Lisa Stiffler, Seattle Times, Author at �鶹Ů�� Health News

Study Finds Lackluster Sign-Ups On State-Run Health Insurance Exchanges

Lisa Stiffler, Seattle Times — Thu, 09 Apr 2015 09:00:48 +0000

Washington was one of two states nationwide in which the number of people buying health insurance through government-run exchanges went down in the second round of open enrollment, which ended in February.

The decline was a modest 2 percent, falling to roughly 160,000 participants — but the state’s goal had been to show a sizable increase.

Overall, the states that ran their own Affordable Care Act-created (ACA) exchanges grew a total of 12 percent, while those using the federal exchange grew by 61 percent, when comparing the close of enrollment in 2014 to sign-ups this year.

“We’re questioning why state-run exchanges did so much worse,” said Chris Sloan, a manager at Avalere Health, which analyzed the figures for a report in which the health-care advisory company examined 11 state-run and 34 federally run exchanges for which there were data.

But officials with Washington’s exchange, called Healthplanfinder, said the report missed a key part of the story.

The broader goal of the ACA is for nearly every American to have health insurance, whether through a private insurance company or a government program. And while Washington’s exchange has had a lackluster performance for 2015 enrollments, the state has covered impressive numbers of people through an expansion in Medicaid, exchange officials said.

Since the state made Medicaid accessible to more people at the start of 2014, more than half-a-million newly eligible adults have joined the program, raising the total enrollment to 1.7 million. As a result, the rate of uninsured residents has dropped by roughly 40 percent in Washington since major provisions of the ACA took effect.

Under the ACA, Medicaid eligibility (in states that chose to do so) was expanded to people whose income was up to 138 percent of the federal poverty level.

Avalere’s analysis of exchange enrollments year over year “was a pretty narrow parameter to define success,” said Michael Marchand, spokesman for the Washington Health Benefit Exchange, which runs Healthplanfinder.

In fact, the 10 states with the lowest growth in their exchanges all had expanded their Medicaid coverage. Conversely, seven of the 10 states with the largest growth didn’t loosen the definition for Medicaid eligibility. In states with expanded Medicaid, some potential exchange customers would have instead qualified for the free health-care program, shrinking the potential customer base.

“You can’t look at the marketplace in isolation because Medicaid was picking up a lot of lower-income people who would have been easiest to enroll,” said Larry Levitt, senior vice president of the Kaiser Family Foundation.

To encourage people to buy exchange insurance, the government offered tax subsidies that cut the cost of monthly premiums. Those making less money qualify for the largest subsidies. In Washington, 77 percent of those enrolled in the exchange received a subsidy.

But while Washington can boast a large reduction in uninsurance rates, exchange enrollments still matter. By law, all exchanges are supposed to be financially self-sustaining by Jan. 1 of this year. And the exchange’s budget is funded primarily by taxes and fees levied on plans sold through the marketplace.

The state had hoped to sign-up 213,000 people during the November to February enrollment window, but only enlisted about 160,000. Washington reopened enrollment days after it closed to give people who were unaware of the tax penalty for going without insurance a chance to get coverage. That window closes April 17, and by late March the enrollment was more than 165,000.

This was the first year that exchange customers needed to renew their coverage and there was some confusion in Washington about what the renewals required.

Public Health — Seattle & King County’s Daphne Pie manages the network of outreach organizations working to get people covered. Public Health and its partner organizations called roughly 1,600 customers who hadn’t renewed their exchange insurance. They found many didn’t understand the renewal process or hit technical snags in renewing online.

“It was a new process, and I think that’s where the state is getting the lower numbers,” Pie said.

And despite all of the publicity around the insurance exchanges and Obamacare, some people are still figuring out what it all means to them.

“For some people health-care reform is still new to them,” Pie said. “It’s not a reality until people get their taxes done and realize they need health insurance” or face a penalty.

For federal taxes being filed this year, the uninsured can expect to pay a penalty of 1 percent of their adjusted household income or $95, whichever is more. The penalties ratchet up each year.

Some people will decide that the penalty isn’t enough to compel them to get insurance, but Levitt expects that to change by 2016 when it goes up to 2.5 percent of income and $695 per adult, predicting

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Boeing, Health Care Providers Join Forces In Bid To Curb Costs

Lisa Stiffler, Seattle Times — Tue, 17 Jun 2014 15:57:00 +0000

Boeing and some of the Northwest’s largest health care providers are teaming up to provide what they say will be higher-quality, more-affordable care for some of the aerospace giant’s employees.

To accomplish this, the company will work with accountable care organizations, or ACOs, an increasingly popular strategy for health-care delivery that puts more responsibility on providers for improving patients’ health and reining in costs.

Boeing has “created a flight plan for a new era of health care,” said Dr. Paul Ramsey, chief executive officer of UW Medicine, at a Seattle news conference Friday to announce the partnerships.

UW Medicine as well as Providence Health & Services and Swedish Health Services have each recruited a network of hospitals and clinics and formed their own ACOs. Boeing has separate contracts with each to provide care for Puget Sound-area employees beginning next year.

These employer-driven ACO arrangements, with no insurance company involved, are believed to be among the first in the nation to use this approach and could serve as models elsewhere.

“The advantage for Boeing will be that they can take the middle man out of the equation between the patients and the health system. It may be able to reduce cost, in part because of the simplification of not having the insurance mechanism in the middle,” said Dr. Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire.

“It’s a very interesting model and worth pursuing,” Fisher said.

There were more than 600 ACOs nationwide at the start of the year, and they are being touted as a key strategy for curbing U.S. health-care costs. The fundamental idea is that doctors and hospitals are rewarded for keeping and making patients healthy, rather than a “fee for service” approach where they earn more for prescribing lots of tests or scheduling appointments regardless of how a patient fares.

“It allows us to innovate and take care of people better,” said Dr. Joseph Gifford, chief executive of Providence-Swedish Health Alliance.

In the deal with Boeing, the contracts set goals for the employees’ medical costs. If the costs are higher or lower, the provider either foots the bill or reaps the savings.

The contracts also include quality goals that matter to patients, such as the ability to schedule appointments in a timely manner and maintaining patient safety and satisfaction. There are additional benchmarks tied to costs, including reducing readmissions to hospitals after treatments and effectively managing chronic conditions such as diabetes and heart disease.

In the fall, 27,000 Puget Sound-area Boeing employees and some 3,000 retirees will be able to choose either of the ACOs as their personal and family health plan, a coverage option Boeing is calling the “Preferred Partnership.”

Eligible participants — who include nonunion workers and certain union-bargaining units — will also have the option of keeping their current plans or choosing another non-ACO plan. Those signing up for Preferred Partnership will select between Providence-Swedish or UW Medicine. The plans go into effect Jan. 1.

Alan May, Boeing’s vice president for human resources, would not say how much the company hopes to save through the ACOs and would not give a time frame for the partnership, but would only say these are “multiyear contracts.”

Boeing officials say there are numerous incentives for using Preferred Partnership, including lower paycheck deductions to pay for care, larger company contributions to Health Savings Accounts, no co-payments in many cases for visiting primary-care doctors and 100 percent coverage for generic-drug prescriptions.

One benefit to the providers is access to more patient data. In a traditional system, a patient sees a doctor who prescribes medicine or a follow-up procedure, but the doctor has no way of knowing if the patient followed through. Because Boeing is paying the costs, the company can share that data with providers, which can then try to determine the cheapest, most effective approaches.

The health-care providers also emphasized that the ACOs will be easier for patients to use because their providers can coordinate appointments and treatment across their network of doctors, clinics and hospitals, relieving patients of that responsibility.

The Providence-Swedish ACO includes the network’s clinics and hospitals, as well as The Everett Clinic, Pacific Medical Centers clinics, The Polyclinic, Proliance Surgeons and others. Some members of the UW Medicine network are Seattle Children’s Hospital, Seattle Cancer Care Alliance and the Overlake and Northwest Hospital centers and clinics.

Patients will have to pay more for care outside of their network, unless they have a disease that requires outside expertise, which they would have access to at no additional cost.

Officials with UW Medicine and Providence-Swedish were clear that Friday’s launch of their ACOs and their partnership with Boeing was just the beginning.

“There is a lot of movement in this direction,” said Dr. Jeff Harris, who leads the Health Promotion Research Center at the University of Washington and is not affiliated with the ACO.

The use of ACOs began picking up after the 2010 passage of the Affordable Care Act, which allowed Medicare to contract with these organizations. Most ACOs serve Medicare recipients, according to the journal Health Affairs. A smaller number are being used to manage Medicaid recipients and patients in the private sector.

Dartmouth’s Fisher is hopeful the ACOs can help heal an inefficient health-care system.

“There is so much waste,” Fisher said. “ACO arrangements are intermediate steps toward more fundamental reforms.”

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Washington State’s Insurance Ads: Quirky And Hip Or Offensive?

Lisa Stiffler, Seattle Times — Tue, 04 Mar 2014 16:50:25 +0000

This story was produced in partnership with

Are the new ads promoting health insurance for Washington state’s young people quirky, hip and funny — or are they insulting and offensive?

Michael Marchand says it doesn’t matter.

“I don’t care if people like or hate what I’m doing, so long as they get the URL right,” said Marchand, director of communications for the Washington Healthplanfinder, the website where people can buy subsidized health insurance plans.

The , feature two fictitious rappers who interview real residents about their success enrolling in health plans through the state’s exchange. The duo are sort of a caricature of rap artists. One is white and wears an absurdly thick gold chain, a coat with a white furry hood and white baseball cap. The other is African American, chubby and wears a green satin jacket and shades.

In the week after the ads started running, there was a 10 percent increase in the number of young adults initiating and completing their enrollment in health insurance plans through the exchange, Marchand said.

At a recent board meeting of the , which runs the insurance site, board members expressed their concern about the campaign.

“People are really offended” by the ads, said Bill Hinkle, a board member.

He told Marchand he wanted the ads pulled. Hinkle, a former lawmaker from Eastern Washington, said people had approached him to say they thought the ads promoted racial stereotyping and were upset about it.

“We’ve gone a little bit beyond proper taste,” Hinkle said, though he did compliment the campaign as creative and Marchand as audacious.

Richard Onizuka, chief executive officer of the exchange, defended the ads, noting they were well researched to find an approach that would resonate with young adults. The state is through ads, contests to win concert tickets and promotions at events including roller derby bouts.

“We worked with a national marketing firm and they understand the demographic,” Onizuka said.

Locally and nationally, folks running the insurance exchanges have pushed to boost enrollment in “young invincibles” — people who are 18 to 34 years old and may think they are unlikely to need health insurance. The demographic is desirable because they tend to be healthier and cheaper to cover, so their insurance premiums can help pay the medical bills for older, sicker enrollees.

So far, young invincibles make up of the insurance exchange enrollees in Washington. Statewide, they represent roughly half of the uninsured population.

Board chair Margaret Stanley asked if the ads could be pulled and replaced with previous ads. Stanley, a retired director of the Puget Sound Health Alliance and former senior vice president at Regence BlueShield, wondered “is this the best use of our dollars and opportunity to reach people?”

Marchand and other officials working for the health insurance exchange said they are going to consider the issue further, but did not commit to removing the ads. They said it came down to a matter a taste.

“Any art form,” Marchand said, “whether it’s ads, painting or music, is going to be subjective.”

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Many Breast-Feeding Moms Unaware Of Health Law Help

Lisa Stiffler, Seattle Times — Tue, 27 Aug 2013 19:00:22 +0000

This story was produced in partnership with

New moms crave information, whether it’s car-seat safety ratings, the pros and cons of pacifiers or how best to sooth a colicky infant.

So it’s a little surprising that many moms aren’t up to speed on how the Affordable Care Act could benefit them. The law has specific requirements targeting moms, including coverage for breast pumps and consultants to help breast-feeding mothers.

“So many moms don’t know about the benefit,” said Cary Seely, director of provider relations at Pumping Essentials, a California-based company selling supplies and services to assist in breast-feeding.

While many of the changes mandated by the Affordable Care Act will benefit low-income Americans by expanding access to health insurance, the Obama administration has tried to build support among a wide swath of the public. Officials routinely tout reforms included in the new law that are designed to help the middle class. Among them are provisions that mandate insurance coverage regardless of pre-existing conditions; allow adult kids to stay on their parents’ insurance plans until they’re 26; require free preventive services such as mammograms, colonoscopies and flu shots — and institute the breast-feeding provisions.

But in a recent poll, only 36 percent of Americans surveyed said the law “will make things better” for the middle class.

When Whitney Courson, of Seattle, was pregnant earlier this year with her first son, a friend advised her that her insurance might pay for a breast pump, which generally costs $200 to $400 for an electric model. She forgot about the tip, even putting the pump on her baby-gift registry, hoping someone would buy it for her. Then another parent mentioned the benefit at a childbirth class.

This time, Courson called a representative at Premera Blue Cross, her insurance provider through her husband’s job at Amazon.com, and learned it would cover the cost of a breast pump. She bought one and had her baby, Nicholas, in July.

She loves the ability to pump and store milk so that she can bottle-feed her son when she needs to, or so that someone else can feed him in her absence.

“Now I’m telling everybody I know, ‘Call your insurance, this is amazing,’ ” she said.

The Affordable Care Act provision supporting breast-feeding went into effect for new health-insurance plans a year ago, but many plans didn’t incorporate the benefit until January 2013, when they were renewed.

One hurdle to more widespread use of the provision is the vague language used to describe it, leaving insurance companies to come up with their own interpretations of what it means.

Many plans require women to purchase their supplies from an approved medical-device provider, while other others will allow a mom to get reimbursed for a purchase made anywhere. Some will pay only for a handheld, nonelectric device, while others cover more premium pumps. The rule is even more unclear on the lactation-support provision, with no definition of who is qualified to assist a woman trying to breast-feed.

When Courson initially found breast-feeding difficult, she again turned to her insurance provider.

“I had so many questions and concerns. I wanted to see a lactation consultant so I called insurance just to see.”

Courson learned that she had coverage for counseling, and found a provider who would visit her home. Now more than a month after delivering Nicholas, breast-feeding is going well.

“Knowing this kind of care is available and covered … that is huge,” she said.

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Mapping A Strategy To Reach Uninsured In King County, Wash.

Lisa Stiffler, Seattle Times — Fri, 09 Aug 2013 09:03:13 +0000

This story was produced in partnership with

Health officials in King County, Wash., are rallying the troops and drafting maps to prepare for an all-out effort to get health-care coverage for uninsured residents.

Countywide, approximately 16 percent of the population lacks health insurance. But from Burien and Tukwila south to the county line, and in scattered pockets to the north, those numbers are higher, reaching nearly one-third in some places.

Officials will specifically target these areas for education and outreach in order to boost insurance coverage as required by the federal Affordable Care Act.

Officials need to be strategic, considering they aim to enroll, in the six months beginning Oct. 1, as many as they can of the 217,300 uninsured adults the county counted in 2011. (The state estimates the number could reach 282,200, including children, by 2014.)

That’s why Dr. David Fleming, director of Public Health — Seattle & King County, wanted a map that took a close look at where the folks without insurance are living.

The information will allow the agency to better understand who they are trying to reach: Is there a high concentration of a certain ethnic group? Does the population include large numbers of “young invincibles,” who often eschew health insurance?

It also helps to highlight where the agency should allocate its resources.

Once enrollment starts in October, state officials will be able to track where people are signing up for insurance. Fleming and his staff will scrutinize and respond to those numbers.

“It allows us in real time to change the focus of our outreach efforts,” Fleming said.

If enrollment is low in an area with a particular immigrant population, for example, the county could provide additional printed materials in their language. Or if the audience includes a lot of young people, the outreach could shift to better appeal to them.

Public Health staff is starting to train an army of health-care troops from community health, housing and social-service centers who will connect with these folks on the ground.

Daphne Pie, program manager for Public Health’s access and outreach, says her organization has weathered countless policy changes over the years. Programs that help low-income families and retired residents can expand, contract or even disappear, but the need to help people navigate shifting policies has remained.

“We have been doing it for so long, we don’t have to create a network,” she said. “We don’t have to ramp up.”

The challenge, Pie said, will be making sure they are able to successfully train the groups partnering with Public Health to help people wend their way through the new insurance and expanded Medicaid programs. Twenty-three community groups will help them educate and recruit uninsured residents.

One partner is Sea Mar Community Health Centers, which has about 60 health facilities across the Puget Sound region.

“It’s a little overwhelming trying to speculate what we’re going to be dealing with,” said Rudy Vasquez, director of Sea Mar’s managed-care operations. “We don’t know what the response is going to be. We’re still trying to wrap our heads around it.”

Despite the uncertainty, Vasquez says people in his organization are trying to get out in front of the effort. Already, they’re attending community events to answer questions about the new law and reaching out to current patients who lack insurance to prepare them to enroll.

Vasquez looks forward to a new normal that includes better care for more people.

“It’s not a project for us,” he said. “It’s more of a mission.”

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