Annie Feidt, APRN, Author at �鶹Ů�� Health News

Focus On Marketplace Enrollment Overlooks Millions Who Bought Private Insurance

Annie Feidt, APRN — Tue, 15 Apr 2014 06:40:00 +0000

Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is exceedingly complicated.

The Obama administration is tracking the number of plans purchased on the federal website and on the state marketplaces, and this month reported that the effort had exceeded expectations by signing up 7.5 million people. In addition, federal officials have said that 3 million people have enrolled in Medicaid since October.

But often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers — and that number could be substantial.

When Alaskan insurance broker Joshua Weinstein wanted to sign someone up for health insurance this year, he asked one key question — would they qualify for a federal subsidy? If they did, it was worth signing up through healthcare.gov to make sure they got that substantial reduction in the cost of the monthly premium. But if they made too much money to qualify for a subsidy, he steered them away from healthcare.gov.

“If you can avoid that whole level of bureaucracy and get a good plan — not necessarily at a good price, but at the same price — and they’re not eligible [for a subsidy], we’re going off the marketplace,” Weinstein says.

One of those clients is Oliver Korshin from Anchorage. Weinstein and Korshin worked together to enroll Korshin’s wife Rachel in a new health plan. She didn’t qualify for a subsidy so they went directly to the insurance firm .

“The actual enrolling wasn’t difficult at all,” Korshin says.

Weinstein estimates that about 15 percent of his clients are signing up for insurance outside the exchanges. He says enrolling directly with insurers is easier because they don’t need the financial information that’s required on healthcare.gov.

“It’s basically gathering demographic information — name, address, phone number, Social Security number,” Weinstein says. Essentially, once the clients decide which plan they want, and how they want to pay the monthly bill, they just sign the application, he says, “and off you go.”

Alaska’s two main insurers say more than 20 percent of their customers in the recent open enrollment period bought plans from them directly. But these customers aren’t being tallied by the Obama administration.

, a senior vice president at the Kaiser Family Foundation, says there’s a lot of focus on the 7.5 million people who signed up through the 14 state exchanges or HealthCare.gov. But the off-exchange number is just as essential to gauging how well the law is working, he says. “I think it’s probably the case that there are more people insured in the individual market off the exchange than on the exchange right now.” (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

In fact, a new survey from the RAND Corp. 7.8 million people nationwide bought health insurance between September and mid-March directly from a carrier.

This story was updated at 1:50 p.m. to correct the spelling of Oliver Korshin’s name.

This story is part of a collaboration that includes , and Kaiser Health News.

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Enrolling In Obamacare In Alaska Is Possible

Annie Feidt, APRN — Fri, 08 Nov 2013 05:34:38 +0000

Despite extensive problems with healthcare.gov, a few dozen Alaskans have managed to enroll in a health plan on the marketplace, and Lara Imler is one of them.

Imler, a 37-year-old hair stylist in Anchorage, ditched her office job as an accountant in 2004. She says she loves making people feel better about themselves and is a lot happier cutting hair than she was sitting in front of a computer. But she does miss one big thing about her old job. “I had health insurance,” she says, “and it was wonderful.”

Even without health insurance, Imler spends a lot of time in doctors’ offices. She has Hashimoto’s disease, an autoimmune disorder that affects the thyroid. The treatments and blood work she needs are expensive — but not as expensive as buying insurance in Alaska’s individual market.

“Being self-employed, getting my premium at anything reasonable, wasn’t happening,” she says. “I think my last quote was $1,200 a month for myself.”

Imler was determined to find something better on the new Affordable Care Act health exchange. She logged onto healthcare.gov a few days after it went live last month. She tried four times that day — and four more times the first week — but kept running into messages that the site was “unavailable.” So she decided to wait it out. On October 24, she logged back in and slowly started making her way through the process.

Imler’s degree is in computer programming, and she’s even built a few websites. She thinks that experience, helped her persevere through the trouble spots on healthcare.gov.

“You get to a point where you finally get to pick what health insurance you want and all the buttons have to be double clicked. If you don’t know that or try that, it doesn’t go anywhere. It just sits there,” says Imler. “This website is so not user friendly. You can’t figure out what they’re trying to get you to do unless you accidentally get there.”

About two hours after she started, she landed on a screen that told her she had successfully enrolled. She was pleasantly surprised by the price. Imler qualified for subsidies, and chose a mid-level plan that will cost her $110 a month.

“The website sucks — I’m not going to lie,” she says, “but the idea that I might be able to afford health insurance is huge to me. It will be a huge burden off my family.”

The plan is a great deal for Imler. But for her insurance company, it’s a different story. The claims from her chronic condition are likely to pile up quickly.

But at least some insurance companies are braced for people like Imler. Jeff Davis, president of Premera Alaska, says the company is prepared to lose money in 2014, maybe even a lot of money. In the long run, though, he hopes Premera will be able to attract more young, healthy people into the mix.

“The first wave will be people who know they need coverage, so that’s a little scary,” Davis says. “So then, the question and the challenge becomes, how do we help inform others, particularly those who are subsidy eligible, that this is available to them and help them figure out how to get to it.”

Imler is still waiting for enrollment confirmation from her new insurance company. She’s optimistic that will come soon. If it doesn’t, she’s willing to log back in to healthcare.gov to keep trying.

This story is part of a partnership that includes ,��, and Kaiser Health News.

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A Road To Health? Rural Alaska Town Argues For Access

Annie Feidt, APRN — Wed, 11 Sep 2013 16:49:00 +0000

The town of is crowded onto a narrow spit of land, surrounded by ocean and volcanic mountains. It’s an Aleut Native community of about 1,000 people, and for roughly a third of the year, weather closes its gravel air strip. When that happens, the only way residents can get to the nearest town, Cold Bay, is by boat — two hours on choppy seas.

So when an emergency call wakes up Bonita Babcock in the middle of the night, she first wants to know how bad the wind is blowing. Babcock is a community health aide and a lifelong resident of King Cove. Her job is to stabilize patients and get them to Cold Bay, where there is a year-round air strip and patients can get to the nearest hospital — in Anchorage, 600 miles away.

King Cove is only 30 miles away from Cold Bay, but there’s no road connecting the two towns.

“We’re looking and most of the time, it’s going to have to be a Medevac. And we’re wondering, ‘What are we looking at here, are they going to be able to get them out?’” Babcock says.

King Cove has been asking for a road to Cold Bay for these types of situations for more than two decades. The U.S. Fish and Wildlife Service has twice. Alaska Senator Lisa Murkowski to hold up the confirmation hearing for Interior Secretary Sally Jewell until Jewell agreed to visit.

Bonita Babcock shows Interior Secretary Sally Jewell around King Cove Clinic in King Cove, Alaska (Photo by Annie Feidt/Alaska Public Radio Network)

So Jewell made the trip to King Cove, where Babcock gave her a tour around the King Cove Clinic.

Jewell heard stories of medical close calls, like a baby who was having trouble breathing and had to be rescued by a Coast Guard helicopter. And she heard about unreliable transportation out of or into the community. Babcock told Jewell the clinic sometimes has to make do without essential medication.

“Last week, six days it sat in Cold Bay . . . one of our patient’s meds,” Babcock explains to Jewell.

The problem King Cove faces is that the 11-mile one-lane gravel road that could make life safer there would slice through the center of . It’s 300,000 acres, and the community and the state are offering to add 60,000 more in exchange for the road. But environmental groups say the deal would set a precedent that could make it easier to build roads through other wilderness areas. Nicole Whittington-Evans, with , says Izembek is important for bird species like black brant and tundra swan.

“When you are in Izembek and you look around at the breathtaking coastal mountains and this incredibly vibrant and ecology rich area, you know this is a global resource we should be protecting,” she says.

Whittington-Evans doesn’t think the road is worth it. It would take more than two hours to drive the full 30 miles between the towns, and she’s skeptical it would be the fastest way to evacuate people with medical emergencies.

King Cove residents acknowledge they want the road for more than health and safety reasons. It would make it cheaper to fly to Anchorage, and high school sports teams could more reliably compete against other villages.

Interior Secretary Sally Jewell (center in maroon vest) tours King Cove, Alaska, with local residents (Photo by Annie Feidt/Alaska Public Radio Network)

The decision ultimately rests with Interior Secretary Jewell, and she says it’s a tough choice.

“I think that there have been efforts to talk about a tradeoff between human safety and wildlife, and the reality is I think we want both, so I understand the interests on both sides. It’s difficult, and I don’t think that’s a reasonable tradeoff,” says Jewell.

Jewell hasn’t said when she’ll decide. But Etta Kuzakin, with the Agdaagux Tribal Council in King Cove hopes Jewell’s visit persuaded her to approve it.

“It’s easy to say no when you see it on writing on paper,” says Kuzakin. “But it’s not easy to say no when you see and you know and you look at the eyes of the people who have been through these tragic situations.”

Five months ago, Kuzakin went into premature labor in King Cove when the winds were howling. She made it out of the community later that day on a Coast Guard helicopter. She has a healthy daughter now named Sunny Ray, but she worries about future emergencies that may not have a similarly happy ending.

This story is part of a partnership that includes , , and Kaiser Health News.

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Meet A New Breed Of Medical Professional: The Health Coach

Annie Feidt, APRN — Mon, 23 Jul 2012 05:58:00 +0000

This story is part of a reporting partnership that includes ,�� and Kaiser Health News.

Every morning, Shannon Orley parks as far away as possible from her office in Anchorage, Alaska. And on the sprawling complex that is really far away.

“Right around a thousand steps each way. Definitely worth it,” Orley said.

Two years ago, Orley was obese. And she faced a dilemma. She had just taken a job helping coordinate Providence’s employee wellness program. But her own wellness was far off track. She drank the equivalent of six sodas a day, loved fast food and didn’t exercise much. So she decided to take advantage of one of the hospital’s new benefits – health coaching.

Health coaches are a new kind of , and it’s their job to help people make those easy-to-say, hard-to-do behavioral changes that promote good health—getting enough exercise, eating a balanced diet, managing stress.

At first, the lifestyle changes Orley made were very small.

“We started out where my goal was to take the stairs instead of the elevator once a day. Not even more than that but just really manageable,” she said.

Soon Orley was drinking more water and less soda. She began walking regularly and attending Pilates classes. She kicked her fast food habit. She lost 50 pounds. Last year, 300 of Providence’s 2,800 employees in Anchorage tried health coaching. Orley’s coach, Kelly Heithold, says her clients have finally made the decision to change.

“When they actually make that step and make an appointment with me, they’re ready,” Heithold said. “And they say, ‘Help me. I know what I need to do, I just don’t know how to get there.'”

Health coaches are still rare in the medical profession. But they are becoming more popular as chronic and often preventable diseases like consume more and more . Tammy Green heads up Providence’s extensive employee wellness program. She thinks coaches are an important piece of the health care puzzle that’s been missing. She says nobody wants to be overweight.

“Really, at the core, everybody wants to be healthy. They really do. We just have not been able to help them achieve those goals with our traditional approach,” Green said.

In three years of health coaching, Providence has seen a small but steady decrease in the number of obese employees – from 36 percent in 2009 to 32 percent in 2011. Green says blood pressure and cholesterol levels are lower, and fewer employees are smoking.

“Something’s happening and you can pretty much assure yourself that if we hadn’t been doing anything, we certainly wouldn’t be seeing those trends,” Green said.

Green is convinced that health coaches are a good investment. Margaret Moore agrees. Moore founded in 2000, a Massachusetts-based company that has trained most of the country’s 6,000 health coaches.

“There’s a reasonable army now of health professionals that have become coaches in this last ten years,” Moore said.

She expects the profession to grow steadily. Especially now that Medicare has started paying for up to 20 obesity counseling sessions a year. But Moore acknowledges there’s debate in the medical field over whether health coaching should be a separate profession or just a new skill set for . She thinks there’s room for both.

Back at Providence, Shannon Orley has reached an intersection on her walk to work. And like a former smoker trying to resist a nicotine urge, she has an important choice to make.

“As you can see on the left side we have our bank of elevators, ready to rock. On the right side, we have the stairs,” Orley said.

On this day, Orley doesn’t hesitate, but she says some days it’s a tough decision.

“You know every time I go to reach for the elevator button there’s a little voice in the back of my head asking me, ‘Really, is this going to make you feel better? Is this part of your goal? Is this where you’re headed?” she said.

With her coach’s help, healthy choices have started to feel better and better.

This story is part of a reporting partnership that includes APRN, NPR and Kaiser Health News

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Alaska Takes Biggest Step Yet Toward Health Insurance Exchange

Annie Feidt, APRN — Tue, 14 Feb 2012 18:33:32 +0000

This story is part of a reporting partnership that includes ,�� and Kaiser Health News.

Alaska has opposed the federal health law so adamantly that it is the that chose not to even apply for a $1 million grant the federal government was passing out to states to plan a health insurance exchange. But that doesn’t necessarily mean there won’t be an online marketplace to buy insurance in Alaska.

Last month, the administration of Gov. Sean Parnell, a Republican, hired Public Consulting Group to study the state’s options for setting up an exchange. The state is spending $200,000 on the contract with the Boston-based firm.

The state-based exchanges will allow consumers to easily find and compare health insurance plans online. The Affordable Care Act establishes the exchanges as one-stop shopping for individuals and small businesses to buy insurance and to qualify for subsidies or Medicaid.

Josh Applebee, Alaska’s deputy director for health care policy, described the reasoning for hiring the consultant.

“The biggest problem, I think, is we don’t have enough information to decide,” Applebee said. “Are we going to do a state exchange? Are we going to do a partnership with the federal government? Are we going to let the federal government run the exchange themselves? If we do the state exchange, what does it look like? What kind of form is it going to take? How much is it going to cost? All of these questions need to be answered.”

States have until Jan. 1, 2013 to submit their exchange plans to the federal government for certification; if a given state doesn’t do so, the feds can set up the exchange for that state. The exchanges are supposed to be working by Jan. 1, 2014.

In addition to Alaska, Public Consulting Group is advising 13 other states on how to implement an exchange. Applebee says the state will benefit from that experience, but the company will also have to take Alaska’s unique characteristics into account.

“Certainly we deliver health care [over greater distances] than any other state and in different ways than any other state,” Applebee said. “So they can bring they’re experience with them, but they also need to apply that to whatever happens here in the state.”

A few states—including and –have exchanges in place and more than a dozen have made significant progress. Applebee says Alaska is benefiting from taking a slow approach: “We’re learning from other state’s mistakes and we’re taking advantage of other state’s successes. And I think that’s an advantage we have in our timeline.”

Meanwhile, state Sen. Hollis French, a Democrat from Anchorage, is hoping to convince other lawmakers to pass his bill establishing an exchange. “Once you realize you’re going to get an exchange imposed upon you from Washington, it only makes sense to try to create one that works for Alaskans,” French said.

Despite the fact that they are both moving in the same direction, Parnell does not support French’s bill, and French does not support the administration’s work.

“I think the governor is making a mistake by circumventing the legislature and going without our input,” French said.

It’s unclear how much support French has among his colleagues in the legislature. He expects to bring his bill to the Senate floor for a vote soon.

Sen. Cathy Giessel, a Republican from Anchorage, said she will not vote for it. She agrees with the administration’s approach studying exchange options. Asked to speculate on how the bill will fare, she says the focus right now in Juneau is on just one thing: . “It’s really sucking the air out of the room, so I don’t know what chance this has of actually getting all the way through the process,” Giessel said.

But French is optimistic. He says other aspects of the Affordable Care Act are controversial, but the health care exchange is not.

“This is really about just trying to find an affordable insurance policy for the citizens of the state, and most people can agree that’s a good thing,” French said. “They may disagree about how you get there, but it’s a pretty rare person who doesn’t want to see more people covered by insurance.”

The Parnell administration expects the consultant’s study and recommendations to be ready by the end of March or early April. That is just in time for oral arguments in the Supreme Court case against the Affordable Care Act. The high court is expected to rule in June, and Applebee says the state of Alaska will be waiting for that ruling. “We’ll know at that point how to proceed,” he said.

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