California Healthline: Health Insurance

Kaiser Permanente Reveals Source of Website Issues

Wed, 27 Jan 2016 20:42:00 Z

Kaiser Permanente is offering some explanation of the "intermittent access issues" its website had earlier this month. Kaiser said the issues were the result of a 20% increase in "post-holiday" traffic to the site, which caused "load-balancing issues." The outages blocked 10.2 million enrollees and thousands of providers from communicating via the health system's My Health Manager system. Kaiser said the outage did not affected its ability to provide care or access health records at any location. San Francisco Business Times' "Bay Area BizTalk."

Anthem Profits Down 64%, Missing Expectations

Wed, 27 Jan 2016 20:28:00 Z

On Wednesday, Anthem reported earnings for the fourth quarter of fiscal year 2015 that are 64% lower than earnings for the same time a year earlier. The health insurer reported $180.9 million in earnings in Q4 2015, compared with $506.7 million in Q4 2014. The decline in earnings can be attributed in part to higher expenses. AP/Washington Times.

Insurer Loses Hard Drives With Personal Health Data on 950K People

Wed, 27 Jan 2016 15:17:00 Z

St. Louis-based health insurer Centene is notifying nearly 950,000 individuals that six hard drives containing customers' personal and health information have gone missing. Centene is working to complete a $6.8 billion acquisition of Woodland Hills-based Health Net, which has about 2.9 million California enrollees. Reuters et al.

One Year Left: How Can Obama Secure His Health Care Legacy?

Wed, 27 Jan 2016 11:30:00 Z

After throwing the bulk of his political capital behind the passage and implementation of the Affordable Care Act in the first seven years of his administration, what can President Obama do in his final year in office to secure that legacy?

Unreasonable Rate Hike? Proposed Legislation Would Tell You About It

Wed, 27 Jan 2016 11:00:00 Z

A new Senate bill proposes that the state inform consumers when state officials find health insurance rates to be unjustified.

CBO Reduces Projection for 2016 ACA Exchange Enrollment by 8M

Tue, 26 Jan 2016 15:27:00 Z

The Congressional Budget Office has scaled back its 2016 enrollment projections for the Affordable Care Act's exchanges, from 21 million people to 13 million. CBO attributes the change in part to projections that fewer individuals will receive federal subsidies to help offset the cost of purchasing exchange coverage. Roll Call et al.

California's Largest Health Plans Could Owe Billions in Back Taxes

Mon, 25 Jan 2016 14:45:00 Z

California's largest health plans -- Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser Permanente -- could owe $10 billion in back taxes and at least $1 billion annually going forward depending on the outcome of cases centering on whether they should be regulated as insurers. San Jose Mercury News.

Health Insurers Grilled Over Merger

Mon, 25 Jan 2016 11:00:00 Z

State officials had some pointed questions for health insurers last week during a hearing on the proposed sale of Health Net to Centene.

Ongoing Access Issues With Kaiser's Website Not Due to Cyberattack, Officials Say

Fri, 22 Jan 2016 19:29:00 Z

Kaiser Permanente says that "intermittent access issues" with its website were not caused by a cyberattack. The issues have been occurring for at least three days. The outages blocked 10.2 million enrollees and thousands of providers from communicating via the health system's My Health Manager system. Kaiser said the outage has not affected its ability to provide care or access health records at any location. San Francisco Business Times' "Bay Area BizTalk."

SCOTUS Ruling Bars Insurers From Suing Some Beneficiaries for Reimbursements After Injury Settlements

Thu, 21 Jan 2016 18:26:00 Z

The Supreme Court on Wednesday in an 8-1 decision ruled that insurers cannot require beneficiaries who were awarded injury settlements to reimburse insurers for medical expenses if the beneficiaries already spent the awards. The ruling, which reverses a decision by the 11th U.S. Circuit Court of Appeals, applies only to plans governed by the federal Employee Retirement Income Security Act. Modern Healthcare.

Hearing on Mergers May Get Testy

Thu, 21 Jan 2016 11:00:00 Z

A hearing this week examining a merger of health insurance companies -- one of three proposed deals pending approval -- could get a little heated.

Study by USC, Harvard Researchers Finds High-Deductible Plans Do Not Prompt Enrollees To Compare Costs

Wed, 20 Jan 2016 19:09:00 Z

A recent study by researchers at the University of Southern California and Harvard University finds that high deductibles do not increase the likelihood that health plan enrollees will search for less expensive care. In a national survey, just 4% of enrollees in high-deductible plans reported comparing costs the last time they used health care services, even though many cited concerned about costs. In comparison, 3% of enrollees in low-deductible plans compared costs for medical care the last time they used it. KPCC's "Impatient."

Obama Administration Tightens ACA Special Enrollment Period Rules

Wed, 20 Jan 2016 15:10:00 Z

CMS has tightened the requirements for special enrollment periods, which allow U.S. residents to purchase coverage through the federal exchange outside of the Affordable Care Act's regular open enrollment periods. However, some stakeholders say the policy update does not go far enough. New York Times et al.

Blue Shield of Calif. Has Approved a Financial Pledge To Meet DMHC Requirements for Care 1st Merger

Thu, 14 Jan 2016 17:56:00 Z

Blue Shield of California says it has made "substantial progress" toward fulfilling financial pledges that were conditions for the approval of the insurer's merger with Care 1st Health Plan. As part of the approval, the state Department of Managed Health Care said Blue Shield must invest at least $14 million a year for 10 years in the Blue Shield Foundation. In a release on Wednesday, the insurer said its board of directors has approved a $35 million contribution to the Blue Shield of California Foundation. San Francisco Business Times' "Bay Area BizTalk."

L.A. Care Health Plan Fined $150K by DMHC Over Claims Payment Issues

Thu, 14 Jan 2016 14:08:00 Z

The Department of Managed Health Care has levied a $150,000 fine against L.A. Care Health Plan after an audit revealed a pattern of unfair payment practices. The audit found that L.A. Care Health Plan paid the wrong interest payments on seven of 73 claims, giving them a compliance rate of 90%, which is below the state's mandated compliance rate of at least 95%. The audit found the health plan also did not respond in a timely manner to 19 of 93 disputed claims, resulting in a compliance rate of 80%. Payers & Providers.

Obama Admin To Update Rules for ACA Special Enrollment Periods

Wed, 13 Jan 2016 14:41:00 Z

Acting CMS Administrator Andy Slavitt says the Obama administration will eliminate certain criteria for special enrollment periods for the federal health insurance exchange and make criteria language easier to understand in response to concerns that people have been misusing the special enrollment periods. Insurers say special enrollment periods could destabilize markets and cause premiums to rise. Wall Street Journal et al.

Former Calif. Regulator Agrees to Fine for Assisting Kaiser in Audit

Wed, 13 Jan 2016 14:16:00 Z

Marcy Gallagher, a former attorney with the California Department of Managed Health Care's enforcement division, has agreed to a fine for helping Kaiser Permanente defend itself against the findings of a 2012 investigation in which she had previously been involved. Los Angeles Times.

Sutter Health, Anthem Blue Cross Reach New Multi-Year Contract Agreement

Tue, 12 Jan 2016 14:29:00 Z

On Friday, Sutter Health and Anthem Blue Cross announced that they have approved a new multi-year agreement. The previous agreement, which expired in December 2015, was reached after two years of contentious negotiations. Sacramento Business Journal.

Many Faces of the MCO Tax

Tue, 12 Jan 2016 11:00:00 Z

Agreement may be near for replacing California's $1.1 billion managed care organization tax, which now looks nothing like it did when it was first proposed.

City of Industry Pays Double the State Average for Public Employees' Health Benefits, Data Show

Mon, 11 Jan 2016 19:33:00 Z

The city of Industry paid an average of $42,770 per employee for health benefits in 2014 -- more than double the state average for the cost of such benefits for public workers, according to data released by Transparent California. Nadereh Pourat, director of research for UCLA's Center for Health Policy Research, said the findings are "very odd," adding, "It boggles the mind, I don't know what that money could be spent on." City Manager Paul Philips said city staff will review the costs, but he questioned the accuracy of Transparent California's numbers. San Gabriel Valley Tribune.

Advocates Urge Calif. Regulators To Scrutinize Health Plan Mergers

Mon, 11 Jan 2016 14:04:00 Z

Consumer advocates are calling on regulators in California and other states to closely scrutinize proposed mergers between some of the nation's largest health insurers, including proposals for Anthem to merge with Cigna and Aetna to merge with Humana. Advocates cite the potential for fewer options and higher costs. Los Angeles Times.

Few Businesses Shifted Full-Time Workers to Part Time in Wake of ACA, Study Finds

Fri, 08 Jan 2016 19:45:00 Z

The Affordable Care Act's employer mandate has not caused employers to shift workers from full time to part time as a way to avoid complying with the mandate's requirements, according to a study published Tuesday in Health Affairs. For the study, researchers looked at data from the Current Population Survey and found that the probability of employees working 25-29 hours per week over the past few years remained about the same, even after the employer mandate took effect in 2015. Likewise, the probability of employees working 30-34 hours per week did not decrease over the past few years. The Hill.

CMS Gets Mixed Feedback on its Medicaid Access Monitoring Rule

Fri, 08 Jan 2016 14:14:00 Z

Providers generally support a CMS final rule that requires state Medicaid agencies to monitor how cuts to provider payment rates affect beneficiaries' access to care but called for additional measures to be monitored. Meanwhile, state Medicaid agencies say they oppose the rule's creation of national standards for access to care. Modern Healthcare.

Survey Finds U.S. Uninsured Rate Plateaued at 11.9% in 2015

Thu, 07 Jan 2016 15:06:00 Z

A new Gallup-Healthways survey finds the percentage of uninsured individuals hovered around 11.9% in 2015, suggesting that the country's uninsured rate has now plateaued. Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, says he "believe[s] the health law has crossed the threshold of sustainability." AP/San Diego-Union Tribune.

New Year, New ACA Provisions, Court Cases and More

Wed, 06 Jan 2016 14:24:00 Z

As the Affordable Care Act heads into its sixth year, employers are bracing for the full employer mandate and new reporting provisions, while the Obama administration prepares to go back to court. In this issue of "Road to Reform," we look ahead to see what 2016 has to hold for health care.

Some ACA Exchange Plans Cover PCP Visits With No Cost-Sharing

Tue, 05 Jan 2016 14:49:00 Z

Health insurers in several markets are offering plans in the Affordable Care Act's exchanges that cover in-network primary care provider visits with no cost-sharing requirements. Such visits are provided in addition to various other preventive services insurers must cover without cost-sharing under the ACA. Kaiser Health News.

Scrutinizing Aetna-Humana Deal

Tue, 05 Jan 2016 11:00:00 Z

At a public hearing yesterday weighing the merits and drawbacks of the Aetna/Humana merger, the director of the state Department of Managed Health Care said she's wary of health insurance consolidation.

CMS: Federal Exchange Enrollment Reached 8.5M as of Dec. 26, 2015

Mon, 04 Jan 2016 15:29:00 Z

CMS says that about 8.5 million U.S. residents had signed up for health plans through the federal health insurance exchange as of Dec. 26, 2015. CMS says 29% of enrollees during the third open enrollment period have been new, while 71% have renewed coverage. The Hill, CMS fact sheet.

8.2M Consumers Signed Up for Federal Exchange Plans, CMS Says

Wed, 23 Dec 2015 14:47:00 Z

The latest CMS data show about 8.2 million U.S. residents have signed up for health plans in the 38 states that use the federal exchange during the Affordable Care Act's third open enrollment period. Meanwhile, officials estimate that millions more U.S. residents have signed up for coverage through the 13 state-based exchanges. Wall Street Journal et al.

Health Reform in 2015: A Year in Review

Wed, 23 Dec 2015 12:57:00 Z

From the King v. Burwell decision to the ultimate "doc fix," there were some major developments in health care reform this year.

Medicare Advantage Enrollment Up 6.8%, Analysis Finds

Tue, 22 Dec 2015 19:34:00 Z

There were 6.8% more U.S. residents enrolled in Medicare Advantage plans as of Dec. 1 of this year than there were at the same time in 2014, according to a Modern Healthcare analysis of CMS data. According to the analysis, 17.76 million senior and disabled U.S. residents were enrolled in MA plans as of Dec. 1, 2015. The 6.8% enrollment growth from 2014 to 2015 is lower than the 8% to 9% annual growth rate MA plans have seen over the past five years. Modern Healthcare.

6M U.S. Residents Singed Up for Federal Exchange Plans as of Dec. 17

Mon, 21 Dec 2015 15:41:00 Z

HealthCare.gov experienced a large surge in signups last week, pushing total enrollment through the federal exchange to about six million U.S. residents. Last week, the Obama administration announced a two-day extension, giving consumers until Dec. 17 to sign up for coverage that will take effect at the beginning of 2016. The Hill et al.

Adventist, Fresno Hospital System To Launch New HMO

Mon, 21 Dec 2015 13:10:00 Z

Adventist Health has joined with Fresno-based Community Medical Centers to launch an HMO serving San Joaquin Valley Medi-Cal beneficiaries. The HMO -- which could provide care to up to 200,000 patients in the first two years -- is subject to approval by state officials. Sacramento Business Journal.

State Urged To Protect Consumers in Proposed Centene-Health Net Merger

Mon, 21 Dec 2015 11:00:00 Z

Consumer advocates, contending that "health care mergers generally lead to … fewer choices, inadequate physician networks and higher premiums," are urging state officials to protect consumers in the proposed merger of Centene and Health Net.

Efforts To Increase Competition, Consumer Choice Through Use of Multistate Plans Unlikely To Succeed

Fri, 18 Dec 2015 17:29:00 Z

An effort to increase the use of multistate plans to help boost competition and consumer choice on the Affordable Care Act's exchanges is not on track to meet its goals. An ACA provision aimed to increase competition by allowing multistate health plans, which can be purchased in more than one state, available on the ACA's exchanges. Some health policy analysts have said the multistate plan program is unlikely to work because of the way health insurance markets typically function. Kaiser Health News.

Analysis: Average Exchange Plan Premiums, Deductibles Rise for 2016

Fri, 18 Dec 2015 15:21:00 Z

A Robert Wood Johnson Foundation analysis finds that the average premium for a silver-level health plan sold on the Affordable Care Act's exchanges for the 2016 coverage year increased by more than 11%, while the average deductible for such a plan increased by 8%. USA Today.

New Study Takes a Closer Look at Market Power, Hospital Prices

Thu, 17 Dec 2015 15:31:00 Z

A soon-to-be-published study in the National Bureau of Economic Research finds little correlation between lower Medicare spending and lower overall health care spending. However, the researchers say there is evidence that hospital market power is strongly related to hospital prices. New York Times' "The Upshot" et al.

Under Review: How DOJ, FTC Decide Whether To OK Health Insurance Mergers

Wed, 16 Dec 2015 12:49:00 Z

While some reviews last just 30 days, it could take antitrust regulators more than a year to approve or deny proposed mergers between Anthem and Cigna and Aetna and Humana. An antitrust law expert says that's because the companies have significant overlap in business products and practices.

State Regulators Could Help Decide Whether Insurer Mergers Move Forward, Experts Say

Tue, 15 Dec 2015 20:20:00 Z

While focus has been on the Department of Justice's role in deciding whether to approve proposed mergers between some of the nation's largest health insurers, state regulators could play a key role in whether the mergers are permitted. In July, Anthem announced that it agreed to acquire Cigna for $48.4 billion. Also in July, Aetna announced it reached a $37 billion deal to purchase Humana. Experts say the companies will not be permitted to merge in states that reject the proposed deals. If enough states reject the mergers, or if the mergers are rejected in just a few states with large populations, the companies could drop the deals because of their reduced financial strength. Modern Healthcare.

More Than 3M U.S. Residents Have Enrolled in Exchange Coverage

Thu, 10 Dec 2015 15:44:00 Z

The latest CMS data show that 2.84 million U.S. residents have signed up for federal exchange plans since the Nov. 1 start of the third open enrollment period. Meanwhile, about 721,000 individuals have signed up for coverage through nine of the 13 state-run exchanges. Modern Healthcare et al.

Calif. Insurers Buck Trend, Report Profits Selling Exchange Plans

Thu, 10 Dec 2015 15:05:00 Z

Blue Shield of California, Kaiser Permanente and Anthem Blue Cross were among the few health plans in the country reporting profits selling policies on the Affordable Care Act's exchanges in 2014. The three insurers accounted for about half of the $362 million in total profit under the risk corridors program. Los Angeles Times.

Slavitt Defends Performance, Sustainability of State-Run Exchanges

Wed, 09 Dec 2015 16:02:00 Z

During a House Energy and Commerce subcommittee hearing yesterday, Republican lawmakers questioned the cost and sustainability of some state-run health insurance exchanges. Acting CMS Administrator Andy Slavitt said some state exchanges have faced financial struggles, but "plenty of adjustments" have been made to ensure the exchanges' success. Modern Healthcare et al.

Hearing Looks at Acquisition of Insurer

Tue, 08 Dec 2015 11:00:00 Z

State regulators heard from all sides during a public hearing yesterday over the planned merger of health insurers Centene and Health Net.

Anthem, Cigna Shareholders Vote To Approve Merger

Mon, 07 Dec 2015 20:42:00 Z

Anthem and Cigna shareholders on Thursday voted to approve a merger agreement between the companies. The companies noted that nearly all of their shareholders voted in favor of the merger. Federal regulators must approve the proposal, and antitrust experts say the Department of Justice and state attorneys general are likely to scrutinize them closely. DOJ will review the proposal over the next year or longer. AP/Sacramento Bee.

Kaiser Permanente To Acquire Seattle-Based Health Insurer

Mon, 07 Dec 2015 14:05:00 Z

On Friday, Kaiser Permanente announced that it will acquire Group Health Cooperative, a Seattle-based health insurer with nearly 600,000 members. Analysts say the move suggests Kaiser is looking to expand its model of integrated care to new markets. Los Angeles Times.

Advocates Ratchet Up Pressure on Blue Shield To Increase Foundation Funding

Mon, 07 Dec 2015 11:00:00 Z

Consumer groups' letter joins concerns raised by the Department of Managed Health Care over insurer's lack of increase in foundation funding after merger approval.

Supreme Court To Hear Case Deciding Fate of All-Payers Claims Databases

Wed, 02 Dec 2015 11:00:00 Z

The nation's highest court is scheduled today to hear a case that could decide the future of statewide health insurance claims databases, which are considered an important tool in improving care and reducing costs.

Cigna Settles Six Class-Action Lawsuits Over Merger With Anthem

Tue, 01 Dec 2015 14:56:00 Z

Cigna has agreed to settle six class-action lawsuits filed by some of the health insurer's shareholders over its proposed merger with Anthem "to avoid the costs, risks and uncertainties inherent in litigation." Shareholders from both insurers will vote Thursday on whether to approve the proposed merger. Modern Healthcare.

Five Charged in $580M Southern Calif. Hospital Kickback Scheme

Tue, 01 Dec 2015 14:09:00 Z

Federal authorities have charged five people in an alleged kickback scheme involving $580 million in improper claims by Pacific Hospital of Long Beach and Tri-City Regional Medical Center. Prosecutors say two of the people charged already have pleaded guilty, while three others have agreed to do so. AP/KQED's "The California Report" et al.

Arizona-Based Co-Op To Close at the End of the Year

Mon, 30 Nov 2015 20:36:00 Z

Executives of an Arizona-based cooperative health insurance plan established under the Affordable Care Act were unable to secure additional financial backing, and the plan will cease operations on Dec. 31. CMS removed health plans offered by Meritus Health Partners and Meritus Mutual Health Partners from the federal exchange following an order for supervision filed by the Arizona Department of Insurance. The co-op did not consent to the order, which prohibited the company from writing new health coverage policies or renewing its existing policies. The health plan's closure means that about 59,000 Arizona residents who had coverage through Meritus will have to find new coverage for 2016. AP/San Francisco Chronicle.

Federal Exchange Sign-Ups Top 560K in Open Enrollment's Third Week

Mon, 30 Nov 2015 15:25:00 Z

The latest federal data show more than 560,000 U.S. residents signed up for health coverage through the federal exchange during the third week of the Affordable Care Act's third open enrollment period, bringing the total number of sign-ups to nearly 1.6 million enrollees. According to the Obama administration, about one-third of those who signed up in the third week are first-time enrollees. The Hill et al.

California Ends State Control of Alameda Alliance for Health

Mon, 30 Nov 2015 14:45:00 Z

Last month, California returned Alameda Alliance for Health, Alameda County's public health insurance provider, to local control, citing the health insurer's financial stability and customer service improvements. In 2014, Alameda Alliance was appointed a state conservator after reports that the insurer was not paying claims properly. San Jose Mercury News.

Insurers Ask HHS for Additional Guidance on Rule Prohibiting Transgender Discrimination

Wed, 25 Nov 2015 16:42:00 Z

Health insurance companies are asking HHS for additional guidance to help them implement a proposed federal rule that aims to prohibit health care discrimination against transgender individuals. Many current enrollment and claims systems record an individual's sex as male or female but do not allow for more specific information about an individual's gender identity, which could lead to confusion. Kris Haltmeyer, vice president of health policy and analysis for the Blue Cross Blue Shield Association, said health plans hope HHS' Office for Civil Rights will grant good faith compliance protection while insurers adjust to the change. Modern Healthcare.

CMS To Provide Full Risk Corridor Payments Despite Program's Funding Shortfall

Mon, 23 Nov 2015 14:07:00 Z

On Thursday, CMS released a memo saying the agency intends to give insurers the full amount of payments the companies requested under the Affordable Care Act's risk corridors provision despite the program's funding shortfall. CMS noted in the memo that if insurers that participated in the exchanges were still owed money under the program next year, HHS "will explore other sources of funding for risk corridors payments, subject to the availability of appropriations." Modern Healthcare.

Disagreement Over Charity Contributions Simmers in Blue Shield's Care1st Deal

Mon, 23 Nov 2015 11:00:00 Z

Blue Shield of California said it is abiding by the language outlining charitable contributions in its agreement with the Department of Managed Health Care clearing the way for its $1.2 billion acquisition of Care1st. Consumer advocates say the insurer is reneging on a promise.

UnitedHealth Considers Pulling Plans From ACA Exchanges

Thu, 19 Nov 2015 19:47:00 Z

On Thursday, UnitedHealth Group signaled it may exit the Affordable Care Act's exchanges, an unexpected announcement that experts say raises concerns about the exchanges' viability. United said it expects significant losses from plans offered via the ACA's exchanges. In an earnings update released Thursday, the company revised its earnings projections for 2015 downward by $425 million because of costs related to individual plans sold on exchanges. Wall Street Journal.

Switching Exchange Plans Could Save Consumers Money, Study Finds

Wed, 18 Nov 2015 15:14:00 Z

A Kaiser Family Foundation study finds that U.S. residents who enrolled in the lowest-cost, silver-level plan through the federal exchange last year likely will see an average 15% premium increase for the 2016 coverage year unless they switch plans. Washington Post's "To Your Health" et al.

Blue Shield, DMHC at Odds Over Terms of Recent Acquisition Deal

Wed, 18 Nov 2015 14:35:00 Z

State officials say that Blue Shield of California is backing out of a charitable pledge of an extra $140 million under a recent acquisition deal. However, the insurer said the terms of the agreement call for a minimum donation of $14 million annually, noting that the deal does not require Blue Shield to pay more than its annual foundation contributions of about $35 million. Los Angeles Times.

Many Unable To Afford Care Under High-Deductible Health Plans Offered Through the ACA's Exchanges

Tue, 17 Nov 2015 18:56:00 Z

Many consumers with health plans purchased through the Affordable Care Act's exchanges say the plans' deductibles are so high that they cannot afford to use their coverage. The high deductibles caused some individuals to drop their health plans and instead pay fines for not complying with the ACA's individual mandate. In multiple states, more than half the health plans available through the federal exchange had annual deductibles of $3,000. New York Times.

Fed Exchange Sign-Ups Reach 543K in First Week of Open Enrollment

Fri, 13 Nov 2015 15:39:00 Z

New CMS data show about 543,000 U.S. residents selected health plans through the federal exchange during the first week of the Affordable Care Act's third open enrollment period. Of those who enrolled through the federal exchange, 66% were re-enrollees, while about 34% were first-time enrollees. The Hill et al.

AMA Calls on DOJ To Block Proposed Health Insurer Mergers

Thu, 12 Nov 2015 15:57:00 Z

In a letter to Assistant Attorney General William Baer, the American Medical Association says the proposed mergers between Anthem and Cigna, as well as Aetna and Humana, would decrease competition and have a negative effect on consumers. However, the insurers argue the mergers, which are subject to federal approval, would bolster competition. The Hill et al.

2016 ACA Exchange Plans Have Higher Premiums, Smaller Networks

Thu, 12 Nov 2015 15:38:00 Z

Individual analyses by Avalere Health, McKinsey and the Robert Wood Johnson Foundation show health insurance plans being sold through the Affordable Care Act's exchanges for the 2016 coverage year have narrower provider networks and higher premium increases than they did this year. Modern Healthcare's "Vital Signs," Politico.

California and its Counties Leading Way on Health Benefits for Undocumented

Wed, 11 Nov 2015 14:32:00 Z

Contra Costa County Supervisor Candice Anderson, Rosa Maria Arriaga, a 72-year-old patient, Álvaro Fuentes of Contra Costa County's Community Clinic Consortium, Gerald Kominski of the UCLA Center for Health Policy Research, Gabrielle Lessard of the National Immigration Law Center, Ira Mehlman of the Federation for American Immigration Reform, Teshina Wilson, a physician at a Richmond clinic, and Anthony Wright of Health Access California spoke with California Healthline about the state's efforts to provide health care to undocumented immigrants.

Calif. Has 36th Lowest Uninsured Rate in U.S., Report Finds

Wed, 11 Nov 2015 14:24:00 Z

A new WalletHub report finds that California's uninsured rate reached 12.45% in 2014 -- the 36th lowest rate in the country. In comparison, the national average was 11.7%. Meanwhile, California between 2010 and 2014 saw an increase in the number of residents enrolled in health coverage. Pacific Business News et al.

White House Launches ACA Enrollment Challenge in 20 U.S. Cities

Tue, 10 Nov 2015 14:44:00 Z

The Obama administration has launched a challenge designed to increase enrollment through the Affordable Care Act's health insurance exchanges in 20 cities during the third open enrollment period. The challenge includes two California cities -- Long Beach and Oakland. The city that enrolls the highest percentage of uninsured residents will win the challenge and a visit from President Obama. Washington Times et al.

Blue Shield Sues Former Executive Over Alleged Breach of Contract

Tue, 10 Nov 2015 10:30:00 Z

Blue Shield of California filed a lawsuit against its former policy director, Michael Johnson, over an alleged breach of contract, arguing that he took and disclosed confidential information. However, Johnson -- who resigned in March and has launched a campaign against the insurer -- says the case has no merit. Los Angeles Times.

L.A. Private Equity Firm Agrees to $2.3M Settlement With Bankruptcy Estate of Former CalPERS Board Member

Mon, 09 Nov 2015 19:42:00 Z

Aurora Capital Group, a Los Angeles-based private equity firm, has agreed to pay a $2.3 million settlement to the bankruptcy estate of former CalPERS board member Alfred Villalobos. Villalobos was indicted on charges of fraud, conspiracy and obstruction of justice after a long investigation into alleged fraudulent efforts to secure million-dollar pension fund investments and other self-benefiting deals. Aurora stopped paying Villalobos in 2010, arguing that his actions constituted a breach of contract. Sacramento Bee.

Insurance Commissioners Aim To Address ACA Health Plan Networks

Mon, 09 Nov 2015 15:53:00 Z

The National Association of Insurance Commissioners has released a proposal that contains recommendations to ensure health insurance companies selling plans through the Affordable Care Act's exchanges have broad provider networks. NAIC drafted the proposal in response to consumers' complaints about limited networks offered in such plans. New York Times.

CDC Data Show U.S. Uninsured Rate Hit New Low of 9%

Fri, 06 Nov 2015 15:43:00 Z

A CDC survey finds that the U.S. uninsured rate fell to 9%, or about 28.5 million people, during the first six months of 2015, reaching a new low. The survey also estimates 16.3 million U.S. residents have gained health coverage since 2013. The Hill, Wall Street Journal.

Preliminary Ruling Could Help UC Retirees Win Benefits

Fri, 06 Nov 2015 14:16:00 Z

Last week, Superior Court Judge George Hernandez in Oakland issued a tentative ruling that could require the University of California to reinstate health care benefits for the UC Livermore Retirees Group. The group argues that during their careers as UC employees, the university made health care commitments and should be required to keep those commitments. The group lost their health benefits in 2008 after University management was replaced with a for-profit consortium and in 2010 filed a lawsuit to regain coverage. Independent News.

Anthem, Blue Shield Fined Over Misleading Provider Directories

Wed, 04 Nov 2015 14:07:00 Z

Yesterday, the California Department of Managed Health Care announced that it has fined Blue Shield of California and Anthem Blue Cross $350,000 and $250,000, respectively, over inaccurate provider directories for their plans sold through Covered California. Los Angeles Times.

Another One Bites the Dust: Why Are 12 ACA Co-Ops Closing?

Wed, 04 Nov 2015 13:12:00 Z

Yesterday, a 12th cooperative health plan created under the Affordable Care Act announced that it will shut down. Why have more than half of such co-ops failed, and what do the closures mean for consumers?

Calif. Has Highest Number of SHOP Exchange Enrollees

Tue, 03 Nov 2015 19:25:00 Z

About 85,000 U.S. residents are enrolled in health plans through the Affordable Care Act's small business exchange, falling significantly short of the Congressional Budget Office's estimate that one million workers would be enrolled in such plans in 2015. As of early last month, California and New York had the highest numbers of SHOP enrollees, with about 6,500 employers enrolling 50,000 workers in the states. Meanwhile, Idaho, Kentucky, Maryland, Minnesota and Washington each had fewer than 200 employers purchase coverage for their workers through the states' SHOP exchanges. Kaiser Health News/USA Today.

China Reportedly Hacked Anthem To Learn About U.S. Health System

Tue, 03 Nov 2015 12:33:00 Z

Individuals familiar with the investigations into a cyberattack against Anthem that affected nearly 80 million people -- including 13.5 million Californians -- say FBI and other investigators have concluded that Chinese hackers conducted the attack to learn about the U.S. health care industry and how it deals with medical care to help improve its own system. Financial Times, MedCity News.

5.5M Reproductive-Age Women Have Gained Health Coverage Under ACA, Report Finds

Fri, 30 Oct 2015 19:01:00 Z

Although 5.5 million reproductive-age women have gained insurance under the Affordable Care Act in the past two years, many continue to face challenges meeting their health care needs, according to a report released by the March of Dimes Foundation and the Urban Institute. The report found that the uninsured rate among women ages 18 to 44 declined from 19.6% in the summer of 2013 to 13.3% in the winter of 2014-2015. According to the report, that decline represents about 5.5 million women gaining insurance coverage. Kaiser Health News.

Study: Some Federal Exchange Plans Lack Access to Specialty Care

Fri, 30 Oct 2015 14:49:00 Z

A new study published in the Journal of the American Medical Association finds about 15% of silver-level health plans sold through the Affordable Care Act's federal exchange in 2015 lacked an in-network physician in at least one specialty. Of those health plans, the study finds five did not cover any of patients' costs for out-of-network physicians. Los Angeles Times et al.

Tenth Co-Op Established Under ACA To Shut Down

Thu, 29 Oct 2015 18:38:00 Z

On Tuesday, Utah officials announced that a not-for-profit cooperative health plan in the state that was established under the Affordable Care Act will shut down by the end of 2015, making it the 10th co-op to close or announce its closure this year. Officials of the co-op, called Arches Health Plan, cited insufficient risk corridors payments as a reason for its closure. Utah Health Commissioner Todd Kiser in a release said, "We are proactively working with other insurers and the federal government to fill the vacancy left by Arches, particularly in the rural areas of the state." Modern Healthcare.

Anthem Agrees To Refund $8.3M to About 50,000 Calif. Policyholders

Wed, 28 Oct 2015 13:11:00 Z

Anthem Blue Cross has agreed to refund $8.3 million to about 50,000 California policyholders to settle a class-action lawsuit over mid-year increases to its annual deductibles, out-of-pocket limits and prescription drug deductibles. Anthem did not admit wrongdoing under the settlement. Los Angeles Times et al.

Silver-Level Federal Exchange Plan Premiums To Increase by 7.5%

Tue, 27 Oct 2015 15:09:00 Z

New HHS data show premiums for silver-level health plans sold through the federal health insurance exchange for 2016 will increase by an average of 7.5%. Insurers requested the increases in part because the costs associated with providing exchange coverage exceeded their projections. Wall Street Journal et al.

Obama Administration Unveils HealthCare.gov Upgrades

Mon, 26 Oct 2015 14:33:00 Z

An updated version of HealthCare.gov includes several new features designed to provide consumers with more information and a smoother enrollment experience. However, officials delayed the release of a tool that will allow consumers to check which physicians and medications are covered under various health plans. Washington Times et al.

Exchange Enrollees Could See Larger Premium Increases in 2016

Mon, 26 Oct 2015 14:21:00 Z

Premium increases for health plans purchased through the state and federal exchanges are expected to be larger in 2016, but they will vary based on local markets. For example, the five insurers participating in Minnesota's exchange are increasing premiums by 14% to 49%, while exchange enrollees in Southern California who re-enroll in their current plans could see an average increase of 1.8%. AP/Sacramento Bee.

Kan., La. and Texas Sue Obama Admin Over ACA Tax

Fri, 23 Oct 2015 19:18:00 Z

Kansas, Louisiana and Texas on Thursday filed a lawsuit against the Obama administration claiming that a tax levied under the Affordable Care Act is unconstitutional. In the suit, the states argue that an excise tax levied on private insurers that helps fund the ACA is ultimately passed on to state governments because the insurers use some of the state funding they receive under Medicaid managed care plans to pay for the levy. Modern Healthcare.

GAO Finds Federal Gov't Paid for Duplicate Coverage Under ACA

Fri, 23 Oct 2015 15:22:00 Z

A Government Accountability Office report released yesterday finds that some individuals received subsidies to help them purchase exchange coverage while they were also enrolled in Medicaid. In a separate investigation, GAO successfully acquired Medicaid coverage and Affordable Care Act subsidies for fake U.S. residents. New York Times et al.

Blue Shield of Calif. CEO Pledges Transparency, Quality Improvements

Fri, 23 Oct 2015 10:39:00 Z

Facing criticism over executive pay, quality and large surpluses, Blue Shield of California CEO Paul Markovich has promised to improve the not-for-profit insurer's poor ratings from patients and disclose more information about executive compensation. Los Angeles Times.

Best Practices for Provider Directories? Study Aims To Inform California Lawmakers

Thu, 22 Oct 2015 10:00:00 Z

Many first-time health insurance buyers rely on plans' provider directories to select coverage or choose a doctor, so why is it so hard for insurers, Medicaid agencies and insurance exchanges to keep those lists up-to-date?

Calif.-Based Collective Health Raises $81M, Partners With Anthem and Blue Shield of California

Wed, 21 Oct 2015 17:53:00 Z

On Tuesday, California-based Collective Health, a provider of employer-based insurance tools, announced it has raised $81 million in a funding round led by Google Ventures and other existing investors. Collective Health also has partnered with Anthem and Blue Shield of California. New York Times' "DealB%k," HIT Consultant.

Few Low-Income Workers Enrolling in Employer-Sponsored Plans

Wed, 21 Oct 2015 13:08:00 Z

Several Affordable Care Act provisions aim to expand low-income workers' access to employer-sponsored health plans, but data show that relatively few of those workers have enrolled in such coverage. Experts say the low enrollment rates could create issues for employers, particularly for smaller businesses. New York Times.

Shareholders Approve Merger Between Aetna, Humana

Tue, 20 Oct 2015 14:26:00 Z

Yesterday, shareholders from Aetna and Humana approved a merger between the two insurance companies. The deal still is subject to federal approval, and antitrust experts say the Department of Justice and state attorneys general are likely to scrutinize it closely. Modern Healthcare, AP/San Francisco Chronicle.

Co-Ops in Colorado, Oregon Announce Plans To Shut Down

Mon, 19 Oct 2015 14:45:00 Z

Two more not-for-profit cooperative health plans established under the Affordable Care Act have announced that they will shut down, leaving just 15 of the original 23 co-ops in operation next year. The Colorado HealthOP and Health Republic Insurance in Oregon both cited low risk corridor payments as a contributing factor. The Hill et al.

Narrow Networks, Low Quality Not Linked in Covered Calif. Plans

Mon, 19 Oct 2015 13:58:00 Z

An analysis of Covered California health plans finds that narrow hospital networks are not typically associated with lower quality, with performance varying more by region. However, the lowest-performing hospitals were in very small networks "suggesting that extreme narrowness may be problematic." FierceHealthPayer et al.

DOI: 27.4% Rate Hike for Aetna Small Businesses 'Unreasonable'

Mon, 19 Oct 2015 13:32:00 Z

The state Department of Insurance says Aetna's average rate increase of more than 27% for its small business health plans "was based on an unreasonable and excessive pricing trend and other unreasonable assumptions." Aetna argues that the increase is necessary because the unit costs of inpatient admissions and other services increased. Sacramento Business Journal, DOI release.

Calif. Lawmaker Proposes Bill To Expand Medicaid Coverage for Former Foster Children

Mon, 19 Oct 2015 13:27:00 Z

Reps. Karen Bass and Jim McDermott have introduced legislation that would allow former foster children to be eligible for Medicaid in any state. Under the Affordable Care Act, young adults who age out of the foster care system remain eligible for Medicaid until they are 26 years old, but only in the state where they were fostered. Kaiser Health News/KQED's "State of Health."

Feinstein Introduces Bill Targeting Large Premium Increases

Mon, 19 Oct 2015 13:23:00 Z

Sen. Dianne Feinstein has introduced a bill that would give the HHS secretary the authority to change or block unreasonable premium insurance increases in states where regulators lack such power. In a release, Feinstein wrote that regulators in California and 14 other states do not have the authority to prevent unjust premium increases. A companion measure has been introduced in the House by Rep. Jan Schakowsky. North Cook News.

HHS Predicts Moderate ACA Enrollment Growth by End of 2016

Fri, 16 Oct 2015 15:00:00 Z

HHS Secretary Sylvia Mathews Burwell says she expects about 10 million U.S. residents will be enrolled in health coverage purchased through the Affordable Care Act's insurance exchanges by the end of 2016. The figure represents a 900,000 increase from the number of individuals expected to be enrolled in exchange coverage by the end of this year. The Hill et al.

Study: High-Deductible Plans Could Deter Sick From Seeking Care

Fri, 16 Oct 2015 13:44:00 Z

A new study by health economists at the National Bureau of Economic Research finds patients with high-deductible health plans were more likely to forgo care, but overall health care prices did not decline as expected. The results contrast with health economists' beliefs that higher deductibles would drive down health care prices by encouraging patients to be more savvy shoppers. Vox.

Blue Shield of Calif. Agrees To Limit Premiums, Recalculate Rebates

Thu, 15 Oct 2015 13:39:00 Z

Blue Shield of California has agreed to a state Department of Managed Health Care order to limit its premiums for certain policies in 2016 and 2017, as well as to recalculate its medical loss ratio estimates for 2015 and 2016. DMHC and Blue Shield said the insurer's recently approved acquisition of Care1st Health Plan did not influence the agreement. Payers & Providers.

Clinton Supports Extending ACA Coverage to Undocumented Immigrants

Thu, 15 Oct 2015 13:02:00 Z

Former Secretary of State Hillary Clinton, who is seeking the Democratic nomination for president, said during Tuesday's Democratic candidate debate that undocumented immigrants should be able to access some benefits under the Affordable Care Act. Clinton said undocumented immigrants should be able to purchase health plans through the ACA's exchanges. However, she noted that such individuals should not be eligible for the law's subsidies to help individuals purchase exchange coverage. The Hill.

53% of Uninsured Californians Eligible for Medi-Cal, ACA Subsidies

Tue, 13 Oct 2015 13:32:00 Z

A new Kaiser Family Foundation report finds that 53% of uninsured Californians qualify for either Medicaid coverage or subsidies under the Affordable Care Act. Meanwhile, more than 50% of the nearly 1.8 million uninsured residents who do not qualify for Medicaid or subsidies are ineligible because of their immigration status. KPCC's "KPCC News," KQED's "State of Health."

ACA Exchanges Face Challenges Retaining Existing Enrollees

Tue, 13 Oct 2015 13:28:00 Z

The number of U.S. residents enrolled in state or federal health insurance exchange plans dropped by about 15% between the end of the Affordable Care Act's most recent open enrollment season in February and June. Experts point to cost and confusion as possible reasons why individuals with exchange plans drop or lose coverage. New York Times.

New Law Will Expand Medi-Cal to 170K Undocumented Children

Tue, 13 Oct 2015 11:54:00 Z

Last week, Gov. Brown signed a bill implementing $40 million allocated in the fiscal year 2015-2016 state budget to extend Medicaid coverage to undocumented immigrant children under age 19. State Sen. Ricardo Lara, who proposed the bill, says it could pave the way for extending health care to all undocumented immigrants in the state. Los Angeles Times' "PolitiCal."