=362498","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/01/26/despite-ongoing-threats-to-the-affordable-care-act-the-head-of-covered-california-says-its-here-for-the-long-haul/","disqusTitle":"Head of Covered California: State Exchange ‘Here for the Long Haul’","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2018/01/2wayKlivansCoveredCASignups.mp3","path":"/stateofhealth/362498/despite-ongoing-threats-to-the-affordable-care-act-the-head-of-covered-california-says-its-here-for-the-long-haul","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Californians have until Jan. 31 to buy a health plan through the state’s health exchange, \u003ca href=\"http://www.coveredca.com/%E2%80%8E\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>.\u003c/span>\u003c/p>\n\u003cp>Despite ongoing uncertainty around the Affordable Care Act (ACA) on a national level, the state's insurance marketplace, Covered California, is recording higher enrollment numbers this year when compared to the same time last year. The instability around the ACA is due to several factors, including Republican attempts to repeal and replace the bill, a shortened, six-week enrollment period in other states (California decided to keep the standard three-month enrollment), and the recent passage in Congress of a \u003ca href=\"https://www.npr.org/2017/12/15/571258698/chart-how-the-new-version-of-the-republican-tax-bill-would-affect-you\" target=\"_blank\" rel=\"noopener\">tax reform bill\u003c/a>, which removed the law's penalty for people who failed to buy health coverage. That coverage \"mandate\" is still in effect this year, but will expire starting in 2019.\u003c/p>\n\u003cp>KQED spoke to Covered California's executive director, Peter V. Lee, who emphasized that despite these challenges, his program remains solid.\u003c/p>\n\u003cp>\u003cem>This interview has been edited for brevity and clarity.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Can people still sign up for health insurance through Covered California? \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Peter V. Lee:\u003c/strong> We're in the very end of open enrollment. Many people are confused because in much of the country open enrollment ended Dec. 15. We’re open through Jan. 31 -- the end of the month. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Anyone that doesn't have insurance should come to our website and check it out. \u003c/span>Three-quarters of those eligible don't know (that they're eligible).\u003c/p>\n\u003cp>Click on “\u003ca href=\"https://www.coveredca.com/find-help/\" target=\"_blank\" rel=\"noopener\">find help near me\u003c/a>,” and you can find a local insurance agent. They're always going to be free. We have people that speak Cantonese, Spanish, and they all speak insurance.\u003c/p>\n\u003cp>\u003cstrong>Right, it feels like another language. You released numbers this past Monday showing how many people enrolled for the very first time, and those numbers are up from this time last year. Why do you think that is?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> This last year has been sort of crazy -- a lot of roller-coaster effects. We've done everything we can to have things be stable for consumers. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">One of the reasons we've seen more people sign up is it's cheaper for many people. About 1.1 million of California consumers get financial help, which lowers their premiums. For them, their health care costs went \u003cem>down\u003c/em> 10 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For those for whom it's not cheaper, which means they don't get a subsidy, it may be on average 10 percent more expensive than last year.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">We're out there pounding the pavement, we're running ads, we're getting the word out through social media, through radio and through TV. People are getting the word out. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">This is the fifth year for open enrollment, and at this point we've become a pretty well-known brand in California. People are used to hearing about us and they come back.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What percentage of people on Covered California get subsidies?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> There's two numbers. First, the individual market has about 2.5 million people. Half of them buy direct from their health plans. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">You can only get a subsidy if you buy from us. So at Covered California about 85 percent of the people that sign up with us get a subsidy. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>You released a report on Jan. 18 predicting that individual insurance markets in all states would see rate hikes in 2019 between 16 and 30 percent. And you called it a \"roller coaster for consumers.\" How will that impact California in 2019?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> First, that projection is for next year. I want to be really clear that for Californians shopping now that get subsidies, their rates went \u003cem>down\u003c/em> in 2018. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But nationally there's removal of the tax penalty [for not buying insurance]. Projections are that some healthier people will drop out of buying insurance. On average, that would increase premiums in California probably eigh,t percent on top of underlying health care costs. So we might see premiums go up next year by 15 percent in California. In other states, it could go up 30 percent or more. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What is your plan for keeping Covered California afloat in the future?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> Number one: Covered California is totally afloat. The worst case is, and this is bad, there might be a few hundred thousand fewer Californians with health insurance. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The penalty being there, or not being there, isn't the glue that holds the Affordable Care Act together. We're here for the long haul and we operate like a business. We've got hundreds of millions of dollars in reserves. We use zero state funds, and zero federal funds. So we're a going proposition. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The issue for 2019 is what this means for people that get no subsidies. They will be saying, “Holy mother of God, I got a 15 percent rate increase!\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What would you like to add?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> This last year, there were interminable attempts to repeal and replace [the Affordable Care Act]. Didn't happen.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> One of the things that I am most surprised by is how much the health care debate has changed from six years ago before the Affordable Care Act. People took for granted that we could be in a world where, if you had diabetes or asthma or cancer, you could be denied getting health care forever. No one wants to go back to those days. That's a huge change.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362498/despite-ongoing-threats-to-the-affordable-care-act-the-head-of-covered-california-says-its-here-for-the-long-haul","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_38","stateofhealth_368","stateofhealth_2808","stateofhealth_2519","stateofhealth_3210"],"featImg":"stateofhealth_16356","label":"stateofhealth"},"stateofhealth_361837":{"type":"posts","id":"stateofhealth_361837","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361837","score":null,"sort":[1509414698000]},"guestAuthors":[],"slug":"human-psychology-makes-health-insurance-a-hard-sell-especially-for-latino-consumers","title":"Human Psychology Makes Health Insurance a Hard Sell – Especially for Latino Consumers","publishDate":1509414698,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The way human brains are wired, it just doesn’t make sense to us to buy something now that we may not need for years in the future.\u003c/p>\n\u003cp>“Health insurance has to be the toughest thing on earth to sell,” said \u003ca href=\"http://www.ogilvy.com/ogilvy-mather-board/christopher-graves/\" target=\"_blank\" rel=\"noopener\">Christopher Graves\u003c/a>, president and founder of Ogilvy’s Behavioral Science Center. “Especially if you're trying to sell it to somebody who's young, healthy and has not had some catastrophe health-wise.\u003c/p>\n\u003cp>That would be most Latinos in California, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\" rel=\"noopener\">a primary target\u003c/a> of the marketing and outreach strategy for \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s insurance marketplace. The more healthy Latinos sign up for insurance, the more their premiums help balance the costs of caring for older, sicker Californians.\u003c/p>\n\u003cp>Latinos represent 38 percent of the marketplace’s potential customer base but about 30 percent of people who actually enroll, so Covered California sees marketing to the demographic as a good return on investment for the whole exchange.\u003c/p>\n\u003cp>But the Trump administration has made the already difficult task, of selling a product people don’t want to think about, even harder. Federal health officials slashed the national budget for marketing around the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s over for Obamacare,” President Trump has been saying since his campaign. “Let Obamacare implode.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=FAJfWfzKSxs\u003c/p>\n\u003cp>But California controls its own marketing budget and plans to invest $111 million to counteract the negative press from the feds. It will also spend 30 percent of its media buy on Spanish-language ads. But in terms of the creative message, California is on the defensive.\u003c/p>\n\u003cp>“Even if they're hearing you know the Affordable Care Act is going away, we're saying ‘No, no, not yet, not yet,' ” said Lizelda Lopez, who helps direct Latino outreach for Covered California as the agency’s deputy director of communications. “We're still here.”\u003c/p>\n\u003cp>That’s the mantra for this year, she said: “We are open for business. We are here. Financial assistance is still available. Open enrollment is Nov. 1 to Jan. 31. We are here.”\u003c/p>\n\u003cp>Such simple messages may work for people who already bought coverage in previous years and just need to renew their plan, said Carlos Santiago, chief strategist at \u003ca href=\"http://santiagosolutionsgroup.com/\" target=\"_blank\" rel=\"noopener\">Santiago Solutions Group\u003c/a>, a research consulting firm. But they could be too simple for new customers.\u003c/p>\n\u003cp>“To convince someone that was uninsured to get it for the first time? Obviously that message is not going to work,” Santiago said. “Especially not this year.”\u003c/p>\n\u003cp>Plus, the belief that illness won’t happen to you -- Santiago said this is especially entrenched in Latino culture.\u003c/p>\n\u003cp>“Latinos are extremely, extremely positive and overly optimistic,” he said, one reason Latinos have higher rates of going uninsured.\u003c/p>\n\u003cp>“We don't need to worry so much about today. Things will be OK,” he said. “And obviously when it comes to insurance, that's not exactly what it's all about.\"\u003c/p>\n\u003cp>On that front, Covered California has some more dramatic ads featuring ambulances and overturned bicycles, or a scene of a \u003ca href=\"https://vimeopro.com/coveredcanews/instant-tv/video/239171245\" target=\"_blank\" rel=\"noopener\">ladder falling backward\u003c/a>. It also plans to push a series of videos on social media. Its market research shows Latina women are very active video sharers, Lopez said.\u003c/p>\n\u003cp>“Mi nombre es Guadalupe,” says a young woman in\u003ca href=\"https://player.vimeo.com/video/215252751/?autoplay=1\" target=\"_blank\" rel=\"noopener\"> one video\u003c/a>, as she shows pictures from her wedding day and talks about suddenly finding out she needed a heart transplant.\u003c/p>\n\u003cp>Without her health plan from Covered California, she said she never would have been able to afford the cost of surgery: $1.5 million.\u003c/p>\n\u003cp>This kind of personal story, which other Latinas can relate to, is good, Santiago said. But Latinos don’t respond to fear, he added, so if the message is too scary, it could backfire.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s a tug of war,” said Christopher Graves. “That trade-off is, people stop taking action. They basically become paralyzed by how overwhelming it is. There needs to be a balance.”\u003c/p>\n\n","blocks":[],"excerpt":"Covered California is doubling down on Obamacare marketing to counteract negative press from the Trump administration.","status":"publish","parent":0,"modified":1509493760,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":695},"headData":{"title":"Human Psychology Makes Health Insurance a Hard Sell – Especially for Latino Consumers | KQED","description":"Covered California is doubling down on Obamacare marketing to counteract negative press from the Trump administration.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361837 https://ww2.kqed.org/stateofhealth/?p=361837","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/10/30/human-psychology-makes-health-insurance-a-hard-sell-especially-for-latino-consumers/","disqusTitle":"Human Psychology Makes Health Insurance a Hard Sell – Especially for Latino Consumers","path":"/stateofhealth/361837/human-psychology-makes-health-insurance-a-hard-sell-especially-for-latino-consumers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The way human brains are wired, it just doesn’t make sense to us to buy something now that we may not need for years in the future.\u003c/p>\n\u003cp>“Health insurance has to be the toughest thing on earth to sell,” said \u003ca href=\"http://www.ogilvy.com/ogilvy-mather-board/christopher-graves/\" target=\"_blank\" rel=\"noopener\">Christopher Graves\u003c/a>, president and founder of Ogilvy’s Behavioral Science Center. “Especially if you're trying to sell it to somebody who's young, healthy and has not had some catastrophe health-wise.\u003c/p>\n\u003cp>That would be most Latinos in California, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\" rel=\"noopener\">a primary target\u003c/a> of the marketing and outreach strategy for \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s insurance marketplace. The more healthy Latinos sign up for insurance, the more their premiums help balance the costs of caring for older, sicker Californians.\u003c/p>\n\u003cp>Latinos represent 38 percent of the marketplace’s potential customer base but about 30 percent of people who actually enroll, so Covered California sees marketing to the demographic as a good return on investment for the whole exchange.\u003c/p>\n\u003cp>But the Trump administration has made the already difficult task, of selling a product people don’t want to think about, even harder. Federal health officials slashed the national budget for marketing around the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s over for Obamacare,” President Trump has been saying since his campaign. “Let Obamacare implode.”\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/FAJfWfzKSxs'\n title='//www.youtube.com/embed/FAJfWfzKSxs'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>But California controls its own marketing budget and plans to invest $111 million to counteract the negative press from the feds. It will also spend 30 percent of its media buy on Spanish-language ads. But in terms of the creative message, California is on the defensive.\u003c/p>\n\u003cp>“Even if they're hearing you know the Affordable Care Act is going away, we're saying ‘No, no, not yet, not yet,' ” said Lizelda Lopez, who helps direct Latino outreach for Covered California as the agency’s deputy director of communications. “We're still here.”\u003c/p>\n\u003cp>That’s the mantra for this year, she said: “We are open for business. We are here. Financial assistance is still available. Open enrollment is Nov. 1 to Jan. 31. We are here.”\u003c/p>\n\u003cp>Such simple messages may work for people who already bought coverage in previous years and just need to renew their plan, said Carlos Santiago, chief strategist at \u003ca href=\"http://santiagosolutionsgroup.com/\" target=\"_blank\" rel=\"noopener\">Santiago Solutions Group\u003c/a>, a research consulting firm. But they could be too simple for new customers.\u003c/p>\n\u003cp>“To convince someone that was uninsured to get it for the first time? Obviously that message is not going to work,” Santiago said. “Especially not this year.”\u003c/p>\n\u003cp>Plus, the belief that illness won’t happen to you -- Santiago said this is especially entrenched in Latino culture.\u003c/p>\n\u003cp>“Latinos are extremely, extremely positive and overly optimistic,” he said, one reason Latinos have higher rates of going uninsured.\u003c/p>\n\u003cp>“We don't need to worry so much about today. Things will be OK,” he said. “And obviously when it comes to insurance, that's not exactly what it's all about.\"\u003c/p>\n\u003cp>On that front, Covered California has some more dramatic ads featuring ambulances and overturned bicycles, or a scene of a \u003ca href=\"https://vimeopro.com/coveredcanews/instant-tv/video/239171245\" target=\"_blank\" rel=\"noopener\">ladder falling backward\u003c/a>. It also plans to push a series of videos on social media. Its market research shows Latina women are very active video sharers, Lopez said.\u003c/p>\n\u003cp>“Mi nombre es Guadalupe,” says a young woman in\u003ca href=\"https://player.vimeo.com/video/215252751/?autoplay=1\" target=\"_blank\" rel=\"noopener\"> one video\u003c/a>, as she shows pictures from her wedding day and talks about suddenly finding out she needed a heart transplant.\u003c/p>\n\u003cp>Without her health plan from Covered California, she said she never would have been able to afford the cost of surgery: $1.5 million.\u003c/p>\n\u003cp>This kind of personal story, which other Latinas can relate to, is good, Santiago said. But Latinos don’t respond to fear, he added, so if the message is too scary, it could backfire.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s a tug of war,” said Christopher Graves. “That trade-off is, people stop taking action. They basically become paralyzed by how overwhelming it is. There needs to be a balance.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361837/human-psychology-makes-health-insurance-a-hard-sell-especially-for-latino-consumers","authors":["3205"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_38","stateofhealth_368","stateofhealth_3192","stateofhealth_3191","stateofhealth_2519","stateofhealth_365"],"featImg":"stateofhealth_361838","label":"stateofhealth"},"stateofhealth_361586":{"type":"posts","id":"stateofhealth_361586","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361586","score":null,"sort":[1508287091000]},"guestAuthors":[],"slug":"two-senators-reach-deal-on-a-health-law-fix-but-bringing-congress-along-is-tricky","title":"Two Senators Reach Deal On A Health Law Fix, But Bringing Congress Along Is Tricky","publishDate":1508287091,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>After nearly two months of negotiations, key senators said Tuesday they have reached a bipartisan deal on a proposal intended to stabilize the Affordable Care Act’s insurance market, which has been rocked by recent actions by President Donald Trump.\u003c/p>\n\u003cp>Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), respectively the chairman and the top Democrat of the Senate Health, Education, Labor and Pensions Committee, negotiated the emerging deal. The milestone agreement, they said, would guarantee payment of “cost-sharing reduction” subsidies that help some policyholders with low incomes afford their deductibles and other out-of-pocket costs for two years, 2018 and 2019.\u003c/p>\n\u003cp>Trump \u003ca href=\"https://khn.org/news/trump-acting-solo-what-you-need-to-know-about-changes-to-the-health-law/\">announced last week\u003c/a> that he would stop funding the subsidies, which have been the subject of a \u003ca href=\"https://khn.org/news/5-things-to-know-about-the-health-issue-that-could-shut-down-the-government/\">long-running lawsuit\u003c/a>. These subsidies are separate from the tax credit subsidies that help eligible consumers pay for their premiums. Those premium subsidies are not affected by Trump’s action.\u003c/p>\n\u003cp>Even if it fails to become law, the deal marks a singular achievement that has been almost completely missing in Congress for the past eight years — a bipartisan compromise on how to make the nation’s health insurance system work.\u003c/p>\n\u003cp>“This is an agreement I am proud to support,” said Murray on the Senate floor, “because of the message it sends about how to get things done.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The proposal — which will require 60 votes to pass the Senate and agreement from a still-dubious House of Representatives — would also restore $110 million in \u003ca href=\"https://khn.org/news/latest-snag-in-aca-sign-ups-those-who-guide-consumers-are-hitting-roadblocks/\">“outreach” funding\u003c/a> cut by the Trump administration. That funding would help guide eligible individuals to sign up for coverage on the health insurance exchanges during the open enrollment period that runs from Nov. 1 to Dec. 15.\u003c/p>\n\u003cp>In exchange for those provisions, urged by Democrats and \u003ca href=\"https://khn.org/news/5-governors-press-congress-for-fast-bucks-to-secure-obamacare-market-in-2018/\">state officials\u003c/a>, Republicans will win some changes to make it easier for states to apply for “waivers” that would let them experiment with alternative ways to provide and subsidize health insurance. The deal would also allow the sale of less comprehensive “catastrophic” plans in the health exchanges. Such plans currently can be sold only to those under age 30.\u003c/p>\n\u003cp>On the Senate floor Tuesday afternoon, Alexander said, “This agreement avoids chaos. I don’t know a Democrat or a Republican who benefits from chaos.”\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) reserved judgment about the deal.\u003c/p>\n\u003cp>Both parties still have some major disagreements when it comes to health care, Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters Tuesday afternoon, but “I think there’s a growing consensus that in the short term we need stability in the markets. So we’ve achieved stability if this agreement becomes law.”\u003c/p>\n\u003cp>More than 60 senators have already participated in the meetings that led to the deal, Alexander said on the Senate floor. But the path to passage in the House is uncertain — with many conservatives vehemently opposed to anything that could be construed as helping the law they call “Obamacare” succeed.\u003c/p>\n\u003cp>Tweeted Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, Tuesday: “The GOP should focus on repealing & replacing Obamacare, not trying to save it. This bailout is unacceptable.”\u003c/p>\n\u003cp>Both Murray and Alexander said Tuesday they were still struggling over language to make sure that if the cost-sharing payments are resumed, insurers would not receive a windfall by keeping both those payments and the higher premiums that many states are allowing in anticipation of the payments being ended.\u003c/p>\n\u003cp>“We want to make sure that the cost-sharing payments go to the benefit of consumers, not the insurance companies,” Alexander said.\u003c/p>\n\u003cp>Trump, who as \u003ca href=\"https://www.whitehouse.gov/the-press-office/2017/10/16/remarks-president-trump-cabinet-meeting\">recently as Monday\u003c/a> called the cost-sharing subsidies “a payoff” to insurance companies, took credit for the negotiations. “If I didn’t cut the CSR’s, they wouldn’t be meeting,” he said. That was not, in fact, the case. The negotiations had picked up \u003ca href=\"http://www.politico.com/story/2017/09/28/alexander-murray-obamacare-plan-243258\">some weeks ago\u003c/a> after being called off earlier in September while the Senate tried for one last-ditch repeal vote.\u003c/p>\n\u003cp>On Friday, White House Budget Director Mick Mulvaney told \u003ca href=\"http://www.politico.com/story/2017/10/13/trump-opposes-bipartisan-obamacare-rescue-plan-243752\">Politico\u003c/a> that the president would not allow a short-term fix, calling a restoration of the cost-sharing reduction funds “corporate welfare and bailouts for the insurance companies.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But on Tuesday the president hailed the deal. “We think it’s going to not only save money, but give people much better health care with a very, very much smaller premium spike,” he told reporters.\u003c/p>\n\n","blocks":[],"excerpt":"The proposal is intended to stabilize the Affordable Care Act’s insurance markets, which have been rocked by recent actions by President Donald Trump.","status":"publish","parent":0,"modified":1508287213,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":783},"headData":{"title":"Two Senators Reach Deal On A Health Law Fix, But Bringing Congress Along Is Tricky | KQED","description":"The proposal is intended to stabilize the Affordable Care Act’s insurance markets, which have been rocked by recent actions by President Donald Trump.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361586 https://ww2.kqed.org/stateofhealth/?p=361586","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/10/17/two-senators-reach-deal-on-a-health-law-fix-but-bringing-congress-along-is-tricky/","disqusTitle":"Two Senators Reach Deal On A Health Law Fix, But Bringing Congress Along Is Tricky","nprByline":"\u003cstrong>Julie Rovner\u003c/strong>, Kaiser Health News","path":"/stateofhealth/361586/two-senators-reach-deal-on-a-health-law-fix-but-bringing-congress-along-is-tricky","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>After nearly two months of negotiations, key senators said Tuesday they have reached a bipartisan deal on a proposal intended to stabilize the Affordable Care Act’s insurance market, which has been rocked by recent actions by President Donald Trump.\u003c/p>\n\u003cp>Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), respectively the chairman and the top Democrat of the Senate Health, Education, Labor and Pensions Committee, negotiated the emerging deal. The milestone agreement, they said, would guarantee payment of “cost-sharing reduction” subsidies that help some policyholders with low incomes afford their deductibles and other out-of-pocket costs for two years, 2018 and 2019.\u003c/p>\n\u003cp>Trump \u003ca href=\"https://khn.org/news/trump-acting-solo-what-you-need-to-know-about-changes-to-the-health-law/\">announced last week\u003c/a> that he would stop funding the subsidies, which have been the subject of a \u003ca href=\"https://khn.org/news/5-things-to-know-about-the-health-issue-that-could-shut-down-the-government/\">long-running lawsuit\u003c/a>. These subsidies are separate from the tax credit subsidies that help eligible consumers pay for their premiums. Those premium subsidies are not affected by Trump’s action.\u003c/p>\n\u003cp>Even if it fails to become law, the deal marks a singular achievement that has been almost completely missing in Congress for the past eight years — a bipartisan compromise on how to make the nation’s health insurance system work.\u003c/p>\n\u003cp>“This is an agreement I am proud to support,” said Murray on the Senate floor, “because of the message it sends about how to get things done.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The proposal — which will require 60 votes to pass the Senate and agreement from a still-dubious House of Representatives — would also restore $110 million in \u003ca href=\"https://khn.org/news/latest-snag-in-aca-sign-ups-those-who-guide-consumers-are-hitting-roadblocks/\">“outreach” funding\u003c/a> cut by the Trump administration. That funding would help guide eligible individuals to sign up for coverage on the health insurance exchanges during the open enrollment period that runs from Nov. 1 to Dec. 15.\u003c/p>\n\u003cp>In exchange for those provisions, urged by Democrats and \u003ca href=\"https://khn.org/news/5-governors-press-congress-for-fast-bucks-to-secure-obamacare-market-in-2018/\">state officials\u003c/a>, Republicans will win some changes to make it easier for states to apply for “waivers” that would let them experiment with alternative ways to provide and subsidize health insurance. The deal would also allow the sale of less comprehensive “catastrophic” plans in the health exchanges. Such plans currently can be sold only to those under age 30.\u003c/p>\n\u003cp>On the Senate floor Tuesday afternoon, Alexander said, “This agreement avoids chaos. I don’t know a Democrat or a Republican who benefits from chaos.”\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) reserved judgment about the deal.\u003c/p>\n\u003cp>Both parties still have some major disagreements when it comes to health care, Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters Tuesday afternoon, but “I think there’s a growing consensus that in the short term we need stability in the markets. So we’ve achieved stability if this agreement becomes law.”\u003c/p>\n\u003cp>More than 60 senators have already participated in the meetings that led to the deal, Alexander said on the Senate floor. But the path to passage in the House is uncertain — with many conservatives vehemently opposed to anything that could be construed as helping the law they call “Obamacare” succeed.\u003c/p>\n\u003cp>Tweeted Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, Tuesday: “The GOP should focus on repealing & replacing Obamacare, not trying to save it. This bailout is unacceptable.”\u003c/p>\n\u003cp>Both Murray and Alexander said Tuesday they were still struggling over language to make sure that if the cost-sharing payments are resumed, insurers would not receive a windfall by keeping both those payments and the higher premiums that many states are allowing in anticipation of the payments being ended.\u003c/p>\n\u003cp>“We want to make sure that the cost-sharing payments go to the benefit of consumers, not the insurance companies,” Alexander said.\u003c/p>\n\u003cp>Trump, who as \u003ca href=\"https://www.whitehouse.gov/the-press-office/2017/10/16/remarks-president-trump-cabinet-meeting\">recently as Monday\u003c/a> called the cost-sharing subsidies “a payoff” to insurance companies, took credit for the negotiations. “If I didn’t cut the CSR’s, they wouldn’t be meeting,” he said. That was not, in fact, the case. The negotiations had picked up \u003ca href=\"http://www.politico.com/story/2017/09/28/alexander-murray-obamacare-plan-243258\">some weeks ago\u003c/a> after being called off earlier in September while the Senate tried for one last-ditch repeal vote.\u003c/p>\n\u003cp>On Friday, White House Budget Director Mick Mulvaney told \u003ca href=\"http://www.politico.com/story/2017/10/13/trump-opposes-bipartisan-obamacare-rescue-plan-243752\">Politico\u003c/a> that the president would not allow a short-term fix, calling a restoration of the cost-sharing reduction funds “corporate welfare and bailouts for the insurance companies.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But on Tuesday the president hailed the deal. “We think it’s going to not only save money, but give people much better health care with a very, very much smaller premium spike,” he told reporters.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361586/two-senators-reach-deal-on-a-health-law-fix-but-bringing-congress-along-is-tricky","authors":["byline_stateofhealth_361586"],"categories":["stateofhealth_1"],"tags":["stateofhealth_38","stateofhealth_2808","stateofhealth_2519"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_361591","label":"stateofhealth_3007"},"stateofhealth_360850":{"type":"posts","id":"stateofhealth_360850","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360850","score":null,"sort":[1503078231000]},"guestAuthors":[],"slug":"amid-uncertainty-over-health-care-covered-california-appeals-to-insurers-bottom-lines","title":"Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines","publishDate":1503078231,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>With ongoing uncertainty around the Affordable Care Act (ACA), the board that oversees California's health care marketplace took action to stabilize the exchange on Thursday. Their goal was to convince insurance companies to continue offering health plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee praised California's overall success as a health care marketplace, but cautioned that the exchange faces significant challenges.\u003c/p>\n\u003cp>\"We think this open enrollment’s going to be the most challenging since year one,\" Lee said. \"We’re dealing with the most federal uncertainty we’ve ever had.\"\u003c/p>\n\u003cp>Lee is referring to Congress's attempts to repeal the ACA, and the Trump administration's threats not to pay subsidies to insurance companies, as required under the health care law.\u003c/p>\n\u003cp>In the meeting, the board unanimously adopted two new resolutions they believe will maintain market stability. \u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/2017-2019%20QHP%20Issuer%20Contract%20Amendment%20Resolution%20(2017-36).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The first\u003c/a> updates contracts between Covered California and insurance companies, allowing insurers who lose money in 2018 to increase profit margins in the following three years in order to recoup losses. Alternatively, if companies make unforeseen profits because of national uncertainty, those profits would go to reducing premiums in the future.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In an email, a spokesperson for Blue Shield of California, one of the exchange's providers, said the company \"supports Covered California’s program to address the pricing uncertainty and will participate to add stability in the market.\"\u003c/p>\n\u003cp>\u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/Fiscal%20Year%202017-18%20Budget%20Revision%20(Resolution%202017-37).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The second resolution\u003c/a> increases Covered California's marketing and outreach budget by over $5 million. Marketing helps convince consumers, especially healthy ones, to sign up for plans. A mix of healthy and sick participants allows health care marketplaces to maintain lower premiums.\u003c/p>\n\u003cp>Finally, the board announced it would delay a decision about whether to further increase 2018 premiums until Sept. 30.\u003c/p>\n\u003cp>[contextly_sidebar id=\"QtimBtKZJz3HyH4ttMNqWM3dVsZyKIDx\"]\u003c/p>\n\u003cp>Those increases could be necessary to make up for the insurance companies' financial losses, if the federal government withholds subsidies designed to decrease costs for low-income consumers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The board hopes that by the end of September it will better understand what will happen to the Affordable Care Act and how that will impact California.\u003c/p>\n\n","blocks":[],"excerpt":"Covered California's board introduces two resolutions and delays a decision about rate increases.","status":"publish","parent":0,"modified":1503091746,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":364},"headData":{"title":"Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines | KQED","description":"Covered California's board introduces two resolutions and delays a decision about rate increases.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"360850 https://ww2.kqed.org/stateofhealth/?p=360850","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/18/amid-uncertainty-over-health-care-covered-california-appeals-to-insurers-bottom-lines/","disqusTitle":"Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines","path":"/stateofhealth/360850/amid-uncertainty-over-health-care-covered-california-appeals-to-insurers-bottom-lines","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>With ongoing uncertainty around the Affordable Care Act (ACA), the board that oversees California's health care marketplace took action to stabilize the exchange on Thursday. Their goal was to convince insurance companies to continue offering health plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee praised California's overall success as a health care marketplace, but cautioned that the exchange faces significant challenges.\u003c/p>\n\u003cp>\"We think this open enrollment’s going to be the most challenging since year one,\" Lee said. \"We’re dealing with the most federal uncertainty we’ve ever had.\"\u003c/p>\n\u003cp>Lee is referring to Congress's attempts to repeal the ACA, and the Trump administration's threats not to pay subsidies to insurance companies, as required under the health care law.\u003c/p>\n\u003cp>In the meeting, the board unanimously adopted two new resolutions they believe will maintain market stability. \u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/2017-2019%20QHP%20Issuer%20Contract%20Amendment%20Resolution%20(2017-36).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The first\u003c/a> updates contracts between Covered California and insurance companies, allowing insurers who lose money in 2018 to increase profit margins in the following three years in order to recoup losses. Alternatively, if companies make unforeseen profits because of national uncertainty, those profits would go to reducing premiums in the future.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In an email, a spokesperson for Blue Shield of California, one of the exchange's providers, said the company \"supports Covered California’s program to address the pricing uncertainty and will participate to add stability in the market.\"\u003c/p>\n\u003cp>\u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/Fiscal%20Year%202017-18%20Budget%20Revision%20(Resolution%202017-37).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The second resolution\u003c/a> increases Covered California's marketing and outreach budget by over $5 million. Marketing helps convince consumers, especially healthy ones, to sign up for plans. A mix of healthy and sick participants allows health care marketplaces to maintain lower premiums.\u003c/p>\n\u003cp>Finally, the board announced it would delay a decision about whether to further increase 2018 premiums until Sept. 30.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Those increases could be necessary to make up for the insurance companies' financial losses, if the federal government withholds subsidies designed to decrease costs for low-income consumers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The board hopes that by the end of September it will better understand what will happen to the Affordable Care Act and how that will impact California.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360850/amid-uncertainty-over-health-care-covered-california-appeals-to-insurers-bottom-lines","authors":["8648"],"categories":["stateofhealth_2442","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_38","stateofhealth_368","stateofhealth_2808","stateofhealth_2519"],"featImg":"stateofhealth_16356","label":"stateofhealth"},"stateofhealth_360820":{"type":"posts","id":"stateofhealth_360820","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360820","score":null,"sort":[1502831183000]},"guestAuthors":[],"slug":"cbo-if-trump-cuts-payments-to-insurance-companies-it-will-cost-taxpayers","title":"CBO: If Trump Cuts Payments To Insurance Companies, It Will Cost Taxpayers","publishDate":1502831183,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it's going to cost him.\u003c/p>\n\u003cp>Or, more accurately, it's going to cost taxpayers — about $194 billion over 10 years.\u003c/p>\n\u003cp>The cost is \"eye-poppingly large,\" says \u003ca href=\"https://www.law.umich.edu/FacultyBio/Pages/FacultyBio.aspx?FacID=nbagley\" target=\"_blank\" rel=\"noopener noreferrer\">Nicholas Bagley\u003c/a>, a professor of health law at the University of Michigan. \"This single policy could effectively end up costing 20 percent of the entire bill of the ACA.\"\u003c/p>\n\u003cp>The deficit figure comes from the Congressional Budget Office, which on Tuesday released an \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53009-costsharingreductions.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimate\u003c/a> of the budget impact of ending what's known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they're required by law to give to low-income customers.\u003c/p>\n\u003cp>The reports also say premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>President Trump threatened repeatedly to cut off the payments, which he's called \"bailouts,\" during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, or Obamacare.\u003c/p>\n\u003cp>More recently, the president has remained mute on the topic, and insurers have been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets\" target=\"_blank\" rel=\"noopener noreferrer\">left to wonder\u003c/a> whether they will receive a check this month for the discounts they paid out in July.\u003c/p>\n\u003cp>Bagley says there's no good policy reason to cut off the payments. \"If you can cover roughly the same number of people for about $200 billion less, why wouldn't you want to do that?\" he asks.\u003c/p>\n\u003cp>Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.\u003c/p>\n\u003cp>The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.\u003c/p>\n\u003cp>Last year, about \u003ca href=\"https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-06-30.html\" target=\"_blank\" rel=\"noopener noreferrer\">85 percent\u003c/a> of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\"The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,\" says \u003ca href=\"http://www.kff.org/person/larry-levitt/\" target=\"_blank\" rel=\"noopener noreferrer\">Larry Levitt\u003c/a>, a vice president at the Kaiser Family Foundation. \"Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.\"\u003c/p>\n\u003cp>The CBO report confirms earlier analyses, including \u003ca href=\"http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/\">this one\u003c/a> by Kaiser and \u003ca href=\"http://health.oliverwyman.com/transform-care/2017/05/impact_defunding_CSR_payments.html\" target=\"_blank\" rel=\"noopener noreferrer\">this one\u003c/a> from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies \u003ca href=\"http://www.npr.org/sections/health-shots/2017/05/16/528584408/trump-refusal-to-bail-out-insurers-might-end-up-making-policies-cheaper\" target=\"_blank\" rel=\"noopener noreferrer\">cheaper\u003c/a> for some individuals.\u003c/p>\n\u003cp>Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear \"because of the substantial uncertainty about the effects of the policy on average health care costs,\" the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.\u003c/p>\n\u003cp>But the agency says insurers would come back over the next two years.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wlu.edu/faculty/emeritus-faculty/tim-jost\" target=\"_blank\" rel=\"noopener noreferrer\">Timothy Jost\u003c/a>, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.\u003c/p>\n\u003cp>He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Yost warns.\u003c/p>\n\u003cp>\"CBO assumes that things will work out rationally, and there will be a smooth landing,\" he says. \"It could be much more chaotic than that.\"\u003c/p>\n\u003cp>Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide what health plans to offer on the Obamacare exchanges and what to charge.\u003c/p>\n\u003cp>The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.\u003c/p>\n\u003cp>House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CBO+Predicts+Rise+In+Deficit+If+Trump+Cuts+Payments+To+Insurance+Companies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The Congressional Budget Office estimates that ending what's known as cost-sharing reduction payments to insurers will raise the deficit $194 billion over 10 years.","status":"publish","parent":0,"modified":1502913964,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":842},"headData":{"title":"CBO: If Trump Cuts Payments To Insurance Companies, It Will Cost Taxpayers | KQED","description":"The Congressional Budget Office estimates that ending what's known as cost-sharing reduction payments to insurers will raise the deficit $194 billion over 10 years.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"360820 https://ww2.kqed.org/stateofhealth/?p=360820","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/15/cbo-if-trump-cuts-payments-to-insurance-companies-it-will-cost-taxpayers/","disqusTitle":"CBO: If Trump Cuts Payments To Insurance Companies, It Will Cost Taxpayers","audioUrl":"http://www.kqed.org/.stream/anon/radio/tcr/2017/08/170816atcr.mp3","nprByline":"\u003ca href=\"http://www.npr.org/people/473143808/alison-kodjak\" target=\"_blank\">Alison Kodjak\u003c/a>","nprImageAgency":" Melina Mara/The Washington Post/Getty Images","nprStoryId":"543714171","nprApiLink":"http://api.npr.org/query?id=543714171&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/08/15/543714171/cbo-predicts-rise-in-deficit-if-trump-cuts-payments-to-insurance-companies?ft=nprml&f=543714171","nprRetrievedStory":"1","nprPubDate":"Tue, 15 Aug 2017 16:19:00 -0400","nprStoryDate":"Tue, 15 Aug 2017 16:14:00 -0400","nprLastModifiedDate":"Tue, 15 Aug 2017 16:19:15 -0400","path":"/stateofhealth/360820/cbo-if-trump-cuts-payments-to-insurance-companies-it-will-cost-taxpayers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it's going to cost him.\u003c/p>\n\u003cp>Or, more accurately, it's going to cost taxpayers — about $194 billion over 10 years.\u003c/p>\n\u003cp>The cost is \"eye-poppingly large,\" says \u003ca href=\"https://www.law.umich.edu/FacultyBio/Pages/FacultyBio.aspx?FacID=nbagley\" target=\"_blank\" rel=\"noopener noreferrer\">Nicholas Bagley\u003c/a>, a professor of health law at the University of Michigan. \"This single policy could effectively end up costing 20 percent of the entire bill of the ACA.\"\u003c/p>\n\u003cp>The deficit figure comes from the Congressional Budget Office, which on Tuesday released an \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53009-costsharingreductions.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimate\u003c/a> of the budget impact of ending what's known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they're required by law to give to low-income customers.\u003c/p>\n\u003cp>The reports also say premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Trump threatened repeatedly to cut off the payments, which he's called \"bailouts,\" during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, or Obamacare.\u003c/p>\n\u003cp>More recently, the president has remained mute on the topic, and insurers have been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets\" target=\"_blank\" rel=\"noopener noreferrer\">left to wonder\u003c/a> whether they will receive a check this month for the discounts they paid out in July.\u003c/p>\n\u003cp>Bagley says there's no good policy reason to cut off the payments. \"If you can cover roughly the same number of people for about $200 billion less, why wouldn't you want to do that?\" he asks.\u003c/p>\n\u003cp>Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.\u003c/p>\n\u003cp>The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.\u003c/p>\n\u003cp>Last year, about \u003ca href=\"https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-06-30.html\" target=\"_blank\" rel=\"noopener noreferrer\">85 percent\u003c/a> of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\"The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,\" says \u003ca href=\"http://www.kff.org/person/larry-levitt/\" target=\"_blank\" rel=\"noopener noreferrer\">Larry Levitt\u003c/a>, a vice president at the Kaiser Family Foundation. \"Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.\"\u003c/p>\n\u003cp>The CBO report confirms earlier analyses, including \u003ca href=\"http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/\">this one\u003c/a> by Kaiser and \u003ca href=\"http://health.oliverwyman.com/transform-care/2017/05/impact_defunding_CSR_payments.html\" target=\"_blank\" rel=\"noopener noreferrer\">this one\u003c/a> from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies \u003ca href=\"http://www.npr.org/sections/health-shots/2017/05/16/528584408/trump-refusal-to-bail-out-insurers-might-end-up-making-policies-cheaper\" target=\"_blank\" rel=\"noopener noreferrer\">cheaper\u003c/a> for some individuals.\u003c/p>\n\u003cp>Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear \"because of the substantial uncertainty about the effects of the policy on average health care costs,\" the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.\u003c/p>\n\u003cp>But the agency says insurers would come back over the next two years.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wlu.edu/faculty/emeritus-faculty/tim-jost\" target=\"_blank\" rel=\"noopener noreferrer\">Timothy Jost\u003c/a>, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.\u003c/p>\n\u003cp>He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Yost warns.\u003c/p>\n\u003cp>\"CBO assumes that things will work out rationally, and there will be a smooth landing,\" he says. \"It could be much more chaotic than that.\"\u003c/p>\n\u003cp>Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide what health plans to offer on the Obamacare exchanges and what to charge.\u003c/p>\n\u003cp>The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.\u003c/p>\n\u003cp>House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CBO+Predicts+Rise+In+Deficit+If+Trump+Cuts+Payments+To+Insurance+Companies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360820/cbo-if-trump-cuts-payments-to-insurance-companies-it-will-cost-taxpayers","authors":["byline_stateofhealth_360820"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_38","stateofhealth_3155","stateofhealth_2808","stateofhealth_2519","stateofhealth_365"],"featImg":"stateofhealth_360821","label":"stateofhealth"},"stateofhealth_360160":{"type":"posts","id":"stateofhealth_360160","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360160","score":null,"sort":[1501633399000]},"guestAuthors":[],"slug":"health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california","title":"Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California","publishDate":1501633399,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>More than half of the Californians who have an individual health insurance policy from Anthem Blue Cross will have to shop for a new plan next year.\u003c/p>\n\u003cp>The company is pulling out of the individual market in all but three regions of the state, abandoning 153,000 of its customers. Of those, 30,000 will be left with just one plan on offer through Covered California.\u003c/p>\n\u003cp>But the former Anthem customers who do have a choice of plans will be able to find reasonable alternatives.\u003c/p>\n\u003cp>“In a number of areas where consumers in Anthem will now be forced to shop, they will find much more cost-competitive options,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>Statewide, premium rates will go up an average 12.5 percent in 2018 in the state’s Affordable Care Act marketplace. But in San Francisco, the average premium increase will be just 6.6 percent. In Fresno, Kings, and Madera counties, the average increase will be 4.7 percent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Anthem customers can keep their plan if they live in the far rural northern part of the state, parts of the Central Valley, and Santa Clara County. But in areas where Anthem is one of only two plans offered for sale – like Modoc, Lassen, and Siskiyou counties in the far north – customers will pay as much as 54 percent more for their Anthem plan. The alternative, Blue Shield, will charge up to 24 percent more next year.\u003c/p>\n\u003cp>In a statement, Anthem said its price increases and partial departure from the market are due largely to federal changes and uncertainty around the future of the Affordable Care Act.\u003c/p>\n\u003cp>“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” it said, because of “continual changes in federal operations, rules and guidance.”\u003c/p>\n\u003cp>The overall lack of predictability “simply does not provide a sustainable path forward to providing affordable plan choices for all California consumers,” the company said.\u003c/p>\n\u003cp>Uncertainty also affected the prices the remaining marketplace insurers plan to charge next year. Of the overall 12.5 percent average increase, 3 percent is due to uncertainty alone, Lee said.\u003c/p>\n\u003cp>Lee warned that some plans will see an additional 12 percent surcharge, on top of the 12.5 percent average increase, if President Trump makes good on his threat to stop so-called \"Cost-Sharing Reduction\" payments to insurers. These CSR payments help insurers provide discounts on co-pays and deductibles for low-income consumers, as they are required to do by the Affordable Care Act.\u003c/p>\n\u003cp>But even if the Trump administration withdraws the money, and insurers add the surcharge to premiums, Lee says most Californians won’t feel it, because the federal subsidy will also go up in kind, covering most of the premium increase.\u003c/p>\n\u003cp>“We do not want to implement this workaround,” Lee said. “It will cause unnecessary confusion, and ultimately cost the federal government billions of dollars more than they would have spent by [just] making the CSR payments directly to health plans.”\u003c/p>\n\u003cp>Covered California submitted \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_CL_2018_Rates-HHSLetter.pdf\">a letter\u003c/a> to federal health officials, saying there's an urgent need to get clarity on the future of the cost-sharing reduction payments. California will have to decide by the end of August whether to add the surcharge to monthly premiums or not. After that, it cannot make changes to \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\">2018 rates\u003c/a>.\u003c/p>\n\u003cp>\"I'm expecting to be dealing with a lot of angry and frustrated consumers as we head into 2018 open enrollment,\" said Jonathan Greer, a health insurance broker with Rockridge Health Benefits in Oakland. \"Unfortunately, many consumers will experience sticker shock this year, especially if the Trump Administration stops making the cost-sharing payments.\"\u003c/p>\n\u003cp>Insurers are also worried that the federal government will make changes to the Affordable Care Act in the middle of next year, after rates are locked in. In addition to the CSR payments, they are concerned the IRS will stop enforcing the individual mandate, the ACA's requirement that almost all Americans buy insurance. The mandate helps balance insurance \"risk pools\" by ensuring young, healthy people also buy policies, to help cover the costs of care for the sick.\u003c/p>\n\u003cp>Covered California had to fend off requests for premium increases well beyond the 12.5 percent average because of these fears.\u003c/p>\n\u003cp>“One of the things that many of the health plans said to us is ‘What if policies change mid-year? Our actuaries are saying, ‘Be really conservative and bump rates a boatload,’” Peter Lee said, recalling the tensions underlying the negotiations. “We said, ‘Take a deep breath. Before you bump up rates a boatload, instead, what can we do to help you plan over the long term?’”\u003c/p>\n\u003cp>The agency convinced insurers to keep the increases in check by drafting a plan that would allow them to make up for any 2018 losses in subsequent years. This backup plan, which still has to be approved by state regulators, wouldn’t cost the state money, Lee said. But it would allow insurers to shift costs internally so they could replenish the coffers in later years.\u003c/p>\n\u003cp>But Lee predicts the state probably won’t have to implement the backup plan. By keeping increases relatively low this year, more people will sign up for health plans, which will give insurers the stability they need to keep prices low in 2019 and beyond.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"Uncertainty around the Affordable Care Act is pushing rates higher in California and has Anthem scaling back coverage.","status":"publish","parent":0,"modified":1501635400,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":922},"headData":{"title":"Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California | KQED","description":"Uncertainty around the Affordable Care Act is pushing rates higher in California and has Anthem scaling back coverage.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"360160 https://ww2.kqed.org/stateofhealth/?p=360160","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/01/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california/","disqusTitle":"Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California","path":"/stateofhealth/360160/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than half of the Californians who have an individual health insurance policy from Anthem Blue Cross will have to shop for a new plan next year.\u003c/p>\n\u003cp>The company is pulling out of the individual market in all but three regions of the state, abandoning 153,000 of its customers. Of those, 30,000 will be left with just one plan on offer through Covered California.\u003c/p>\n\u003cp>But the former Anthem customers who do have a choice of plans will be able to find reasonable alternatives.\u003c/p>\n\u003cp>“In a number of areas where consumers in Anthem will now be forced to shop, they will find much more cost-competitive options,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>Statewide, premium rates will go up an average 12.5 percent in 2018 in the state’s Affordable Care Act marketplace. But in San Francisco, the average premium increase will be just 6.6 percent. In Fresno, Kings, and Madera counties, the average increase will be 4.7 percent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Anthem customers can keep their plan if they live in the far rural northern part of the state, parts of the Central Valley, and Santa Clara County. But in areas where Anthem is one of only two plans offered for sale – like Modoc, Lassen, and Siskiyou counties in the far north – customers will pay as much as 54 percent more for their Anthem plan. The alternative, Blue Shield, will charge up to 24 percent more next year.\u003c/p>\n\u003cp>In a statement, Anthem said its price increases and partial departure from the market are due largely to federal changes and uncertainty around the future of the Affordable Care Act.\u003c/p>\n\u003cp>“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” it said, because of “continual changes in federal operations, rules and guidance.”\u003c/p>\n\u003cp>The overall lack of predictability “simply does not provide a sustainable path forward to providing affordable plan choices for all California consumers,” the company said.\u003c/p>\n\u003cp>Uncertainty also affected the prices the remaining marketplace insurers plan to charge next year. Of the overall 12.5 percent average increase, 3 percent is due to uncertainty alone, Lee said.\u003c/p>\n\u003cp>Lee warned that some plans will see an additional 12 percent surcharge, on top of the 12.5 percent average increase, if President Trump makes good on his threat to stop so-called \"Cost-Sharing Reduction\" payments to insurers. These CSR payments help insurers provide discounts on co-pays and deductibles for low-income consumers, as they are required to do by the Affordable Care Act.\u003c/p>\n\u003cp>But even if the Trump administration withdraws the money, and insurers add the surcharge to premiums, Lee says most Californians won’t feel it, because the federal subsidy will also go up in kind, covering most of the premium increase.\u003c/p>\n\u003cp>“We do not want to implement this workaround,” Lee said. “It will cause unnecessary confusion, and ultimately cost the federal government billions of dollars more than they would have spent by [just] making the CSR payments directly to health plans.”\u003c/p>\n\u003cp>Covered California submitted \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_CL_2018_Rates-HHSLetter.pdf\">a letter\u003c/a> to federal health officials, saying there's an urgent need to get clarity on the future of the cost-sharing reduction payments. California will have to decide by the end of August whether to add the surcharge to monthly premiums or not. After that, it cannot make changes to \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\">2018 rates\u003c/a>.\u003c/p>\n\u003cp>\"I'm expecting to be dealing with a lot of angry and frustrated consumers as we head into 2018 open enrollment,\" said Jonathan Greer, a health insurance broker with Rockridge Health Benefits in Oakland. \"Unfortunately, many consumers will experience sticker shock this year, especially if the Trump Administration stops making the cost-sharing payments.\"\u003c/p>\n\u003cp>Insurers are also worried that the federal government will make changes to the Affordable Care Act in the middle of next year, after rates are locked in. In addition to the CSR payments, they are concerned the IRS will stop enforcing the individual mandate, the ACA's requirement that almost all Americans buy insurance. The mandate helps balance insurance \"risk pools\" by ensuring young, healthy people also buy policies, to help cover the costs of care for the sick.\u003c/p>\n\u003cp>Covered California had to fend off requests for premium increases well beyond the 12.5 percent average because of these fears.\u003c/p>\n\u003cp>“One of the things that many of the health plans said to us is ‘What if policies change mid-year? Our actuaries are saying, ‘Be really conservative and bump rates a boatload,’” Peter Lee said, recalling the tensions underlying the negotiations. “We said, ‘Take a deep breath. Before you bump up rates a boatload, instead, what can we do to help you plan over the long term?’”\u003c/p>\n\u003cp>The agency convinced insurers to keep the increases in check by drafting a plan that would allow them to make up for any 2018 losses in subsequent years. This backup plan, which still has to be approved by state regulators, wouldn’t cost the state money, Lee said. But it would allow insurers to shift costs internally so they could replenish the coffers in later years.\u003c/p>\n\u003cp>But Lee predicts the state probably won’t have to implement the backup plan. By keeping increases relatively low this year, more people will sign up for health plans, which will give insurers the stability they need to keep prices low in 2019 and beyond.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360160/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california","authors":["3205"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_38","stateofhealth_368","stateofhealth_2808","stateofhealth_28","stateofhealth_2519","stateofhealth_365","stateofhealth_3143"],"featImg":"stateofhealth_360144","label":"stateofhealth"},"stateofhealth_356393":{"type":"posts","id":"stateofhealth_356393","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"356393","score":null,"sort":[1500486172000]},"guestAuthors":[],"slug":"trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment","title":"Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown","publishDate":1500486172,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what's next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick \"repeal-and-replace\" strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">\"Nobody knew health care could be so complicated.\"\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as \"mean\"\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be \"beautiful,\"\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have \"heart\" and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill's fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already \"yes\" votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn't the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka \"Obamacare,\" is now part of its warp and woof. Ripping it out would disrupt the health care system's delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That's why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer's hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president's Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell's magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a \"public option\" format as a faster track to single-payer \"Medicare for all.\" But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state's families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue's salience will continue to grow. The average American wants good health care and has been increasingly promised \"the best.\" But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of \"single-payer\" is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of \"Medicare for all,\" government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still \"socialized medicine\" and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children's Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden's salty choice of words is more politely repeated by the initials \"BFD.\"\u003c/a> But his assessment of the moment's importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden's BFD?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n","blocks":[],"excerpt":"President Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if Trump had plunged into the trenches, his presence there might not have made the difference.","status":"publish","parent":0,"modified":1533585974,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1474},"headData":{"title":"Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown | KQED","description":"President Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if Trump had plunged into the trenches, his presence there might not have made the difference.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"356393 https://ww2.kqed.org/stateofhealth/?p=356393","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/19/trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment/","disqusTitle":"Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown","nprImageCredit":"Carlos Barria","nprByline":"\u003cstrong>\u003ca href=”http://www.npr.org/people/1930203/ron-elving”>Ron Elving\u003c/a>\u003cbr />\u003ca href=”https://npr.org”>NPR\u003c/a>\u003c/strong>","nprImageAgency":"Reuters","nprStoryId":"537948116","nprApiLink":"http://api.npr.org/query?id=537948116&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/2017/07/19/537948116/trumps-big-repeal-deal-8-thoughts-on-the-senate-s-meltdown-moment?ft=nprml&f=537948116","nprRetrievedStory":"1","nprPubDate":"Wed, 19 Jul 2017 09:24:00 -0400","nprStoryDate":"Wed, 19 Jul 2017 05:00:00 -0400","nprLastModifiedDate":"Wed, 19 Jul 2017 09:24:53 -0400","path":"/stateofhealth/356393/trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what's next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick \"repeal-and-replace\" strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">\"Nobody knew health care could be so complicated.\"\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as \"mean\"\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be \"beautiful,\"\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have \"heart\" and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill's fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already \"yes\" votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn't the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka \"Obamacare,\" is now part of its warp and woof. Ripping it out would disrupt the health care system's delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That's why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer's hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president's Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell's magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a \"public option\" format as a faster track to single-payer \"Medicare for all.\" But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state's families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue's salience will continue to grow. The average American wants good health care and has been increasingly promised \"the best.\" But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of \"single-payer\" is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of \"Medicare for all,\" government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still \"socialized medicine\" and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children's Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden's salty choice of words is more politely repeated by the initials \"BFD.\"\u003c/a> But his assessment of the moment's importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden's BFD?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/356393/trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment","authors":["byline_stateofhealth_356393"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_38","stateofhealth_2995","stateofhealth_2808","stateofhealth_3131","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_356396","label":"stateofhealth"},"stateofhealth_348513":{"type":"posts","id":"stateofhealth_348513","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348513","score":null,"sort":[1498741245000]},"guestAuthors":[],"slug":"small-town-clinics-and-businesses-fear-economics-of-obamacare-repeal","title":"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal","publishDate":1498741245,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.\u003c/p>\n\u003cp>She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I guess it's true, build it and they will come,” Morris says.\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-29a-tcr.mp3\" Image=\"https://u.s.kqed.net/2017/06/29/Stethoscope.jpg\" Title=\"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal\" program=\"The California Report\"]\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uO0r77wi0xkfHFV79VI4jRtVOZYGMW8u\"]\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n","blocks":[],"excerpt":"Dismantling Obamacare could force layoffs and shrink local business revenues in small, rural towns.","status":"publish","parent":0,"modified":1498772451,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":31,"wordCount":944},"headData":{"title":"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal | KQED","description":"Dismantling Obamacare could force layoffs and shrink local business revenues in small, rural towns.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"348513 https://ww2.kqed.org/stateofhealth/?p=348513","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/29/small-town-clinics-and-businesses-fear-economics-of-obamacare-repeal/","disqusTitle":"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal","path":"/stateofhealth/348513/small-town-clinics-and-businesses-fear-economics-of-obamacare-repeal","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.\u003c/p>\n\u003cp>She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I guess it's true, build it and they will come,” Morris says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-29a-tcr.mp3","image":"https://u.s.kqed.net/2017/06/29/Stethoscope.jpg","title":"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348513/small-town-clinics-and-businesses-fear-economics-of-obamacare-repeal","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_38","stateofhealth_3123","stateofhealth_2808","stateofhealth_2519","stateofhealth_365","stateofhealth_251"],"featImg":"stateofhealth_348514","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us","airtime":"SUN 2pm-3pm, MON 12am-1am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png","officialWebsiteLink":"https://www.wnycstudios.org/shows/otm","meta":{"site":"news","source":"wnyc"},"link":"/radio/program/on-the-media","subscribe":{"apple":"https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2","tuneIn":"https://tunein.com/radio/On-the-Media-p69/","rss":"http://feeds.wnyc.org/onthemedia"}},"our-body-politic":{"id":"our-body-politic","title":"Our Body Politic","info":"Presented by KQED, KCRW and KPCC, and created and hosted by award-winning journalist Farai Chideya, Our Body Politic is unapologetically centered on reporting on not just how women of color experience the major political events of today, but how they’re impacting those very issues.","airtime":"SAT 6pm-7pm, SUN 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Our-Body-Politic-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://our-body-politic.simplecast.com/","meta":{"site":"news","source":"kcrw"},"link":"/radio/program/our-body-politic","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/our-body-politic/id1533069868","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9feGFQaHMxcw","spotify":"https://open.spotify.com/show/4ApAiLT1kV153TttWAmqmc","rss":"https://feeds.simplecast.com/_xaPhs1s","tuneIn":"https://tunein.com/podcasts/News--Politics-Podcasts/Our-Body-Politic-p1369211/"}},"pbs-newshour":{"id":"pbs-newshour","title":"PBS NewsHour","info":"Analysis, background reports and updates from the PBS NewsHour putting today's news in context.","airtime":"MON-FRI 3pm-4pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.pbs.org/newshour/","meta":{"site":"news","source":"pbs"},"link":"/radio/program/pbs-newshour","subscribe":{"apple":"https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2","tuneIn":"https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/","rss":"https://www.pbs.org/newshour/feeds/rss/podcasts/show"}},"perspectives":{"id":"perspectives","title":"Perspectives","tagline":"KQED's series of of daily listener commentaries since 1991","info":"KQED's series of of daily listener commentaries since 1991.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Perspectives-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/perspectives/","meta":{"site":"radio","source":"kqed","order":"15"},"link":"/perspectives","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/id73801135","npr":"https://www.npr.org/podcasts/432309616/perspectives","rss":"https://ww2.kqed.org/perspectives/category/perspectives/feed/","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"}},"planet-money":{"id":"planet-money","title":"Planet Money","info":"The economy explained. 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The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.","airtime":"SAT 4pm-5pm","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png","officialWebsiteLink":"https://www.revealnews.org/episodes/","meta":{"site":"news","source":"npr"},"link":"/radio/program/reveal","subscribe":{"apple":"https://itunes.apple.com/us/podcast/reveal/id886009669","tuneIn":"https://tunein.com/radio/Reveal-p679597/","rss":"http://feeds.revealradio.org/revealpodcast"}},"says-you":{"id":"says-you","title":"Says You!","info":"Public radio's game show of bluff and bluster, words and whimsy. 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