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Immigrant Groups Try to Block Termination of Health Plans

by Louise Radnofsky
The Wall Street Journal, Washington Wire (not dated)

Immigrant advocates are accusing the Obama administration of violating antidiscrimination provisions in the federal health-care law by moving to terminate coverage for around 115,000 people who bought coverage through HealthCare.gov who didn’t take additional steps to prove they are legal U.S. residents.

Two immigrant groups filed complaints Tuesday with the Department of Health and Human Services’ Office of Civil Rights asking it to block the action, which is being carried out by other units of the department. The Office of Civil Rights is in charge of enforcing rules in the 2010 law that bar discrimination in the sale of health plans.

The groups say the agency didn’t take adequate steps to tell people who speak languages other than English and Spanish that the health coverage they bought through HealthCare.gov was about to be terminated because the federal government couldn’t verify their immigration or citizenship status.

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We need Single Payer/Medicare for all!

by US Sen. Bernie Sanders
Tuesday, September 30, 2014

One year after health insurance markets were opened to the public, Politico asked “some of the country's smartest health-care thinkers” what Obamacare hasn't fixed in the American health care system and what we can do now. Sen. Bernie Sanders shared his idea for a Medicare-for-all, single-payer system.

“The Affordable Care Act has made modest improvements in American health care since it took effect. Twenty million Americans have gained insurance under the law, including young people who can stay on their parents' policies and others who may no longer be denied insurance because of pre-existing conditions. The law also has expanded access to primary care to some 4 million more Americans through community health centers that also provide dental care, low-cost prescription drugs and mental health counseling. 

“But the United States remains, shamefully, the only major country on Earth that does not guarantee health care to all its people as a right. And because of the profiteering of the pharmaceutical industry and private insurance companies, the United States spends almost twice as much per capita on health care as any other nation, while our life expectancy, infant mortality and preventable deaths are higher than most other countries. If our goal is to provide high-quality health care for all Americans in a cost-effective way, we must move toward a single-payer system.

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Paying Till It Hurts

Costs Can Go Up Fast When E.R. Is in Network but the Doctors Are Not

Luke Adami with his father, Greg. The Adamis took Luke to a hospital that was in their insurance network. Credit Ozier Muhammad/The New York Times

Luke Adami with his father, Greg. The Adamis took Luke to a hospital that was in their insurance network. Credit Ozier Muhammad/The New York Times

by ELISABETH ROSENTHAL
For the New York Times, 9-29-14

hen Jennifer Hopper raced to the emergency room after her husband, Craig, took a baseball in the face, she made sure they went to a hospital in their insurance network in Texas. So when they got a $937 bill from the emergency room doctor, she called the insurer, assuming it was in error.

But the bill was correct: UnitedHealthcare, the insurance company, had paid its customary fee of $151.02 and expected the Hoppers to pay the remaining $785.98, because the doctor at Seton Northwest Hospital in Austin did not participate in their network.

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Feds disclose which Oregon providers take the most pharma money

The government released a database of all payments to doctors and hospitals from drug makers.

The government released a database of all payments to doctors and hospitals from drug makers.

by Dennis Thompson
Contributing Reporter- Portland Business Journal for Health Care Inc. Sep 30, 2014

Eugene plastic surgeon Dr. Mark Jewell received more payments and gifts from drug companies and medical device manufacturers than any other Oregon physician included in today’s release of data by the Centers for Medicare and Medicaid Services.

Jewell received $73,156 in payments and gifts during the last five months of 2013, according to data gathered by CMS and released today as part of its Open Payments program.

The Open Payments program, created by the Affordable Care Act, identifies specific doctors and lists the consulting fees, research grants, travel reimbursements and other gifts they have received from the health care industry.

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Community health centers stuck with unpaid bills for insured patients

Posted by Don McCanne MD on
Friday, Sep 26, 2014

Underinsured ACA Enrollees Strain Community Health Centers
Kaiser Health News, Daily Health Policy Report, September 26, 2014

Obamacare enrollees are straining the finances of community health centers around the country, some health center leaders say. The issue is that many lower-income patients with insurance coverage through the federal and state exchanges bought bronze-tier plans with lower premiums but high deductibles, coinsurance and copayments and no federal cost-sharing subsidies. When these patients face high out-of-pocket costs for care that falls below the deductible, they can’t afford it.  So the centers are subsidizing that care by offering them means-tested sliding-scale fees. When the centers, which are not allowed to turn away patients for inability to pay, try to get the insurers to pay, the claims are usually denied, and the centers have to write it off as uncompensated care (Modern Healthcare, Dickson, 9/25).

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After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

by ELISABETH ROSENTHAL
New York Times, Sept 20, 2014

Peter Drier, a bank technology manager in New York City, was blindsided after neck surgery by a $117,000 bill from a doctor he did not recall meeting. Credit Joshua Bright for The New York Times

Peter Drier, a bank technology manager in New York City, was blindsided after neck surgery by a $117,000 bill from a doctor he did not recall meeting. Credit Joshua Bright for The New York Times

Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.

He was blindsided, though, by a bill of about $117,000 from an “assistant surgeon,” a Queens-based neurosurgeon whom Mr. Drier did not recall meeting.

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Low-Wage Workers Feel the Pinch on Health Insurance

The Wall Street Journal-Washington Wire, Sep 18, 2014
Think Tank

We did not see big changes in employer-based coverage in the Kaiser-HRET annual Employer Health Benefit Survey released last week. Mostly this is good news, particularly on the cost side where premiums increased just 3%.

But one long-term trend that is not so good is how this market works for firms with relatively large shares of lower-wage workers (which we define as firms where at least 35% of employees earn less than $23,000). These low-wage firms often do not offer health benefits at all. And, as the chart below shows, when they do offer coverage, it has lower premiums on average (likely meaning skimpier coverage) and requires workers to pay more for it. Workers in low-wage firms pay an average of $6,472 for family coverage, compared with $4,693 for workers in higher wage firms.

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