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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 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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":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks","datePublished":"2018-03-26T16:45:17.000Z","dateModified":"2018-08-15T02:05:03.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"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_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":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Human Psychology Makes Health Insurance a Hard Sell – Especially for Latino Consumers","datePublished":"2017-10-31T01:51:38.000Z","dateModified":"2017-10-31T23:49:20.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"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_361815":{"type":"posts","id":"stateofhealth_361815","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361815","score":null,"sort":[1509323287000]},"guestAuthors":[],"slug":"acute-confusion-as-enrollment-for-affordable-care-act-nears","title":"Acute Confusion As Enrollment for Affordable Care Act Nears","publishDate":1509323287,"format":"standard","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>If the comments on Covered California’s \u003ca href=\"https://www.facebook.com/CoveredCA/\">Facebook page\u003c/a> are any indication, you’re all suffering from acute health insurance confusion:\u003c/p>\n\u003cp>\u003cem>“I wanted to sign up again this year. … I’m hesitant now because of what Trump has done. Should I still consider?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“Does the removal of subsidies mean we might lose our premium tax credits during the year?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“So you’re telling me that [Trump’s] executive order didn’t do anything? I am so confused.”\u003c/em>\u003c/p>\n\u003cp>I don’t blame you. Choosing a health plan will be doubly hard this year given \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump’s recent move\u003c/a> to cut off federal payments for a key consumer subsidy, his administration’s decision to shorten exchange open-enrollment periods in most states to 45 days, Congress’ failed attempts to repeal Obamacare and the departure of some insurers from certain markets.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Let me ease your mind straightaway on three critical points:\u003c/p>\n\u003cp>1. In California, open enrollment for individuals and families who buy their 2018 plans through Covered California and in the open market lasts three months, from Nov. 1 to Jan. 31.\u003c/p>\n\u003cp>2. You won’t lose the tax credits that help you — and the vast majority of Covered California enrollees — afford your premiums, assuming you still qualify.\u003c/p>\n\u003cp>3. The same goes for the cost-sharing subsidies that reduce out-of-pocket costs for some Covered California members, despite Trump’s decision to stop funding them.\u003c/p>\n\u003cp>But shopping will be challenging. Anthem Blue Cross is pulling out of a large swath of California’s individual market, on and off the exchange, forcing hundreds of thousands of consumers to find new plans. And in addition to regular, annual rate hikes — averaging 12.3 percent statewide — silver-level plans will bear an additional \u003ca href=\"https://californiahealthline.org/news/california-slaps-surcharge-on-aca-plans-as-trump-remains-coy-on-subsidies/\">12.4 percent average surcharge\u003c/a> to make up for the loss of federal funding for the cost-sharing subsidies.\u003c/p>\n\u003cp>Remember, those are averages. Your actual premium will depend on several factors, including where you live, your income, what level of coverage you choose and which insurer you pick.\u003c/p>\n\u003cp>In an unexpected twist, some people may actually benefit from the surcharge because it could bring plans with more robust coverage within financial reach.\u003c/p>\n\u003cp>Before we get into all that, my most important piece of advice remains the same this year as before:\u003c/p>\n\u003cp>Don’t do this alone. Help from certified insurance agents and enrollment “navigators” is free. You can find local options by clicking on the “Find Help” tab on Covered California’s website, \u003ca href=\"http://www.coveredca.com/\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Silver-Plan Surcharge\u003c/strong>\u003c/p>\n\u003cp>Nearly half of Covered California enrollees qualify for cost-sharing subsidies, which lower their copays, deductibles and coinsurance. The subsidies are paid directly to insurers, and are separate from the tax credits that reduce monthly premiums.\u003c/p>\n\u003cp>These discounts are available only to silver-plan enrollees whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four. That’s why Covered California added the 12.4 percent average surcharge only to silver plans amid Trump’s threats — \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">and ultimate decision\u003c/a> — to stop funding the subsidies.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com/news/\">Covered California estimates\u003c/a> that 78 percent of subsidized consumers will pay the same as — or less than — this year, despite the surcharge, because their tax credits will rise with their premiums. About half of the remaining 22 percent will see increases of less than $25 per month.\u003c/p>\n\u003cp>“This is potentially good news for both insurers and consumers,” says \u003ca href=\"http://axenehp.com/consultants/greg-fann-fsa-fca-maaa/\">Greg Fann\u003c/a>, a senior consulting actuary based in Murrieta. “And bad news for taxpayers,” who are footing the bill for the increased tax credits.\u003c/p>\n\u003cp>Fann offers advice to consumers based on their income.\u003c/p>\n\u003cp>Covered California enrollees with incomes up to roughly 200 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\">federal poverty level\u003c/a> — or about $49,200 for a family of four — should probably remain in silver plans, he advises, because they qualify for significant cost-sharing reduction subsidies.\u003c/p>\n\u003cp>Policyholders who make between 200 and 400 percent of the federal poverty level (400 percent is about $98,400 for a family of four) should consider ditching silver plans and applying their higher tax credits to gold or platinum plans, he says. \u003ca href=\"https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/\">Tax credits\u003c/a> are pegged to the cost of silver plans, which means that all subsidized enrollees will benefit from higher tax credits as silver premiums rise, regardless of which plan they ultimately purchase.\u003c/p>\n\u003cp>\u003ca href=\"https://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">Gold and platinum plans\u003c/a> are more expensive than silver plans, but they offer higher levels of coverage and lower out-of-pocket costs.\u003c/p>\n\u003cp>In some cases, “the gold may be cheaper than the silver,” Fann says.\u003c/p>\n\u003cp>You could also apply your increased tax credits to bronze plans, which have lower premiums and higher out-of-pocket costs. According to Covered California, three-quarters of enrollees can sign up for bronze coverage for less than $10 a month.\u003c/p>\n\u003cp>“I suspect a lot of people are going to downgrade their plans to high-deductible plans,” says \u003ca href=\"http://ruffinsolutions.com/about/helena-ruffin-company-president/\">Helena Ruffin\u003c/a>, an insurance agent in Playa Vista.\u003c/p>\n\u003cp>Finally, there are about 65,000 Covered California enrollees with silver plans who don’t receive premium tax credits, says exchange spokeswoman Amy Palmer.\u003c/p>\n\u003cp>People in this group must pay the entire cost of their premiums.\u003c/p>\n\u003cp>“These are the ones in the middle class that are … getting hammered,” Ruffin says.\u003c/p>\n\u003cp>If you’re in this category, avoid the surcharge by buying a bronze, gold or platinum plan. Or, opt for a newly created silver plan sold off the exchange that won’t be subject to the surcharge — if you’re confident your income will remain above the threshold to qualify for premium tax credits.\u003c/p>\n\u003cp>“There may be better options off the exchange,” Palmer says. But if your income fluctuates, “it may be better to stay on the exchange so that you can receive tax credits if you become eligible,” she adds.\u003c/p>\n\u003cp>\u003cstrong>Health Plan Departures\u003c/strong>\u003c/p>\n\u003cp>Anthem will pull out of 16 of California’s 19 pricing regions, affecting about \u003ca href=\"https://californiahealthline.org/news/anthems-retreat-leaves-californians-with-fewer-choices-more-worries/\">300,000 policyholders\u003c/a> who purchase from the individual market, both on and off the exchange.\u003c/p>\n\u003cp>Its departure will leave about 60,000 Covered California consumers \u003ca href=\"https://californiahealthline.org/news/anthems-exit-leaves-thousands-with-no-choice-of-health-plans/\">with one option\u003c/a> — Blue Shield of California. If you do not select a new plan by mid-November, Covered California will \u003ca href=\"https://www.coveredca.com/members/renewal/\">automatically enroll you\u003c/a> in one. If you’re not satisfied with its decision, you can change it before the end of open enrollment, assuming you have a choice.\u003c/p>\n\u003cp>For those of you losing your insurer, you’ll want to know whether your existing providers are in any other Covered California plan networks.\u003c/p>\n\u003cp>Unfortunately, “the doctors networks are smaller and smaller all the time,” says \u003ca href=\"http://crazyhealthinsurance.com/\">Tom Freker\u003c/a>, an insurance broker in Fountain Valley.\u003c/p>\n\u003cp>Covered California this year has debuted a revamped online directory that will allow you to search five doctors, hospitals or pediatric dentists at once.\u003c/p>\n\u003cp>It’s part of the agency’s “\u003ca href=\"https://apply.coveredca.com/apspahbx/ahbxanonym.portal?_nfpb=true&_st=&_nfls=false&_pageLabel=previewPlanPage\">Shop and Compare\u003c/a>” tool that allows you to enter your personal details to retrieve your plan choices and costs.\u003c/p>\n\u003cp>Because the directory is new, I urge you to cross-check with your plan and/or your provider.\u003c/p>\n\u003cp>Also, if you’re in the middle of treatment for a complex medical condition and lose your insurer, you may have options. \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">A new state law\u003c/a> will allow some seriously ill patients to continue seeing their current providers for a limited time.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Your new insurer may also be able to work with your existing provider to finish your treatment. Covered California advises you to call your new health plan to explain your situation.\u003c/p>\n\n","blocks":[],"excerpt":"Choosing a health plan will be doubly hard this year, after Trump made big changes to the online insurance exchanges. But Covered California responded by adding extra consumer protections for shoppers. ","status":"publish","parent":0,"modified":1509323603,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":43,"wordCount":1319},"headData":{"title":"Acute Confusion As Enrollment for Affordable Care Act Nears | KQED","description":"Choosing a health plan will be doubly hard this year, after Trump made big changes to the online insurance exchanges. But Covered California responded by adding extra consumer protections for shoppers. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Acute Confusion As Enrollment for Affordable Care Act Nears","datePublished":"2017-10-30T00:28:07.000Z","dateModified":"2017-10-30T00:33:23.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"361815 https://ww2.kqed.org/stateofhealth/?p=361815","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/10/29/acute-confusion-as-enrollment-for-affordable-care-act-nears/","disqusTitle":"Acute Confusion As Enrollment for Affordable Care Act Nears","nprByline":"\u003ca href=\"https://californiahealthline.org/news/author/emily-bazar/\">\u003cstrong>Emily Bazar\u003c/strong>\u003c/a>\u003cbr>Kaiser Health News","path":"/stateofhealth/361815/acute-confusion-as-enrollment-for-affordable-care-act-nears","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>If the comments on Covered California’s \u003ca href=\"https://www.facebook.com/CoveredCA/\">Facebook page\u003c/a> are any indication, you’re all suffering from acute health insurance confusion:\u003c/p>\n\u003cp>\u003cem>“I wanted to sign up again this year. … I’m hesitant now because of what Trump has done. Should I still consider?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“Does the removal of subsidies mean we might lose our premium tax credits during the year?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“So you’re telling me that [Trump’s] executive order didn’t do anything? I am so confused.”\u003c/em>\u003c/p>\n\u003cp>I don’t blame you. Choosing a health plan will be doubly hard this year given \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump’s recent move\u003c/a> to cut off federal payments for a key consumer subsidy, his administration’s decision to shorten exchange open-enrollment periods in most states to 45 days, Congress’ failed attempts to repeal Obamacare and the departure of some insurers from certain markets.\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>Let me ease your mind straightaway on three critical points:\u003c/p>\n\u003cp>1. In California, open enrollment for individuals and families who buy their 2018 plans through Covered California and in the open market lasts three months, from Nov. 1 to Jan. 31.\u003c/p>\n\u003cp>2. You won’t lose the tax credits that help you — and the vast majority of Covered California enrollees — afford your premiums, assuming you still qualify.\u003c/p>\n\u003cp>3. The same goes for the cost-sharing subsidies that reduce out-of-pocket costs for some Covered California members, despite Trump’s decision to stop funding them.\u003c/p>\n\u003cp>But shopping will be challenging. Anthem Blue Cross is pulling out of a large swath of California’s individual market, on and off the exchange, forcing hundreds of thousands of consumers to find new plans. And in addition to regular, annual rate hikes — averaging 12.3 percent statewide — silver-level plans will bear an additional \u003ca href=\"https://californiahealthline.org/news/california-slaps-surcharge-on-aca-plans-as-trump-remains-coy-on-subsidies/\">12.4 percent average surcharge\u003c/a> to make up for the loss of federal funding for the cost-sharing subsidies.\u003c/p>\n\u003cp>Remember, those are averages. Your actual premium will depend on several factors, including where you live, your income, what level of coverage you choose and which insurer you pick.\u003c/p>\n\u003cp>In an unexpected twist, some people may actually benefit from the surcharge because it could bring plans with more robust coverage within financial reach.\u003c/p>\n\u003cp>Before we get into all that, my most important piece of advice remains the same this year as before:\u003c/p>\n\u003cp>Don’t do this alone. Help from certified insurance agents and enrollment “navigators” is free. You can find local options by clicking on the “Find Help” tab on Covered California’s website, \u003ca href=\"http://www.coveredca.com/\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Silver-Plan Surcharge\u003c/strong>\u003c/p>\n\u003cp>Nearly half of Covered California enrollees qualify for cost-sharing subsidies, which lower their copays, deductibles and coinsurance. The subsidies are paid directly to insurers, and are separate from the tax credits that reduce monthly premiums.\u003c/p>\n\u003cp>These discounts are available only to silver-plan enrollees whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four. That’s why Covered California added the 12.4 percent average surcharge only to silver plans amid Trump’s threats — \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">and ultimate decision\u003c/a> — to stop funding the subsidies.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com/news/\">Covered California estimates\u003c/a> that 78 percent of subsidized consumers will pay the same as — or less than — this year, despite the surcharge, because their tax credits will rise with their premiums. About half of the remaining 22 percent will see increases of less than $25 per month.\u003c/p>\n\u003cp>“This is potentially good news for both insurers and consumers,” says \u003ca href=\"http://axenehp.com/consultants/greg-fann-fsa-fca-maaa/\">Greg Fann\u003c/a>, a senior consulting actuary based in Murrieta. “And bad news for taxpayers,” who are footing the bill for the increased tax credits.\u003c/p>\n\u003cp>Fann offers advice to consumers based on their income.\u003c/p>\n\u003cp>Covered California enrollees with incomes up to roughly 200 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\">federal poverty level\u003c/a> — or about $49,200 for a family of four — should probably remain in silver plans, he advises, because they qualify for significant cost-sharing reduction subsidies.\u003c/p>\n\u003cp>Policyholders who make between 200 and 400 percent of the federal poverty level (400 percent is about $98,400 for a family of four) should consider ditching silver plans and applying their higher tax credits to gold or platinum plans, he says. \u003ca href=\"https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/\">Tax credits\u003c/a> are pegged to the cost of silver plans, which means that all subsidized enrollees will benefit from higher tax credits as silver premiums rise, regardless of which plan they ultimately purchase.\u003c/p>\n\u003cp>\u003ca href=\"https://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">Gold and platinum plans\u003c/a> are more expensive than silver plans, but they offer higher levels of coverage and lower out-of-pocket costs.\u003c/p>\n\u003cp>In some cases, “the gold may be cheaper than the silver,” Fann says.\u003c/p>\n\u003cp>You could also apply your increased tax credits to bronze plans, which have lower premiums and higher out-of-pocket costs. According to Covered California, three-quarters of enrollees can sign up for bronze coverage for less than $10 a month.\u003c/p>\n\u003cp>“I suspect a lot of people are going to downgrade their plans to high-deductible plans,” says \u003ca href=\"http://ruffinsolutions.com/about/helena-ruffin-company-president/\">Helena Ruffin\u003c/a>, an insurance agent in Playa Vista.\u003c/p>\n\u003cp>Finally, there are about 65,000 Covered California enrollees with silver plans who don’t receive premium tax credits, says exchange spokeswoman Amy Palmer.\u003c/p>\n\u003cp>People in this group must pay the entire cost of their premiums.\u003c/p>\n\u003cp>“These are the ones in the middle class that are … getting hammered,” Ruffin says.\u003c/p>\n\u003cp>If you’re in this category, avoid the surcharge by buying a bronze, gold or platinum plan. Or, opt for a newly created silver plan sold off the exchange that won’t be subject to the surcharge — if you’re confident your income will remain above the threshold to qualify for premium tax credits.\u003c/p>\n\u003cp>“There may be better options off the exchange,” Palmer says. But if your income fluctuates, “it may be better to stay on the exchange so that you can receive tax credits if you become eligible,” she adds.\u003c/p>\n\u003cp>\u003cstrong>Health Plan Departures\u003c/strong>\u003c/p>\n\u003cp>Anthem will pull out of 16 of California’s 19 pricing regions, affecting about \u003ca href=\"https://californiahealthline.org/news/anthems-retreat-leaves-californians-with-fewer-choices-more-worries/\">300,000 policyholders\u003c/a> who purchase from the individual market, both on and off the exchange.\u003c/p>\n\u003cp>Its departure will leave about 60,000 Covered California consumers \u003ca href=\"https://californiahealthline.org/news/anthems-exit-leaves-thousands-with-no-choice-of-health-plans/\">with one option\u003c/a> — Blue Shield of California. If you do not select a new plan by mid-November, Covered California will \u003ca href=\"https://www.coveredca.com/members/renewal/\">automatically enroll you\u003c/a> in one. If you’re not satisfied with its decision, you can change it before the end of open enrollment, assuming you have a choice.\u003c/p>\n\u003cp>For those of you losing your insurer, you’ll want to know whether your existing providers are in any other Covered California plan networks.\u003c/p>\n\u003cp>Unfortunately, “the doctors networks are smaller and smaller all the time,” says \u003ca href=\"http://crazyhealthinsurance.com/\">Tom Freker\u003c/a>, an insurance broker in Fountain Valley.\u003c/p>\n\u003cp>Covered California this year has debuted a revamped online directory that will allow you to search five doctors, hospitals or pediatric dentists at once.\u003c/p>\n\u003cp>It’s part of the agency’s “\u003ca href=\"https://apply.coveredca.com/apspahbx/ahbxanonym.portal?_nfpb=true&_st=&_nfls=false&_pageLabel=previewPlanPage\">Shop and Compare\u003c/a>” tool that allows you to enter your personal details to retrieve your plan choices and costs.\u003c/p>\n\u003cp>Because the directory is new, I urge you to cross-check with your plan and/or your provider.\u003c/p>\n\u003cp>Also, if you’re in the middle of treatment for a complex medical condition and lose your insurer, you may have options. \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">A new state law\u003c/a> will allow some seriously ill patients to continue seeing their current providers for a limited time.\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>Your new insurer may also be able to work with your existing provider to finish your treatment. Covered California advises you to call your new health plan to explain your situation.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361815/acute-confusion-as-enrollment-for-affordable-care-act-nears","authors":["byline_stateofhealth_361815"],"categories":["stateofhealth_1"],"tags":["stateofhealth_3117","stateofhealth_3180","stateofhealth_2808","stateofhealth_2519","stateofhealth_365"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_361821","label":"stateofhealth_3036"},"stateofhealth_361137":{"type":"posts","id":"stateofhealth_361137","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361137","score":null,"sort":[1506114368000]},"guestAuthors":[],"slug":"a-tale-of-two-states-california-loses-and-texas-wins-under-gop-health-plan","title":"A Tale of Two States: California Loses and Texas Wins Under GOP Health Plan","publishDate":1506114368,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>California stands to lose billions in health care funding under the GOP’s latest plan to repeal and replace the Affordable Care Act, resulting in millions of Californians losing coverage.\u003c/p>\n\u003cp>The Graham-Cassidy legislation under discussion in the Senate would redistribute the funds now used to pay for the Affordable Care Act, effectively taking money from states that embraced all aspects of the law, like California, and redistributing it to other states, that didn't, like Texas.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains - those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, senior fellow at the \u003ca href=\"https://www.cbpp.org/\">Center on Budget and Policy Priorities\u003c/a>.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">The bill's Republican authors say redistributing the health funds is about fairness, and will give states more \"flexibility\" to redesign their own health systems.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">But health officials in California predict dire consequences if the measure were to pass.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,” top officials from the state Department of Health Care Services wrote in \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/09/graham_cassidy_impact_memo_dhcs_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis\u003c/a> released Friday. “If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs [and] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide.”\u003c/p>\n\u003cp> \u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">By 2026, California would lose $85.7 billion in federal funds, and by 2027 it would lose $138.8 billion, according to the analysis. That could cause 6.7 million Californians to lose insurance coverage, according to \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\">estimates\u003c/a> from the The UC Berkeley Labor Center.\u003c/p>\n\u003cp>A lot of those people are entrepreneurs or their employees. Under the Affordable Care Act in California, half a million self-employed entrepreneurs -- and a million employees who work for small businesses -- got health coverage because of the ACA, either through the expansion of Medi-Cal, or through a subsidized personal insurance plan on the state exchange, Covered California.\u003c/p>\n\u003cp>\"It would be very difficult for entrepreneurs and self employed folks to access some level of coverage,\" said Mark Herbert, California director for the \u003ca href=\"http://www.smallbusinessmajority.org/states/california\" target=\"_blank\" rel=\"noopener noreferrer\">Small Business Majority\u003c/a>. \"So it would be massively destabilizing to the ability of small employers to attract talent.\"\u003c/p>\n\u003cp>Beyond that, there would be damaging ripple effects, Herbert added: \"There's no way that you can remove those sorts of dollars out of our local communities and not see some sort of economic impact on small businesses.\"\u003c/p>\n\u003cp>Under the Graham-Cassidy bill’s redistribution formula, several states that shunned the Affordable Care Act would get more money, according to a \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> by health consulting firm Avalare.\u003c/p>\n\u003cp>Texas will get a windfall of $35 billion in health funding over the next ten years, more than any other state. State officials would get to decide how they want to spend that money. But advocates and analysts say more money for Texas doesn't necessarily guarantee an improved health care system.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“Regardless of the size of the block grant, there's just no assurance that it would translate into good coverage, or coverage that's as affordable as what we have today,” said Stacey Pogue with the \u003ca href=\"http://bettertexasblog.org/2017/09/harmful-medicaid-cutaca-repeal-bill-resurfaces-senate/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Public Policy Priorities \u003c/a>in Austin.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">Texas already has the highest number of uninsured folks, and Pogue says the state just doesn't have the infrastructure in place to expand coverage to more people. It didn't expand Medicaid in 2014, which was optional under the ACA, and the state didn't set up its own exchange, like California did with \"Covered California.\" Texans who wanted subsidized insurance plans had to use the federal exchange, healthcare.gov, which meant Texas had less flexibility when it came to regulating insurers.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“There's no planning and no thought put into, 'How would we create affordable coverage for low-income Texans?\" Pogue said, \"Unlike the 31 states that have expanded Medicaid, have done some central planning. And Texas would be starting from scratch.”\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">It would also take a lot of political will to make sure the state is actually expanding health care, Pogue added, and that motivation has been lacking among state lawmakers for years. In order to get the block grant, states would need to create a workable health infrastructure by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare statewide insurance market.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We are very concerned,” said Stacy Wilson, president of the Children's Hospital Association of Texas.\u003c/p>\n\u003cp>Wilson said this pot of money from Cassidy-Graham wouldn't solve chronic problems with Medicaid, 70 percent of which covers children. Wilson explained that's because the federal government would pay a fixed amount per person, under a per capita cap. That formula locks in how much the state gets per Medicaid enrollee, no matter how much treatment those enrollees need.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We have very low per-capita costs already, and we get locked into that forever,” Wilson said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">A conservative policy group in Texas, \u003ca href=\"https://www.texaspolicy.com/press_release/detail/tppf-statement-on-graham-cassidy-health-care-bill\" target=\"_blank\" rel=\"noopener noreferrer\">The Texas Public Policy Foundation\u003c/a>, is also not happy about the bill, but their concern is that it doesn't go far enough to repeal Obamacare.\u003c/p>\n\n","blocks":[],"excerpt":"The Graham-Cassidy bill to repeal and replace the Affordable Care Act redistributes money from states that worked hard to implement Obamacare and gives it to states that refused Obamacare funding. ","status":"publish","parent":0,"modified":1506126021,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":915},"headData":{"title":"A Tale of Two States: California Loses and Texas Wins Under GOP Health Plan | KQED","description":"The Graham-Cassidy bill to repeal and replace the Affordable Care Act redistributes money from states that worked hard to implement Obamacare and gives it to states that refused Obamacare funding. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A Tale of Two States: California Loses and Texas Wins Under GOP Health Plan","datePublished":"2017-09-22T21:06:08.000Z","dateModified":"2017-09-23T00:20:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"361137 https://ww2.kqed.org/stateofhealth/?p=361137","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/09/22/a-tale-of-two-states-california-loses-and-texas-wins-under-gop-health-plan/","disqusTitle":"A Tale of Two States: California Loses and Texas Wins Under GOP Health Plan","nprByline":"\u003cstrong>April Dembosky\u003c/strong>, KQED and \u003cstrong>Ashley Lopez\u003c/strong>, KUT","path":"/stateofhealth/361137/a-tale-of-two-states-california-loses-and-texas-wins-under-gop-health-plan","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California stands to lose billions in health care funding under the GOP’s latest plan to repeal and replace the Affordable Care Act, resulting in millions of Californians losing coverage.\u003c/p>\n\u003cp>The Graham-Cassidy legislation under discussion in the Senate would redistribute the funds now used to pay for the Affordable Care Act, effectively taking money from states that embraced all aspects of the law, like California, and redistributing it to other states, that didn't, like Texas.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains - those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, senior fellow at the \u003ca href=\"https://www.cbpp.org/\">Center on Budget and Policy Priorities\u003c/a>.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">The bill's Republican authors say redistributing the health funds is about fairness, and will give states more \"flexibility\" to redesign their own health systems.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">But health officials in California predict dire consequences if the measure were to pass.\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>“Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,” top officials from the state Department of Health Care Services wrote in \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/09/graham_cassidy_impact_memo_dhcs_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis\u003c/a> released Friday. “If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs [and] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide.”\u003c/p>\n\u003cp> \u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">By 2026, California would lose $85.7 billion in federal funds, and by 2027 it would lose $138.8 billion, according to the analysis. That could cause 6.7 million Californians to lose insurance coverage, according to \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\">estimates\u003c/a> from the The UC Berkeley Labor Center.\u003c/p>\n\u003cp>A lot of those people are entrepreneurs or their employees. Under the Affordable Care Act in California, half a million self-employed entrepreneurs -- and a million employees who work for small businesses -- got health coverage because of the ACA, either through the expansion of Medi-Cal, or through a subsidized personal insurance plan on the state exchange, Covered California.\u003c/p>\n\u003cp>\"It would be very difficult for entrepreneurs and self employed folks to access some level of coverage,\" said Mark Herbert, California director for the \u003ca href=\"http://www.smallbusinessmajority.org/states/california\" target=\"_blank\" rel=\"noopener noreferrer\">Small Business Majority\u003c/a>. \"So it would be massively destabilizing to the ability of small employers to attract talent.\"\u003c/p>\n\u003cp>Beyond that, there would be damaging ripple effects, Herbert added: \"There's no way that you can remove those sorts of dollars out of our local communities and not see some sort of economic impact on small businesses.\"\u003c/p>\n\u003cp>Under the Graham-Cassidy bill’s redistribution formula, several states that shunned the Affordable Care Act would get more money, according to a \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> by health consulting firm Avalare.\u003c/p>\n\u003cp>Texas will get a windfall of $35 billion in health funding over the next ten years, more than any other state. State officials would get to decide how they want to spend that money. But advocates and analysts say more money for Texas doesn't necessarily guarantee an improved health care system.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“Regardless of the size of the block grant, there's just no assurance that it would translate into good coverage, or coverage that's as affordable as what we have today,” said Stacey Pogue with the \u003ca href=\"http://bettertexasblog.org/2017/09/harmful-medicaid-cutaca-repeal-bill-resurfaces-senate/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Public Policy Priorities \u003c/a>in Austin.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">Texas already has the highest number of uninsured folks, and Pogue says the state just doesn't have the infrastructure in place to expand coverage to more people. It didn't expand Medicaid in 2014, which was optional under the ACA, and the state didn't set up its own exchange, like California did with \"Covered California.\" Texans who wanted subsidized insurance plans had to use the federal exchange, healthcare.gov, which meant Texas had less flexibility when it came to regulating insurers.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“There's no planning and no thought put into, 'How would we create affordable coverage for low-income Texans?\" Pogue said, \"Unlike the 31 states that have expanded Medicaid, have done some central planning. And Texas would be starting from scratch.”\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">It would also take a lot of political will to make sure the state is actually expanding health care, Pogue added, and that motivation has been lacking among state lawmakers for years. In order to get the block grant, states would need to create a workable health infrastructure by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare statewide insurance market.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We are very concerned,” said Stacy Wilson, president of the Children's Hospital Association of Texas.\u003c/p>\n\u003cp>Wilson said this pot of money from Cassidy-Graham wouldn't solve chronic problems with Medicaid, 70 percent of which covers children. Wilson explained that's because the federal government would pay a fixed amount per person, under a per capita cap. That formula locks in how much the state gets per Medicaid enrollee, no matter how much treatment those enrollees need.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We have very low per-capita costs already, and we get locked into that forever,” Wilson said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">A conservative policy group in Texas, \u003ca href=\"https://www.texaspolicy.com/press_release/detail/tppf-statement-on-graham-cassidy-health-care-bill\" target=\"_blank\" rel=\"noopener noreferrer\">The Texas Public Policy Foundation\u003c/a>, is also not happy about the bill, but their concern is that it doesn't go far enough to repeal Obamacare.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361137/a-tale-of-two-states-california-loses-and-texas-wins-under-gop-health-plan","authors":["byline_stateofhealth_361137"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_368","stateofhealth_2808","stateofhealth_3169","stateofhealth_2519","stateofhealth_365","stateofhealth_3105"],"featImg":"stateofhealth_361149","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":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"CBO: If Trump Cuts Payments To Insurance Companies, It Will Cost Taxpayers","datePublished":"2017-08-15T21:06:23.000Z","dateModified":"2017-08-16T20:06:04.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"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":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California","datePublished":"2017-08-02T00:23:19.000Z","dateModified":"2017-08-02T00:56:40.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"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_360142":{"type":"posts","id":"stateofhealth_360142","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360142","score":null,"sort":[1501624963000]},"guestAuthors":[],"slug":"covered-california-expects-12-5-average-rate-rise-in-2018","title":"Covered California Announces 2018 Rate Hikes, and an Anthem Exit","publishDate":1501624963,"format":"standard","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>Covered California said Tuesday that premiums on its health insurance plans would rise by an average of 12.5 percent statewide next year, amid continuing uncertainty over the future of the Affordable Care Act.\u003c/p>\n\u003cp>The state’s Obamacare exchange also said one of its largest insurers, Anthem Blue Cross, would pull out of the exchange and the overall individual market in 16 of the 19 regions it currently serves, forcing 153,000 consumers to find new health plans.\u003c/p>\n\u003cp>The rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.\u003c/p>\n\u003cp>The expected 2018 rate increase is down from 2017’s average rise of 13.2 percent, and it includes a one-time increase averaging 2.8 percentage points because of the end of a “holiday” that gave health plans a break from the tax they are required to pay under the Affordable Care Act.\u003c/p>\n\u003cp>Without that one-time hit, Covered California said, the average 2018 premium increase would be lower than 10 percent. And the exchange said consumers could face increases as low as 3.3 percent if they shop for the best-priced plan at the same level of coverage they already have.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The expected California premium increases are dwarfed by some of the rates proposed in other states. In Iowa, for example, the sole carrier remaining on the exchange — Medica — has proposed a \u003ca href=\"http://www.desmoinesregister.com/story/news/health/2017/07/31/iowa-insurance-premiums-could-spike-moref-obamacare-funding-cut/526363001/\">43 percent increase \u003c/a>for next year, and it has said it would propose another increase of 12 to 20 percent on top of that if President Donald Trump decides to eliminate an important subsidy that helps some consumers reduce the cost of doctor visits, hospital stays and other medical services.\u003c/p>\n\u003cp>Blue Cross-Blue Shield of Georgia, the only insurer covering all counties in that state, is proposing a \u003ca href=\"http://www.myajc.com/news/state--regional-govt--politics/citing-uncertainty-blue-cross-seeks-big-rate-increases-georgia/hEVvZdpt6ODVmbtNokL12H/\">40.6 percent increase\u003c/a>, in large part because of the uncertainty surrounding these so-called \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/ask-emily/article2581624.html\">cost-sharing subsidies\u003c/a>.\u003c/p>\n\u003cp>Some states, however, will see more moderate rate hikes next year than in California. In \u003ca href=\"http://www.bnd.com/news/article164506387.html\">Minnesota\u003c/a>, which has been hit in the past with large increases, some consumers could see their premiums shrink by as much as 15 percent, while others could pay 11 percent more. In Pennsylvania, premiums on exchange-based plans are expected to rise by a relatively tame \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/19/538099050/uncertainty-over-obamacare-leaves-next-years-rates-in-limbo\">9 percent on average \u003c/a>if the cost-sharing subsidies continue, and by 20 percent if they don’t.\u003c/p>\n\u003cp>Covered California’s calculation of the average statewide premium increase assumes the federal government will continue to fund the subsidies — which may not be a safe assumption.\u003c/p>\n\u003cp>The exchange said there could be an additional charge averaging 12.4 percent on silver plans — the second-least-expensive type of policy among the exchange’s \u003ca href=\"http://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">four tiers\u003c/a> — if the administration under Trump decides not to continue funding them. The subsidies, paid directly to insurers, help reduce what some consumers pay out of their own pockets for medical expenses, such as physician visits, prescription drugs and hospital stays.\u003c/p>\n\u003cp>An announcement on whether the Trump administration will continue paying for them, at least for another month, was expected as early as this week. So far, Trump has let the subsidies continue on a month-to-month basis. But after Senate efforts to pass a repeal of the Affordable Care Act failed last week, he suggested in a tweet that he might pull the plug on them.\u003c/p>\n\u003cp>“We’ve prepared these rates in the midst of great uncertainty,” said Peter Lee, Covered California’s executive director. “We are doing our best to protect consumers. We hope to get clarity from the federal government before we make a decision by the end of August” on whether to tack on the silver plan surcharge to offset the loss of the federal subsidies, he said.\u003c/p>\n\u003cp>Lee said the exchange hoped not to do that, because “it will cause unnecessary confusion and ultimately cost the fed government billions of dollars more.”\u003c/p>\n\u003cp>Many Covered California consumers would not pay more out-of-pocket even if the cost of their health plans were to rise sharply, because the extra expense would be covered by federal tax credits intended to keep premiums affordable for consumers. Those subsidies, not directly threatened by Trump, are separate from the ones that help consumers with their out-of-pocket costs.\u003c/p>\n\u003cp>About 650,000 Covered California enrollees, or nearly half the exchange’s total enrollment, benefit from the cost-sharing reductions.\u003c/p>\n\u003cp>Those reduced rates are available only to Covered California enrollees who choose silver-level plans and whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four.\u003c/p>\n\u003cp>The exchange can’t wait too long before determining which rates consumers will face in 2018. State regulators need at least 60 days to review the rates, and Covered California and health plans also need to time to prepare for open enrollment, which begins Nov. 1.\u003c/p>\n\u003cp>Current enrollees will have the option to start renewing their plans sometime in October, said Covered California spokeswoman Lizelda Lopez.\u003c/p>\n\u003cp>Covered California also plans to create a new silver plan to be sold on the exchange for individuals and families who make too much money to qualify for tax credits and cost-sharing reductions. The surcharge will not be applied to that plan.\u003c/p>\n\u003cp>Covered California started offering plans in 2014. In the following two years, the agency successfully negotiated 4 percent average premium increases, far below the double-digit rate hikes that were the norm before the federal health law. That streak ended this year when rates shot up.\u003c/p>\n\u003cp>All of the rates are subject to state regulatory review and public comment. But neither of the state’s insurance regulators, the Department of Managed Health Care and Insurance Commissioner Dave Jones, has the authority to block the hikes.\u003c/p>\n\u003cp>The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low. The proportion of Californians lacking health insurance was 7.1 percent last year, down from 17 percent in 2013, before the coverage-expanding provisions of Obamacare began, federal data show.\u003c/p>\n\u003cp>The expansion of Medi-Cal, the state’s Medicaid program for lower-income residents, accounts for a significant part of that reduction. About 3.8 million Californians became eligible for Medi-Cal coverage under the Affordable Care Act. Total enrollment is 13.5 million, or about a third of the state’s population.\u003c/p>\n\u003cp>\u003cem>Chad Terhune contributed to this report.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"The figure could be higher if President Trump ends an important consumer subsidy, which he has threatened to do. Anthem Blue Cross also says it won't offer individual coverage in large parts of the state next year. ","status":"publish","parent":0,"modified":1501635243,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":1124},"headData":{"title":"Covered California Announces 2018 Rate Hikes, and an Anthem Exit | KQED","description":"The figure could be higher if President Trump ends an important consumer subsidy, which he has threatened to do. Anthem Blue Cross also says it won't offer individual coverage in large parts of the state next year. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Covered California Announces 2018 Rate Hikes, and an Anthem Exit","datePublished":"2017-08-01T22:02:43.000Z","dateModified":"2017-08-02T00:54:03.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"360142 https://ww2.kqed.org/stateofhealth/?p=360142","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/01/covered-california-expects-12-5-average-rate-rise-in-2018/","disqusTitle":"Covered California Announces 2018 Rate Hikes, and an Anthem Exit","nprByline":"Emily Bazar and Pauline Bartolone","path":"/stateofhealth/360142/covered-california-expects-12-5-average-rate-rise-in-2018","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Covered California said Tuesday that premiums on its health insurance plans would rise by an average of 12.5 percent statewide next year, amid continuing uncertainty over the future of the Affordable Care Act.\u003c/p>\n\u003cp>The state’s Obamacare exchange also said one of its largest insurers, Anthem Blue Cross, would pull out of the exchange and the overall individual market in 16 of the 19 regions it currently serves, forcing 153,000 consumers to find new health plans.\u003c/p>\n\u003cp>The rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.\u003c/p>\n\u003cp>The expected 2018 rate increase is down from 2017’s average rise of 13.2 percent, and it includes a one-time increase averaging 2.8 percentage points because of the end of a “holiday” that gave health plans a break from the tax they are required to pay under the Affordable Care Act.\u003c/p>\n\u003cp>Without that one-time hit, Covered California said, the average 2018 premium increase would be lower than 10 percent. And the exchange said consumers could face increases as low as 3.3 percent if they shop for the best-priced plan at the same level of coverage they already have.\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 expected California premium increases are dwarfed by some of the rates proposed in other states. In Iowa, for example, the sole carrier remaining on the exchange — Medica — has proposed a \u003ca href=\"http://www.desmoinesregister.com/story/news/health/2017/07/31/iowa-insurance-premiums-could-spike-moref-obamacare-funding-cut/526363001/\">43 percent increase \u003c/a>for next year, and it has said it would propose another increase of 12 to 20 percent on top of that if President Donald Trump decides to eliminate an important subsidy that helps some consumers reduce the cost of doctor visits, hospital stays and other medical services.\u003c/p>\n\u003cp>Blue Cross-Blue Shield of Georgia, the only insurer covering all counties in that state, is proposing a \u003ca href=\"http://www.myajc.com/news/state--regional-govt--politics/citing-uncertainty-blue-cross-seeks-big-rate-increases-georgia/hEVvZdpt6ODVmbtNokL12H/\">40.6 percent increase\u003c/a>, in large part because of the uncertainty surrounding these so-called \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/ask-emily/article2581624.html\">cost-sharing subsidies\u003c/a>.\u003c/p>\n\u003cp>Some states, however, will see more moderate rate hikes next year than in California. In \u003ca href=\"http://www.bnd.com/news/article164506387.html\">Minnesota\u003c/a>, which has been hit in the past with large increases, some consumers could see their premiums shrink by as much as 15 percent, while others could pay 11 percent more. In Pennsylvania, premiums on exchange-based plans are expected to rise by a relatively tame \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/19/538099050/uncertainty-over-obamacare-leaves-next-years-rates-in-limbo\">9 percent on average \u003c/a>if the cost-sharing subsidies continue, and by 20 percent if they don’t.\u003c/p>\n\u003cp>Covered California’s calculation of the average statewide premium increase assumes the federal government will continue to fund the subsidies — which may not be a safe assumption.\u003c/p>\n\u003cp>The exchange said there could be an additional charge averaging 12.4 percent on silver plans — the second-least-expensive type of policy among the exchange’s \u003ca href=\"http://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">four tiers\u003c/a> — if the administration under Trump decides not to continue funding them. The subsidies, paid directly to insurers, help reduce what some consumers pay out of their own pockets for medical expenses, such as physician visits, prescription drugs and hospital stays.\u003c/p>\n\u003cp>An announcement on whether the Trump administration will continue paying for them, at least for another month, was expected as early as this week. So far, Trump has let the subsidies continue on a month-to-month basis. But after Senate efforts to pass a repeal of the Affordable Care Act failed last week, he suggested in a tweet that he might pull the plug on them.\u003c/p>\n\u003cp>“We’ve prepared these rates in the midst of great uncertainty,” said Peter Lee, Covered California’s executive director. “We are doing our best to protect consumers. We hope to get clarity from the federal government before we make a decision by the end of August” on whether to tack on the silver plan surcharge to offset the loss of the federal subsidies, he said.\u003c/p>\n\u003cp>Lee said the exchange hoped not to do that, because “it will cause unnecessary confusion and ultimately cost the fed government billions of dollars more.”\u003c/p>\n\u003cp>Many Covered California consumers would not pay more out-of-pocket even if the cost of their health plans were to rise sharply, because the extra expense would be covered by federal tax credits intended to keep premiums affordable for consumers. Those subsidies, not directly threatened by Trump, are separate from the ones that help consumers with their out-of-pocket costs.\u003c/p>\n\u003cp>About 650,000 Covered California enrollees, or nearly half the exchange’s total enrollment, benefit from the cost-sharing reductions.\u003c/p>\n\u003cp>Those reduced rates are available only to Covered California enrollees who choose silver-level plans and whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four.\u003c/p>\n\u003cp>The exchange can’t wait too long before determining which rates consumers will face in 2018. State regulators need at least 60 days to review the rates, and Covered California and health plans also need to time to prepare for open enrollment, which begins Nov. 1.\u003c/p>\n\u003cp>Current enrollees will have the option to start renewing their plans sometime in October, said Covered California spokeswoman Lizelda Lopez.\u003c/p>\n\u003cp>Covered California also plans to create a new silver plan to be sold on the exchange for individuals and families who make too much money to qualify for tax credits and cost-sharing reductions. The surcharge will not be applied to that plan.\u003c/p>\n\u003cp>Covered California started offering plans in 2014. In the following two years, the agency successfully negotiated 4 percent average premium increases, far below the double-digit rate hikes that were the norm before the federal health law. That streak ended this year when rates shot up.\u003c/p>\n\u003cp>All of the rates are subject to state regulatory review and public comment. But neither of the state’s insurance regulators, the Department of Managed Health Care and Insurance Commissioner Dave Jones, has the authority to block the hikes.\u003c/p>\n\u003cp>The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low. The proportion of Californians lacking health insurance was 7.1 percent last year, down from 17 percent in 2013, before the coverage-expanding provisions of Obamacare began, federal data show.\u003c/p>\n\u003cp>The expansion of Medi-Cal, the state’s Medicaid program for lower-income residents, accounts for a significant part of that reduction. About 3.8 million Californians became eligible for Medi-Cal coverage under the Affordable Care Act. Total enrollment is 13.5 million, or about a third of the state’s population.\u003c/p>\n\u003cp>\u003cem>Chad Terhune contributed to this report.\u003c/em>\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> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360142/covered-california-expects-12-5-average-rate-rise-in-2018","authors":["byline_stateofhealth_360142"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_368","stateofhealth_2519","stateofhealth_365"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_23937","label":"stateofhealth_3036"},"news_11596552":{"type":"posts","id":"news_11596552","meta":{"index":"posts_1591205157","site":"news","id":"11596552","score":null,"sort":[1501175215000]},"guestAuthors":[],"slug":"states-have-already-tried-versions-of-skinny-repeal-it-didnt-go-well","title":"States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well","publishDate":1501175215,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>[contextly_sidebar id=\"3xCHRB83RCegO5eCE9I9b7XUGYrDBx2J\"]\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uvPSgszQseNfQlpVIo48aD8k0r8xaCVy\"]\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Republican senators are warming to the idea of a scaled-back plan that would delete the ACA's individual and employer mandates.","status":"publish","parent":0,"modified":1501191229,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1259},"headData":{"title":"States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well | KQED","description":"Republican senators are warming to the idea of a scaled-back plan that would delete the ACA's individual and employer mandates.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well","datePublished":"2017-07-27T17:06:55.000Z","dateModified":"2017-07-27T21:33:49.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11596552 https://ww2.kqed.org/news/?p=11596552","disqusUrl":"https://ww2.kqed.org/news/2017/07/27/states-have-already-tried-versions-of-skinny-repeal-it-didnt-go-well/","disqusTitle":"States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well","source":"NPR","sourceUrl":"www.npr.org","nprImageCredit":"J. Scott Applewhite","nprByline":"Julie Appleby\u003cbr>NPR","nprImageAgency":"AP","nprStoryId":"539588546","nprApiLink":"http://api.npr.org/query?id=539588546&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/07/27/539588546/states-have-already-tried-versions-of-skinny-repeal-it-didn-t-go-well?ft=nprml&f=539588546","nprRetrievedStory":"1","nprPubDate":"Thu, 27 Jul 2017 10:14:00 -0400","nprStoryDate":"Thu, 27 Jul 2017 05:00:24 -0400","nprLastModifiedDate":"Thu, 27 Jul 2017 10:14:44 -0400","path":"/news/11596552/states-have-already-tried-versions-of-skinny-repeal-it-didnt-go-well","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\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>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\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>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11596552/states-have-already-tried-versions-of-skinny-repeal-it-didnt-go-well","authors":["byline_news_11596552"],"programs":["news_6944","news_72"],"categories":["news_457","news_8","news_13"],"tags":["news_2409","news_3890","news_17286"],"featImg":"news_11596651","label":"source_news_11596552"},"news_11593208":{"type":"posts","id":"news_11593208","meta":{"index":"posts_1591205157","site":"news","id":"11593208","score":null,"sort":[1501007165000]},"guestAuthors":[],"slug":"the-senate-health-care-vote-simplified","title":"The Senate Health Care Vote, Simplified","publishDate":1501007165,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain's decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the \"failures\" of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it's still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>NPR's health and politics teams have been doing our best to shed some light on what's a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here's our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says \"nope\"?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won't get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That's \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people's health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\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=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The president called on the Senate to repeal and replace the ACA this week. Here's what they would vote on.","status":"publish","parent":0,"modified":1501022230,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":469},"headData":{"title":"The Senate Health Care Vote, Simplified | KQED","description":"The president called on the Senate to repeal and replace the ACA this week. Here's what they would vote on.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"The Senate Health Care Vote, Simplified","datePublished":"2017-07-25T18:26:05.000Z","dateModified":"2017-07-25T22:37:10.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11593208 https://ww2.kqed.org/news/?p=11593208","disqusUrl":"https://ww2.kqed.org/news/2017/07/25/the-senate-health-care-vote-simplified/","disqusTitle":"The Senate Health Care Vote, Simplified","source":"NPR","sourceUrl":"www.npr.org","nprByline":"\u003cstrong>\u003ca href=\"http://www.npr.org/people/536711382/gisele-grayson\">Gisele Grayson\u003c/a>\u003c/strong>","nprImageAgency":"John Holcroft/Getty Images/Ikon Images","nprStoryId":"539051768","nprApiLink":"http://api.npr.org/query?id=539051768&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/07/24/539051768/the-senate-health-care-vote-simplified?ft=nprml&f=539051768","nprRetrievedStory":"1","nprPubDate":"Tue, 25 Jul 2017 09:26:00 -0400","nprStoryDate":"Mon, 24 Jul 2017 16:23:00 -0400","nprLastModifiedDate":"Tue, 25 Jul 2017 09:26:43 -0400","path":"/news/11593208/the-senate-health-care-vote-simplified","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain's decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the \"failures\" of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it's still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\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>NPR's health and politics teams have been doing our best to shed some light on what's a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here's our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says \"nope\"?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won't get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That's \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people's health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\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=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11593208/the-senate-health-care-vote-simplified","authors":["byline_news_11593208"],"programs":["news_6944","news_72"],"categories":["news_457","news_8","news_13"],"tags":["news_21167","news_21264","news_3890","news_21249","news_17286"],"featImg":"news_11593211","label":"source_news_11593208"}},"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. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. 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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. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.","airtime":"MON-FRI 7pm-8pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/fresh-air/","meta":{"site":"radio","source":"npr"},"link":"/radio/program/fresh-air","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Fresh-Air-p17/","rss":"https://feeds.npr.org/381444908/podcast.xml"}},"here-and-now":{"id":"here-and-now","title":"Here & Now","info":"A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. 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Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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