Chabeli Herrera, The Miami Herald, Author at �鶹Ů�� Health News

Paperwork Inconsistencies Causing Thousands To Lose Obamacare Subsidies

Chabeli Herrera, The Miami Herald — Wed, 17 Jun 2015 14:58:49 +0000

Michel River’s application for an Obamacare insurance plan ran smoothly. He signed up with an agent in November, submitted supporting income documents and started paying his monthly premium of $48.

That’s why he was surprised a few months later when his health insurer, Molina Healthcare of Florida, charged him $536 — the full cost of one month of insurance without the tax credits that made his plan affordable.

The reason? A problem processing paperwork that sometimes results in the government cutting off tax credits when there are inconsistencies in documentation, especially when it comes to income estimates. The problems are affecting thousands of consumers around the country, say enrollment agents and healthcare counselors, including some in South Florida — where more people signed up for insurance plans under the Affordable Care Act than in 47 entire states.

The issue isn’t new. A U.S. Department of Health and Human Services from the Office of the Inspector General said that between October and December of 2013, the federal marketplaces were unable to resolve 2.6 million data inconsistencies, which occur when the marketplace can’t cross-check applicant information with other data.

The report found that the federal marketplace “was unable to resolve inconsistencies even if applicants submitted appropriate documentation” and noted that “an inconsistency does not necessarily indicate that an applicant provided inaccurate information.” When the report was published last summer, the Centers for Medicare and Medicaid Services said it was working toward swifter resolutions.

Eventually, 97,000 of the households with income inconsistencies either lost their tax credits or had them adjusted for 2014 coverage.

The paperwork processing problem, however, persists.

In 2015, the number of consumers who had their tax credits adjusted or lost due to an income inconsistency rose as enrollment went up. According to a recent , 223,000 households had their tax credit or cost-sharing reductions adjusted for their 2015 coverage.

HHS could not say how many consumers overall saw their tax credits revoked because of an inconsistency in their documents, nor could it say what percentage of those people turned out to have been wrongly denied subsidies.

The Issue With Income Projections

The problems frequently seem to start with the income projection portion of the Obamacare application.

When consumers enroll in an ACA plan, they are asked to estimate their income for the coming year. They may also have to provide supporting documentation, such as tax returns and pay stubs. The income estimate is used to determine the amount of tax credits — financial assistance to lower the monthly cost of insurance — a person will receive.

But when the marketplace asks for supporting documentation, its notices are leaving consumers confused, said Judy Solomon, vice president of health policy at the Center on Budget and Policy Priorities.

“There’s a difficult communication so that people are not always clear what is happening in their case and what they need to send,” Solomon said.

The notices list possible documents a consumer can submit to resolve their inconsistency, but is unclear which specific documents are needed. Consumers may send in a document on the list that fails to resolve the issue, and get the same notice again, Solomon said. The cycle may lead consumers to believe the documents weren’t received, not understanding that they didn’t sent the correct document.

When the tax credits are slashed, they wonder what went wrong — particularly when they thought they had supplied the needed paperwork, as in River’s case.

The Miami computer technician, 42, who said he is generally healthy, only signed up for coverage because it is required by law: “If you are going to force someone to do it, be on top of it. Do your job right. Everyone has bills and $536 is a lot.”

When he learned there was an inconsistency in his data, he said he and his agent called the marketplace in March, explained that the documents were uploaded at the time of enrollment, and that he never received notices that he needed to provide more information — or lose the credits.

HHS said it attempts to contact consumers at least four times and as many as nine or 10 times through email or phone about data inconsistencies.

River filed an appeal with the marketplace and is hoping for reimbursement.

‘An Epidemic’

Ammer Cabrera, an agent with Sunshine Life and Health Advisors, one of the largest enrollment agencies in the Miami-Dade county area, said the issue has become an “epidemic.”

At least 10 percent of about 100,000 people the agency says it enrolled for 2015 have returned to the Sunshine offices trying to regain their tax credits after document issues stripped them away, Cabrera said.

“This year, they’ve been cutthroat with paperwork,” Cabrera said. “Now you go from paying $25 to $325. For a lot of people, that’s what they make. That’s like half their salary.”

Juanita Mainster, an enrollment counselor with the Epilepsy Foundation, the second largest enrollment group in the state, said documents she sent through certified mail were still reported missing by the marketplace.

“There are instances where the marketplace will tell us that, ‘No, the consumer has not submitted anything,’ when the consumer is sitting here with return receipts of registered certified mail,” Mainster said.

She said she has also seen consumers cause their own problems through misinformation or forgetting to check their marketplace account.

Yudisey Medina, a Miami business owner, said that when her premium rose from $21 to $265 after her tax credits were revoked, she considered canceling her coverage.

“I preferred to cancel my Obamacare, even if I was going to get the penalty,” said Medina, 36, who had replied to letters from the marketplace to prove her income with supporting documents. “I was overwhelmed.”

Medina moved to Miami from Spain about a year and a half ago, so she did not have enough income information filed with the Internal Revenue Service when the marketplace attempted to verify her income.

The tax data used to verify income is about two years old, according to the OIG report.

Solomon of the Center on Budget and Policy Priorities said the marketplace eligibility process was meant to be supported by information from other sources — which is often dated.

“This was designed to be very much an automated process but it really can’t be, because people’s situations are so complicated and so different,” Solomon said. “If we think about people who have stable incomes this works, but that’s not really the folks that we are talking about.”

River, a contract worker, said his income fluctuates, making it tough to project.

“You don’t believe me because last year I might have had a better year and you’re going to take my tax credit?” asked River.

But HHS said it also has to watch out for people trying to dupe the system. And the agency insists it has made strides to eliminate some of the issues.

“We’ve worked hard to improve our processes so that data-matching issues are resolved quickly and easily, and conducted large outreach campaigns to inform consumers of their responsibility for providing supporting documentation to verify their eligibility information,” HHS said in a statement.

Consumers who lost their tax credits will likely get them back in their tax returns — if they can wait that long. The U.S. Department of Treasury said Tuesday consumers may get a larger tax refund if their subsidies were too low.

Meantime, the paperwork issues continue to cause more confusion.

“I think it will continue to be a significant problem until they can do a better job of explaining to people what they need to do,” Solomon said.

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Florida To Review Proposed Obamacare Rate Hikes For First Time

Chabeli Herrera, The Miami Herald — Thu, 04 Jun 2015 14:03:05 +0000

After two years with its regulatory hands tied, the Florida Office of Insurance Regulation is free this year to challenge insurers again — in a market seeing double digit hikes.

A 2013 law barred the Florida Office of Insurance Regulation from regulating proposed rates in Affordable Care Act plans, stating that the state office could not have a final say over federal laws and regulations such as the ACA. That meant the office spent the first two years of the ACA’s enforcement in , determining if rates were in compliance with state and federal rules but unable to act if they weren’t.

That law expired this year.

Insurance office staff actuaries will now be able to review the insurers’ proposed changes and have the final say in whether the proposals are justified, said Harvey Bennett, spokesman for the office. If not, insurers will have to file new rates or, in certain cases, may appeal the decision.

The office will look at plan benefits and wording as well as check for discriminatory rating practices to ensure that rates are justified and comply with with Florida and federal law.

What the office’s reestablished role this will mean for consumers is still unclear. The office refused to comment on the subject.

But consumer advocacy groups such as Florida CHAIN, a nonprofit that supports the ACA, said the reinstated regulation capabilities will likely spell good things for consumers.

Laura Brennaman, health policy consultant with Florida CHAIN, said consumers will likely save millions of dollars thanks to rate review protections, which under the ACA are meant to be the role of state regulators.

“We are hopeful and optimistic that the OIR [Office of Insurance Regulation] will safeguard the healthcare consumers in Florida by maintaining a transparent review process and granting rate increases only where they are required to provide high quality healthcare to subscribers,” Brennaman said in an email.

Greg Mellowe, health policy director for the Florida Center for Fiscal and Economic Policy, a nonpartisan nonprofit, said the insurance regulation office’s reinstated role, after having their powers restricted for two years, will likely help consumers in the long run.

It can only help, he said, “for them to be able to do the job that they should have been able to do all along.”

And Florida’s insurance regulator is regaining its rate review authority just in time. Insurers are requesting double digit increases, with Aetna seeking the highest with a proposed 21.22 percent hike on ACA plans.

Like other Florida plans that proposed hikes, Aetna cited rising health costs as the key impetus behind the rates.

“U.S. healthcare spending is on track to grow from $2.9 trillion in 2013 to $5 trillion in 2022,” said Walt Cherniak, a spokesman for Aetna and Coventry. “The rates that we are filing simply reflect the costs of healthcare including the cost of services, the amount of services people will receive and an increase in pharmaceutical costs.”

Coventry, too, is proposing raising ACA plan rates by 16 percent.

Insurers with rate increases over 10 percent were required to to the federal government and justify their proposals.

Cigna, with an increase of 12.82 percent, said part of its justification for the jump comes from the data insurers now have on the newly insured ACA population.

“As our understanding of the specific clinical experience, needs, claims and medical trends of our individual customers becomes more extensive, Cigna continues to refine its offerings so that our health plans are more closely aligned with the needs and preferences of the communities we serve,” said Cigna spokesman Joe Mondy in a statement.

Other plans with increases greater than 10 percent included United Healthcare (18.19 percent) and Preferred Medical Plan (14.5 percent.) Missing from the mix was the state’s largest insurer: Florida Blue.

For 2015, Florida Blue averaging 17.6 percent on its exchange plans. The proposed 2016 rate will increase by less than 10 percent but the company chose to keep the actual rate under trade secret protection citing competitive reasons.

Still, the proposed rates for many of the companies will likely change before they are finalized at the end of the summer.

Miami Herald reporter Daniel Chang contributed to this report.

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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South Florida Lawmakers Discuss Medicaid Expansion At Forum

Chabeli Herrera, The Miami Herald — Thu, 28 May 2015 19:38:40 +0000

Florida Senators Rene Garcia, R-Miami (left), Anitene Flores, R-Miami, (center) and Rep. David Richardson, D-Miami talk about Medicaid expansion’s role in Florida’s upcoming special legislative session during Wednesday’s Gap Coverage educational forum held by the Health Foundation in South Florida. (Photo by Chabeli Herrera/Miami Herald)

With a special legislative session set for next week, South Florida lawmakers, hospital representatives and health groups gathered Wednesday to discuss Medicaid expansion, the future of healthcare in Florida and a looming Supreme Court decision on subsidies.

Sen. Rene Garcia, a Miami Republican who chairs the Senate healthcare budget committee, in a panel discussion with Sen. Anitere Flores, R-Miami, and Rep. David Richardson, D-Miami Beach, said a health care crisis still exists in Florida after the Legislature adjourned without passing a budget. About 850,000 Floridians fall into the healthcare “gap” created when Florida chose not to expand Medicaid.

Garcia said he is frustrated with the House’s refusal to explore options for Medicaid expansion: “It just makes no sense to me that you cannot sit in a room and have a conversation as to how we are going to fix the problem.”

The panel offered some hope of a solution to the impasse, noting that House appropriations chair Rep. Richard Corcoran, R-Land O’ Lakes, called the Senate’s proposed Medicaid expansion plan earlier this week, with the caveat that the Senate guarantees it will take up several other House proposals.

Still, no House Republicans attended the Health Foundation of South Florida’s forum, though they were invited.

Lawmakers at the forum also noted that a Supreme Court decision expected in late June could change everything if the court decides that financial assistance for Obamacare premiums will only be available from state-established insurance marketplaces. Florida and 26 other states have federally run marketplaces. About Floridians would become uninsured if the court rules for the plaintiff in King v. Burwell — more than any other state.

“Maybe … things have to get worse before they have to get better,” Flores said. “The sad thing about that is that in the issue of healthcare, when things get worse before they get better, it means that people die.”

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When Paying The Obamacare Penalty Is Cheaper Than Buying Insurance

Chabeli Herrera, The Miami Herald — Wed, 20 May 2015 09:00:44 +0000

When Angela Denig couldn’t cover the costs of Obamacare health insurance this year, she made the only decision she could: She gave up on coverage, paid the fee for not being insured and hoped she wouldn’t get sick.

A few months later, a health scare would put the South Florida woman’s high-stakes gamble to the test. But at the time, she said, the calculation was clear. Paying a “several hundred dollar” penalty for remaining uninsured was much cheaper than forking over a monthly insurance premium of at least $200 under the Affordable Care Act — the only insurance she qualifies for.

Angela Denig, who has chosen to live without health insurance and pay the Affordable Care Act penalty for being uninsured, holds her medical bills in her Florida home. Months after Denig, 41, chose to pay the penalty, she was diagnosed with a benign tumor in her breast and the cost of surgeries soaked up her savings. (Photo by Charles Trainor Jr./Miami Herald)

For Denig, buying insurance for herself is way down on a list of expenses that starts with taking care of her two teenage sons. And the penalty, which is designed to exert increasing pressure on the uninsured to sign up for a plan, wasn’t high enough this year to change her priorities.

The Obamacare fee is still small enough this year — $95 or 1 percent of household income in 2014, whichever is greater — to make it worthwhile for people like Denig to opt out of health coverage. The U.S. Department of Health and Human Services estimated earlier this year that 2 to 4 percent of consumers would pay the penalty, but final numbers have not yet been released by the Internal Revenue Service.

That’s likely to change, though, when the penalty nearly quadruples next year and then spikes to $695 or 2.5 percent of household income, whichever is greater, in 2016.

For Denig and others, the affordability of insurance is still the key question — and the main frustration.

“I feel let down and defeated,” Denig, 41, said of the high premiums she was offered and rejected. “Then they’re gonna punish me by making me pay for it?”

The Margate office manager said that when she checked her Obamacare eligibility online, she was floored to see her premiums ranged from $200 to $500 per month. Financial assistance to reduce premiums is available to those whose incomes are below 400 percent of the federal poverty level, which for an individual is $46,680 a year.

But she didn’t qualify for a subsidy to make insurance more affordable. She went to H&R Block to be sure she had her facts right. She learned that household expenses aren’t part of the equation when determining who gets reduced-cost premiums. And that she’d be required to pay a penalty if she didn’t enroll in an insurance plan.

“When they said 1 percent of your income, I almost fell out of my chair,” she said.

She chose the penalty, hoping she could manage for a year without insurance.

Stitching Together Health Care

Who chooses to pay the penalty rather than pay for insurance tends to vary by income bracket.

Health centers that generally enroll lower-income consumers say they have seen more people who decide to pay the penalty. Conversely, health advisers with clients who have a variety of income levels say they see fewer people deciding to pay the penalty.

In general, access to health insurance increases as income increases, often through employer-obtained coverage, said Joan Alker, executive director at the Georgetown University Center for Children and Families. Part-time and service jobs that usually pay less tend not to offer health insurance.

And those consumers — who fall below 400 percent of the federal poverty level, the limit to receive financial assistance toward health insurance — are more likely to be the penalty payers.

Eduardo Herrera, a coordinator for outreach and enrollment programs at Community Health of South Florida, said about a quarter of the 7,800 people the centers helped during the most recent enrollment period — from Nov. 15 to April 30 — ultimately chose to pay the penalty rather than buy insurance.

The centers serve an overwhelmingly low-income and uninsured population, which means the same people who decided not to buy insurance might later turn to those clinics for low-cost and free healthcare.

And what’s affordable for one person can be unaffordable for another, Herrera said. Premiums also can change, year to year.

In Miami-Dade County, premiums 1 to 5 percent for the benchmark silver-level Obamacare plan from 2014 to 2015, according to nonprofit health policy group Kaiser Family Foundation (KHN is an editorially independent program of the Kaiser Family Foundation) .

Herrera said an increase from a $50 premium to a $100 premium has pushed some families to forgo coverage, while others have chosen penalties when their premiums were as high as $600 and $700.

“They tell me, ‘I’m not going to stop eating so I can have health insurance,’” Herrera said.

Miami Beach real estate agent Robert Young goes to a health center to stitch together his healthcare while he waits for an option that doesn’t force him to pay the penalty. He paid the minimum penalty for 2014 and will pay again when tax time rolls around next April.

“I had to give up surfing because I can’t afford to break anything else,” said Young who goes to the Miami Beach Community Health Center. There, he pays $35 for a doctor visit and $50 for a dental cleaning. His premiums under Obamacare were priced at about $500 a month. He has been uninsured for a decade.

Young knows the 2016 penalty — $695 or 2.5 percent of household income — will make him reconsider. At one point, he said, the penalty will surpass the premiums and then he will be left with no options — unless something changes on either end.

“Am I going to keep paying penalties? Probably,” said Young, who is in his 50s. “I can’t afford it otherwise.”

A Flaw in the Application

The law offers some ways to reduce the number of consumers paying a penalty, said Justin Giovannelli, a research fellow at Georgetown University’s Health Policy Institute. But the application form still leaves out household expenses when calculating need, an omission that health counselors have said might hurt those who sign up.

The ACA caps the amount a person’s premium can take from their income. The cap is no more than 2 percent of income at 100 to 133 percent of the federal poverty level and can go as high as 9.5 percent of income for those between 300 and 400 percent of the federal poverty level.

“That doesn’t mean that the legal definition of what’s affordable and not doesn’t leave some people paying a lot money,” Giovannelli added.

Those above 400 percent of the federal poverty level don’t get a cap or financial assistance on their premiums.

Still, exemptions for those who suffer hardships or have trouble paying bills have bailed some consumers out of the penalty.

Herrera, of CHI, said he’s been able to file various exemptions for consumers who felt their premiums were too high, stating that other expenses make purchasing healthcare difficult on their budget. Most have been approved, and the penalty waived.

But a health counselor for the Epilepsy Foundation, Juanita Mainster, said the flaw in the law has been a barrier for enrollees: When consumers sign up for health insurance all they are asked to report is their gross income — not expenses.

“I had people that came in and said, ‘Well, I have to pay my car payment and I have to pay whatever other expenses, and why can’t they take that into consideration?’” Mainster said.

That was the concern for Giancarlo Alfano, 26, who had to give up his $70 a month Obamacare plan when he landed a full-time job. The job caused his income to rise and his premium to skyrocket to nearly $400.

For the administrative assistant, who moved to Miami from Venezuela last January, the job was the break he was hoping for — but it came at a price.

“Now that I’m making more money than I was before, I don’t have any benefits, and I don’t think that’s very fair,” Alfano said.

He got married in August, and he and his wife, Paola, decided they could forgo coverage if it meant beginning to make a life together.

“We want to start building up our finances, buying a house, building a family,” Giancarlo Alfano said. “We decided let’s just take the penalty because it’s going to be less expensive than having to pay for insurance.”

A Rainy Day

For the penalty payers, a health scare can change everything.

In the case of Denig, the single mother from Margate, that fear became a reality only months after she decided to risk a year without insurance.

A tumor in her breast led to mammograms, MRIs and, eventually, surgery. Luckily, the growth was benign.

But her rainy day funds — only for emergencies — evaporated.

“The rain came,” Denig said. “And in Florida, it rains a lot.”

She is out of money if another health problem comes her way. Her eldest son, who graduated from high school last year, went to work at a part-time job the next day. The family is unable to pay for college, even though — according to the ACA — Denig can afford hundreds of dollars a month in insurance.

And the ever-growing penalty looms in the horizon.

“Next year, the penalty will be so high it will completely swallow my income tax refund, and what will I do then?” Denig said.

Next year, there won’t be a rainy day fund.

“As the months roll by, I feel the noose tightening around my neck,” she said.

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Retail Health Care Spurs Innovation In South Florida

Chabeli Herrera, The Miami Herald — Thu, 12 Mar 2015 09:00:16 +0000

In the growing world of retail health care, where you can get your flu shots down the aisle from your Fritos, insurers like Florida Blue are jumping into the business — with a South Florida spin.

Clinic Practice Manager Lilia Pino examines 6-year-old Ashera Samad in Kendall, Florida (Photo by Patrick Farrell/Miami Herald Staff).

In September, the insurer will debut three “integrated care” facilities designed to cater to South and Central American populations by offering primary care, specialty services, labs and diagnostics under one roof — a model that is common in Latin America.

The move reflects a consumer-focused style of administering care that has grown in popularity since the implementation of the Affordable Care Act. Now, more consumers are insured than ever before — 1.6 million Floridians enrolled in the marketplace in 2015 alone — many also leaving their employer’s coverage to shop for individual plans on the exchange.

The result: Consumers want more transparency and affordability, with the option to price compare and get speedy service.

Enter retail health care — the Expedia model for medical services — in which clinics post their prices and allow consumers to choose which services they want, where and when. No making appointments. No waiting for doctors. No ambiguous price schemes.

Krista Bowers, managing director for Miami-based health care consulting firm BDC Advisors, said that out-of-pocket costs and high deductibles, which are common in the most popular marketplace plans, have made consumers more price conscious. And that has fueled the growth of a retail-centric clinic model.

“They have more skin in the game,” Bowers said. “The more money you have at stake, the more you’re willing to shop.”

People don’t want to wait months to get an appointment with a primary care provider, Bowers said, nor do they want to guess how much a service will cost.

“The traditional kind of physician office, because of its inability to be super effective and because of its inability to offer convenient costs, is being attacked,” Bowers said.

In the last decade, more retailers have joined the charge, led by CVS, which opened its MinuteClinics in 2006 offering anything from flu shots to physicals. Now there are more than 960 MinuteClinics nationwide. About 300 have opened since 2012 alone, including 33 in Florida.

Andrew Sussman, president of the MinuteClinics, said that a primary care doctor shortage, an aging population and an epidemic of chronic disease has powered the retail health care option.

According to a report released this month by the Association of American Medical Colleges, there will be a predicted shortage of 46,100 to 90,400 physicians by 2025.

This is where the retail clinics will fill the void, experts said, by not replacing the primary care physician, but rather adding another avenue for care.

Patrick Carroll, chief medical officer of the Walgreens Health care clinics and a family practice physician, said he was managing 3,000 patients at his practice, many of whom he could not schedule for same-day appointments or on nights and weekends.

More than a third of Walgreens patients and about half of CVS patients visit the clinics after work hours or on weekends, the companies said. The clinics are frequently staffed by nurse practitioners, who are expected to increasingly become patients’ first stop for less-complicated medical issues.

But Susan Lynch, CEO of the Florida Association of Nurse Practitioners, said this may become a problem in Florida where nurse practitioners are more limited in practice than in any other state.

Florida is the only state that does not allow nurse practitioners to become licensed to prescribe medications such as cough medicine with codeine and some pain killers, Lynch said. Florida nurse practitioners must also be supervised by a physician. A Florida Senate bill this year proposes expanding their abilities to prescribe drugs.

In South Florida, Florida Blue is leading the charge for more innovation in retail health care by tapping into technology and the area’s cultural ties.

At Florida Blue’s storefront across from The Falls mall, a futuristic white and blue pod called HealthSpot waits to serve clients with minor medical issues.

Patients can enter the 8-foot-by-7-foot pod and video chat with a local doctor. The doctor can release one or more of the six hatches next to the screen, revealing devices like a stethoscope or a blood pressure cuff, that a medical attendant will then use to check the patient.

Christine Suarez, the telehealth medical assistant at The Falls Florida Blue, said customers were skeptical at first about using the kiosk but most left pleased with their care. Services can cost up to $49 and are only available for Florida Blue policy holders.

The Falls retail store is the first to offer HealthSpot, which opened in mid-November, but more are planned in the future, said Penny Shaffer, Florida Blue South Florida market president.

“A lot of the conditions could be treated in a less expensive and more appropriate setting,” Shaffer said. “It’s driven a number of organizations to look for where those gaps are and try to fill those gaps.”

In South Florida, she said, Florida Blue has found that those gaps are in the way health care is provided to the area’s large Central and South American population.

Up next in retail health care will be CiniSanitas, three clinics to be opened in Kendall, Doral and Miami Lakes by September that offer a variety of services for these populations.

In a partnership between Organizacion Sanitas Internacional, a health care business group in Colombia, Venezuela, Peru and Brazil, and Florida Blue’s parent company Guidewell, the integrated care clinics will tap into a model of health care that South and Central American populations are familiar with.

In Latin America, clinics are “the more preferred setting for care that provides really integrated health outcomes,” Shaffer said.

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In Florida, 93 Percent Of Enrollees Get Financial Help For Obamacare

Chabeli Herrera, The Miami Herald — Wed, 11 Mar 2015 16:30:11 +0000

The vast majority of Floridians who signed up for healthcare coverage under the Affordable Care Act this year received financial assistance — the second highest rate of financial help in the nation, according to federal data released Tuesday.

The numbers were released from the U.S. Department of Health and Human Services just as the legality of the financial help, which comes in the form of tax credits, is being tested in the courts. The U.S. Supreme Court heard arguments March 4 in a case challenging tax credits under the provisions of the ACA.

About 93 percent of the nearly 1.6 million Floridians who signed up for health insurance on the federally-facilitated marketplace during the enrollment period that ran from Nov. 15 to Feb. 15 received a tax credit to lower the cost of their monthly premium. In 2014, 91 percent of Florida consumers had financial help.

Only Mississippi ranked higher, with 94 percent of enrollees receiving a tax credit.

“The figures released today tell a story of health coverage consumers rely on for financial and health security — and of coverage they don’t want to lose,” said HHS Secretary Sylvia M. Burwell, in a press release.

Before financial assistance, the average monthly premium in Florida was $376. The average tax credit awarded was $294. That means the average monthly premium in Florida was only $82.

Just two states — Mississippi with $52 and Georgia with $73 — have lower average monthly payments.

Nick Duran, Florida state director for Enroll America, a nonprofit that advocates for people to gain coverage, said that while educating consumers about their access to financial assistance, many began to reexamine their healthcare options.

“We have seen the need and the access to financial assistance is a big interest and a big conversation starter,” Duran said. “Folks went out and took advantage of that opportunity to do so.”

The Tuesday report offered little information on minority enrollment. It is not required to specify race or ethnicity when signing up for coverage, and about 37 percent of people elected not to, said Meena Seshamani, director of the office of health reform at HHS.

Nationally, of those who did list race and ethnicity, 11 percent were Latino, 14 percent were African American and 65 percent were white.

In total, 11.7 million consumers signed up for coverage on either a state or federally-facilitated marketplace across the country. About 87 percent who enrolled though HealthCare.gov received a tax credit.

Florida, the national leader in sign ups, reenrolled 45 percent of its consumers. About 55 percent were new enrollees.

Of those who reenrolled, 41 percent switched plans from last year, a figure that federal officials said revealed greater consumer engagement with the marketplace.

“Marketplace consumers took charge of their healthcare and that sends an important signal to insurers,” said Kevin Griffis, acting assistant secretary for public affairs at HHS. “It is not enough to simply be in the marketplace. If you want to win in business, it’s critical to compete on price.”

Griffis said that nationally, there were 25 percent more insurers in the marketplace this year. Still, the average premium in Florida went up slightly from $68 last year.

Ron Pollack, executive director of Families USA, the national organization for healthcare consumers, said that fluctuation is not surprising.

“The fact that this has been an enormous success in Florida means that more insurance companies will be encouraged to offer plans in this marketplace,” Pollack said. “That helps to put downward pressure on premium costs.”

The importance of the tax credits to lower premiums will come to a head in June, when the Supreme Court is expected to make a decision in King v. Burwell, the case which challenges specific wording in the ACA that says tax credits will only be available to consumers who purchase coverage in exchanges “established by the state” — not the federal government.

In Florida, which has a federally-run exchange, about 1.48 million people would likely stand to lose their tax credits.

Last week, Families USA sent several Floridians to Washington, D.C., to tell their stories about the importance of their tax subsidies on the steps of the court as oral arguments for the case began.

“If the opponents of the ACA prevail in court, it will mean that huge numbers of people will have their subsidies withdrawn and they will probably rejoin the ranks of the uninsured,” Pollack said. “The stakes, with respects to the court decision, could not be higher.”

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South Florida Doctors Explain Co-Insurance, As Well As Cholesterol Counts

Chabeli Herrera, The Miami Herald — Thu, 05 Mar 2015 10:00:39 +0000

In the last two years, pulmonary specialist Dr. Eduardo G. Martinez has become accustomed to the sight in his Hialeah office: newly insured patients flashing laminated healthcare insurance cards to show they are now covered under the Affordable Care Act.

“Most people hand you that card like they are giving you an American Express Platinum without a limit,” said Martinez, vice president of the Dade County Medical Association, the largest physician group in the South Florida county.

Dr. Bernd Wollschlaeger speaks to a patient at his North Miami Beach practice in 2007. Wollschlaeger, a family medicine doctor, has had to educate consumers who know little about their Affordable Care Act coverage plans while also juggling a higher patient load, more paperwork and issues with reimbursement since the passage of the act. (Photo by Peter Andrew Bosch/Miami Herald)

But for many physicians, the so-called Obamacare cards also mean new challenges — consumer misinformation, increased paperwork, heavier patients loads and the worry of unreliable reimbursements and payments.

“We have turned people away,” Martinez said. “ I know some colleagues who said, ‘At this time we are not taking any Obamacare patients.’ It’s a preventative action to avoid having these problems.”

The ACA does not penalize doctors for refusing to take Obamacare patients, but those who do may be in violation of their their contractual agreements with insurance companies.

The stresses for providers then become evident from the moment new patients come in.

Some don’t know the name of their insurance companies. Many are surprised by high deductibles. Doctors are placed in the sometimes-difficult position of teaching patients that insurance doesn’t mean everything is covered.

“The level of health care literacy is difficult to deal with because it’s often very low,” said North Miami Beach family physician Dr. Bernd Wollschlaeger. “Am I now the explainer-in-chief, after the fact?”

Most new enrollees pick a plan based on sticker price — the monthly premium — ignoring other costs such as the deductible, the amount patients must pay before the insurer begins to cover costs, or co-pays, payments by the patient for covered services like doctor’s visits.

According to , a health insurance analysis company, the average 2015 deductible for a bronze plan, which is the lowest cost and least coverage plan, is about $5,000 The silver-level plans, which offer more coverage at a slightly higher price and are the most popular among consumers, have deductibles at about $2,650.

Until the deductible is paid, services doctors provide outside the ACA’s free preventative care screenings go unpaid, a situation that can become volatile when a screening reveals a chronic condition that requires deductible payments before treatment begins.

“They look at you like if you’re crazy and say, ‘No, but I have insurance,’” Martinez said. “We become the target of their frustrations. We are the doctors. We are the bad people. They have the card and [they think] we don’t want to see them.”

Wollschlaeger said explaining deductible costs has led to “bad blood” between him and several of his patients, with some even leaving his practice.

“I have to explain that it’s not me, it’s the insurance plan they chose,” he said.

Communicating with insurance companies and ensuring payment for services is often difficult, too.

Under the ACA, patients who stop paying their monthly premiums have a 90-day “grace period” to start paying their bills. After the first 30 days, these patients go into a “pending” status with their insurance company. Once pending, the patients can continue to receive care, but physicians will not be reimbursed by the insurance company, and if the patients can’t cover the costs either, the doctors are left unpaid.

Martinez said his office staff spends up to 30 minutes on the phone with insurance companies to establish if ACA patients are still paying their monthly premiums. Even after insurance companies say the person is on the plan, they often add the caveat of “no guarantee for payment,” Martinez said.

Money isn’t the reason most doctors go into the profession, he said, but it is necessary to keep his practice afloat and pay his staff.

“People don’t understand that running a medical office is like running a small business,” Martinez said.

And then there’s the extra paperwork that must be completed, from charts for new ACA patients to quality of care self assessments.

Wollschlaeger said administrative tasks have become about 40 percent of his workload, up from 20 percent before the ACA. On Monday, he finished seeing patients and started paperwork at 6 p.m., a time he would have used for that modern-day rarity, house calls.

“Something has to give,” Wollschlaeger said. “More paperwork means less patient care.”

Steven Ullmann, director of the Center for Health Sector Management and Policy at the University of Miami, said the average load for a primary care doctor is about 3,000 patients a year. This year, Florida enrolled 1.6 million consumers in the federal marketplace, adding to the primary care burden.

According to a 2014 survey by the Physicians Foundation, 81 percent of doctors describe themselves as over-extended or at full capacity, up from 75 percent in 2012 before enrollment began. About 44 percent said they planned to cut back on the number of patients they see, stop taking new patients altogether, work part-time or retire.

Wollschlaeger has come up with his own solution to juggle the growing patient load: work more hours.

As the program continues to develop in the next few years, doctors say consumer education and streamlining of paperwork and payments will help.

“The success stories of the system are when a patient tells me that it’s the first time that they can get regular care,” Wollschlaeger said. “I want the system to work.”

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Lesser-Known Florida Insurance Exchange Spends $2.4M, Signs Up 50 People

Chabeli Herrera, The Miami Herald — Tue, 24 Feb 2015 10:00:34 +0000

The federal marketplace, healthcare.gov, was not the only place where Floridians could sign up for coverage during the 2015 open enrollment period, but it sure was better known.

The other alternative was Florida Health Choices, a voluntary marketplace created in 2008 for Floridians to purchase coverage. It operates independently of the federal exchange at healthcare.gov — which enrolled 1.6 million Floridians — and unlike the federal exchange, does not offer subsidies.

With the open enrollment period over on Feb. 15, the numbers are in. A total of 42 consumers enrolled for health care plans this year and another nine people obtained other insurance coverage on the state marketplace. Their total premiums: $253,170.

The state has spent $2.4 million to run the program, despite signing up fewer than 50 Floridians, said Rose Naff, CEO of the state exchange.

The average monthly premium for a plan at Florida Health Choices was $427, Naff said.said Rose Naff, CEO of the state exchange.

Still, Naff insisted it is not a healthcare.gov vs. Florida Health Choices issue.

“We are not in competition with healthcare.gov,” Naff said. “Our target audiences are miles apart from each other. We don’t offer any subsidies and we are not giving it away for free.”

She said about 25 percent of consumers who contacted the Florida exchange left to pick a plan on the federal exchange instead.

The Florida exchange, which started by selling discount plans with limited benefits, began selling Affordable Care Act compliant plans on Jan. 5.

Naff noted the exchange has only been open from that date to the end of open enrollment on Feb. 15. Open enrollment on the federal marketplace opened Nov. 15.

In an attempt to reach more consumers, Florida Health Choices spent $75,000 in a marketing campaign targeting the key uninsured markets of Miami, Tampa and Orlando with billboard and radio ads. Most of the signs-ups were in the Tampa and Orlando area, Naff said, as well as some Miami-Dade County residents.

In December, Florida Health Choices sent letters to presidents of 15 nonprofits who used some variation of its slogan, “The Health Insurance Marketplace,’’ a phrase Naff said infringed on the trademark protection of the Florida Health Choices brand.

Naff sent out another 11 letters earlier this month to those who had ignored her original request.

The brand dispute has not been resolved, she said.

Naff said the exchange will not expect to receive further state funding.

“This is going to be a self sustaining venture,” she said.

Miami Herald Staff Writer Daniel Chang contributed to this report.

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